Syncope

Syncope (SINK-a-pee) is another word for fainting or passing out. Someone is considered to have syncope if they become unconscious and go limp, then soon recover. For most people, syncope occurs once in a great while, if ever, and is not a sign of serious illness. However in others, syncope can be the first and only warning sign prior to an episode of sudden cardiac death. Syncope can also lead to serious injury. Talk to your physician if syncope happens more often.

Pre-syncope is the feeling that you are about to faint. Someone with pre-syncope may be lightheaded (dizzy) or nauseated, have a visual "gray out" or trouble hearing, have palpitations, or feel weak or suddenly sweaty. When discussing syncope with your doctor, you should note episodes of pre-syncope as well.

Becoming unconscious due to a seizure, heart attack, head injury, stroke, intoxication, blow to the head, diabetic hypoglycemia or other emergency condition is not considered syncope.

Someone who faints should be moved so they are lying down to allow blood to flow to the brain. If they do not regain consciousness promptly, start CPR.

Syncope occurs when there is not enough blood flow to the brain. There are many potential causes, but the most common ones include:

Serious Cardiovascular Conditions (Cardiac Syncope): If fainting occurs frequently and is not because of dehydration or sudden postural change, you may need to be tested for a serious heart or vascular condition. Cardiac syncope often occurs suddenly, without dizziness or other pre-syncope symptoms. Common causes of cardiac syncope:
- Arrhythmia and abnormal heart rhythm: During episodes of heart arrhythmia, the heart works inefficiently and not enough oxygenated blood can circulate to the brain. There are many types of cardiac arrhythmias that may cause syncope. These include bradyarrhythmias (the heart beats too slowly) and tachyarrhythmias (the heart beats too fast).
- Aortic dissectiona tear in the large artery that carries blood from the heart to the rest of the body. This is a very rare but life-threatening condition.
- Aortic valve stenosis a narrowing of the valve between the heart and the aorta. Aortic valve stenosis can be congenital (present from birth) or can develop in old age.
Reflex Syncope (Neurally Mediated Syncope, Vasovagal Syncope, Vasodepressor Syncope, the Common Faint): Reflex syncope is the result of a reflex response to some trigger, in which the heart slows or blood vessels dilate (widen). This causes blood pressure to drop, so less blood flows to the brain and fainting (syncope) or near-fainting (pre-syncope) occurs. Reflex syncope is the most frequent cause of fainting.
Orthostatic Hypotension: Orthostatic (upright) hypotension (low blood pressure when standing) can also cause fainting because blood has trouble going against gravity to reach the brain. Orthostatic hypotension is defined as a fall in systolic blood pressure of 20 mmg Hg or more on standing, resulting in syncope or pre-syncope. Orthostatic hypotension is common in elderly individuals and is often exacerbated by dehydration or medications that lower blood pressure, such as diuretics. Less commonly, orthostatic hypotension can be caused by a neurologic condition such as Parkinson’s disease or multisystem atrophy, formerly known as Shy-Drager syndrome.
Postural Orthostatic Tachycardia Syndrome (POTS): Postural orthostatic tachycardia syndrome (increased heart rate when standing), or POTS, is a rare clinical syndrome characterized by an increase in heart rate of at least 30 beats per minute on standing and orthostatic intolerance — when standing brings on symptoms such as palpitations, lightheadedness and fatigue. POTS generally appears in young women. After excluding other causes, the diagnosis is made on physical examination, medical history and tilt-table test. Treatment usually consists of increased salt and fluid intake, recumbent exercise (not standing upright) and education in avoiding triggers. POTS does not usually get worse with age.

The treatment for syncope will depend upon the underlying condition but may include:

Catheter ablation: procedure to cauterize the specific heart cells that cause abnormal heart rhythms
Pacemakers: device inserted under the skin below the collarbone to deliver regular electrical pulses through thin, highly durable wires attached to the heart; used to treat bradycardia, heart block and some types of heart failure
Implantable cardioverter-defibrillators (ICDs): a small implanted device that delivers an electrical pulse to the heart to reset a dangerously irregular heartbeat; often used to treat ventricular tachycardia or heart failure
Avoiding known triggers

If you or someone you know is suffering syncope, please contact JKC Clinic through phone or online for proper diagnosis and treatment recommendations tailored to your specific situation.