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Facts about fainting

There is nothing to get worried about syncope (fainting) but the condition should not be ignored

DR MD HABIBE MILLAT
Majority of the population may have one episode of syncope (fainting) in their lives. Depending on the cause of syncope, the prognosis varies from excellent to poor.
Syncope can occur in otherwise healthy people too. The patient feels faint, dizzy, or light-headed, or loses consciousness.
What is syncope?
Syncope is the temporary loss of consciousness due to a sudden decline in blood flow to the brain. It is described as "fainting" or "passing out.”
What causes syncope?
The causes of syncope are myriad, but majority of the episodes have a recognisable cardiovascular cause. It may be caused by emotional stress, pain, pooling of blood in the legs due to sudden changes in body position, overheating (heat stroke), dehydration, heavy sweating or exhaustion. It also may result from several heart, neurological, psychiatric, metabolic and lung disorders. And it may be a side effect of some medicine. In the absence of focal neurological symptoms or signs, a neurological cause is rare.
Some forms of syncope suggest serious disorders -- those occurring with exercise, those associated with palpitations or irregularities of the heart, those associated with family history of recurrent syncope or sudden death. What is neurally mediated syncope?
This is the most frequent cause of fainting. Neurally mediated syncope (NMS) is called also neurocardiogenic, vasovagal,
vasodepressor or reflex mediated syncope. It is a benign condition. NMS is more common in children and young adults, although it can occur at any age. NMS happens because blood pressure drops, reducing circulation to the brain and causing loss of consciousness.
Recommendation
According to American Heart Association, the majority of children and
young adults with syncope have no structural heart disease or significant arrhythmia (abnormal heart rhythm). So, extensive medical work-up is rarely needed. A careful physical examination by a physician, including blood pressure and heart rate measured lying and standing, is generally the only evaluation required.
ECG, exercise stress test, Holter monitor, echocardiogram, etc. may be needed to rule out other cardiac causes of syncope. A tilt table test is valuable for defining disorders of cardiovascular reflexes, e.g. vasovagal or vasodepressor syncope. Carotid Doppler, CT/MRI of brain sometimes needed to find out the cause.
Management
To help prevent syncope, people with NMS should be on a high-salt diet and drink plenty of fluids to avoid dehydration and maintain blood volume. They should watch for the warning signs of fainting -dizziness, nausea and sweaty palms -- and sit or lie down if they feel the warning signs. Some people also may need medication.
Conclusion
Syncope is a dramatic event and can even be life-threatening if not treated appropriately. Non-cardiac syncope is treated acutely by lying down with the legs elevated. Infrequent episodes of non-cardiac syncope usually do not require treatment. Generally, however, recovery is usually complete within minutes to hours.
Dr Md Habibe Millat MBBS, FRCS(Edin) is a Senior Specialist Registrar, Department of Cardiothoracic Surgery, Cork University Hospital, Republic of Ireland.