NAME: Dr. Javier E. Banchs
TITLE: Cardiologist with a specialty in cardiac electrophysiology
COMPANY: Penn State Hershey Heart and Vascular Institute
YEARS IN FIELD: 7
Q: How common is fainting among the general population? Is there any particular group that seems to be more affected by fainting spells?
A: Fainting is known in medicine as “syncope.” It is defined as a sudden and temporary loss of consciousness followed by rapid and spontaneous recovery. Fainting is rather common and it is more likely to occur as we get older. One large study that followed a patient population for 17 years reported fainting in 10 percent of participants across all ages. In a survey among patients older than 45, fainting was reported by 19 percent of them. It is more common among women, older individuals, patients with heart disease and those taking blood pressure or cardiovascular medicines.
Q: What causes fainting spells?
A: The most common cause of fainting among the general population is temporary decrease in blood pressure caused by an exaggerated, otherwise normal reflex also known as “vaso-vagal syncope.” It is usually benign and special circumstances that trigger it can be recognized, like the sight of blood, fear, waiting a long time standing in line, exposure to heat and dehydration.
The human body has a complex system that allows it to automatically regulate the blood pressure and heart rate. In predisposed individuals or specific circumstances the system may transiently overreact and cause a temporary drop in blood pressure. If it is enough to limit blood supply to the brain, consciousness and the ability to maintain the body’s posture may be temporarily lost. Advanced cardiac and neurological disease can also cause fainting spells and when it happens in this setting more investigation is frequently needed to assure safety and prevent recurrences.
Q: What should you do if someone near you faints?
A: When someone faints near you try to remain calm. You should lay them back immediately and assess for their responsiveness. Lying on the back and elevating the legs will help return blood to the brain and should speed up regaining consciousness. If it is a true fainting spell, a rapid spontaneous recovery of consciousness should follow and the individual will be back to normal in a few minutes.
If the person remains unresponsive, you might have just witnessed a cardiac arrest. The first thing to do would be to call for help. Either you or someone else needs to call 911 and get an AED. If the person isn’t responding and isn’t breathing (or only gasping) begin CPR. The 911 operator can guide you through the steps of CPR. You will need to push on the center of the chest hard and fast (at least 2 inches deep at a rate of at least 100 pushes a minute). These simple steps can help keep a victim alive until medical help arrives. Pulse checks and breathing are not essential steps for nonmedical personnel, but can be done by individuals who know how to perform those skills. For more information see www.heart.org/handsonlycpr.
Q: What tests do doctors perform to figure out why someone is fainting?
A: A detailed analysis of the events and medical conditions by a physician is frequently enough and the most useful. An electrocardiogram, ultrasound of the heart and stress test may be appropriate for patients with cardiovascular risk factors. When heart or neurological disease is present or uncovered, more detailed tests may be needed to establish the diagnosis, prognosis and treatment plan. For recurrent fainting spells without clear cause, ambulatory heart rhythm monitors and a so-called “tilt table” test may be helpful. Heart monitors can “capture” a recording of the heart rhythm during a fainting episode; the “tilt table” test is used to attempt reproducing the fainting spell in a monitored setting to better understand its cause.
Q: Is there any treatment for fainting spells or any way to prevent them?
A: The treatment of the common form of fainting, or “vaso-vagal syncope,” is usually hydration and behavioral changes to avoid the precipitant factors and stop the episodes. Aerobic exercise, salt and compression stockings are also helpful.
Occasionally medication to help retain fluid or raise the blood pressure might be needed. Specific treatments exist for other more specific and disease-related causes of syncope, like pacemakers for slow heart rhythms and ablation, implantable defibrillators or medication for fast abnormal heart rhythms. The appropriate treatment plan for an individual should be discussed with the treating physician including risks, benefits and alternatives to each treatment.
Interview conducted via email by The Patriot-News staff.