The Fainting Checklist
The Fainting Checklist has been designed to help you and your healthcare provider reach the correct diagnosis. The Fainting Checklist provides information on the major reasons for experiencing loss of consciousness, provides advice on how to prepare for a doctor's appointment and what to expect if you have to attend a hospital appointment.
Fainting: What you need to know
If someone loses consciousness for a few seconds or minutes, they are often said to have fainted.
However, there are three MAJOR reasons why people may lose consciousness:
Syncope: a sudden lack of blood supply to the brain. Syncope (pronounced sin-co-pee) is caused by a problem with the heart or by a problem in the regulation of blood pressure.
Epilepsy: an electrical “short-circuiting” in the brain. Epileptic attacks are usually called seizures. Diagnosis of epilepsy is made by a neurologist.
Psychogenic faints: resulting from stress or anxiety. Psychogenic faints occur most often in young adults and may be difficult to diagnose. Psychogenic does not mean that people are “making it up.” However, there is often underlying stress due to extreme pressure at school or work.
Every patient presenting with a fainting episode should consider getting a 12-lead EKG (heart rhythm check)
If there is uncertainty about diagnosis the EKG should be reviewed by a heart rhythm specialist.
Most faints are caused by syncope
Many people, including doctors, assume that fainting episodes are due to epilepsy, but much more commonly they are due to syncope. Syncope can affect all age groups, but the causes vary with age, and in older adults multiple causes often exist. Up to 50 percent of the population will faint due to syncope during their lifetime. Epilepsy on the other hand, only affects slightly less than 1 percent of the population.
Many syncopal episodes are mistaken for epilepsy
Research shows that approximately 30 percent of adults and up to 40 percent of children diagnosed with epilepsy do not have the condition. Many elements of a syncopal episode, such as random jerking of limbs, are similar to those experienced during an epileptic seizure. Diagnosis of epilepsy is made by a neurologist.
Providing an accurate history is vital to a correct diagnosis
A correct diagnosis starts with gathering a history (information) about your fainting episodes. Complete the questions in the Preparing your own Checklist section (download checklist) to record your own history of your faints to take with you to your first consultation to share with your physician.
Many syncope episodes only require reassurance and education from your primary care physician
In many cases, your primary health provider can determine that the fainting episode was not related to a serious health condition. Consultation with a specialist will be necessary, though, if the cause of the faints remains uncertain, if there are particularly concerning symptoms or there is a family history of a heart condition.
Preparing for specialist tests at the hospital
Following your appointment with your primary care physician, who will have initially taken your full family medical history, you may be referred for some tests with a specialist to discover the cause of your fainting. Make sure you receive the right test based on the nature of your symptoms.
Every patient experiencing a fainting episode should be given a 12-lead EKG.
If there is uncertainty about diagnosis the EKG should be reviewed by a heart rhythm specialist (electrophysiologist).
Tests aimed at Syncope:
Heart Monitor – This is used to record heart rhythms while away from the hospital or to activate during an episode. A 24-hour/7 day heart rate monitor is very unlikely to identify any problems if you experience fainting episodes once a week or less, so do not hesitate to ask about other options.
Insertable Cardiac Monitor (ICM) – This device should be used to monitor heart rhythms for months at a time, and can remain in place for up to 3 years. Download ICM information sheet
Tilt Table Testing – This procedure can be used to induce a syncopal/fainting episode while connected to heart and blood pressure monitors.
Lying and standing blood pressure recording – Drops in blood pressure with changes in posture can cause dizziness, falls and fainting, particularly in older patients and those on blood pressure medication and water tablets.