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Eight Possible Reasons for A Fainting Attack

Drotumdi O

Otumdi Omekara, MD., Member of Society of Physician Entrepreneurs

Syncope or fainting attack is a short-term loss of consciousness and balance, which occurs when the brain temporarily shuts down due to inadequate blood supply. There may be a short spell of seizure and after-faint confusion. The longer the fainting episode and the more convulsive the seizure, the more likely it is an epileptic attack. Having a sense of which it could be in emergency could make the difference between life and death. 

While a cube of sugar may be put under the tongue of a fainted person not having a seizure, no intervention is encouraged in a patient having seizure, other than making sure the person is breathing and the pulse can be felt. Although fainting may be more common among teenagers and seniors, the average person has a 40-50% lifetime chance of having a fainting spell. 

There are at least eight possible reasons why a person may faint. Knowing about these potential causes of fainting or syncope helps us to be pro active in preventing it. It will inform our First Aid and CPR intervention limits in an emergency It will also enhance our telephone reporting to the 911 operator when a person suddenly slumps to the ground. Some patients experience dizziness, palpitations, transient vision or hearing loss, or cold sweats, before they pass out. Quickly loosening neckties or laying down on a couch may abort an at attack at this presyncopal stage. 

Neurogenic Syncope or Fainting of Nervous Origin 

The most frequent reason why people faint is neurogenic syncope caused by the failure of the peripheral nervous system reflex that controls blood pressure. Physicians diagnose about 24 % of syncope as neural in origin. This usually happens in people with marginally low blood volume due to low sodium intake or high sodium loss through diuretics. Under stressful situations like very hot environment, the sympathetic nervous system reflexly dilates the veins to increase sweating and heat loss. 

The dilating of veins suddenly drops the venous return to the heart. The heart responds via the carotid sinus by pumping faster (tachycardia). It is the exaggerated attempt of the vagal parasympathic nervous system to control this tachycardia that slows the heart to the point of under-perfusion of heart muscles. Under-perfused heart then pumps inadequate blood supply to the brain, leading to the fainting experience. Once flat on the ground the patient soon gets increased blood supply to the brain and quickly recovers consciousness in a simple fainting episode. 

Idiopathic Syncope or Fainting of Unknown Origin 

Unfortunately, about another 24 % of fainting attacks end up with unknown diagnosis even after a full work up. Such fainting incidents are managed mainly by supportive treatment. 

Cardiovascular Syncope or Fainting from Circulatory Failure 

About 18 % of fainting attacks fall into this category. It may be due to structural abnormalities in the heart or blood vessels leading to under-perfusion of the heart and brain (ischemia). In other situations it may be due to abnormal heart rhythm (arrhythmia)   

Hypotensive Syncope or Postural Fainting 

About 11 % of fainting attacks are postural in origin. A sudden rise from lying to standing position drops the blood pressure faster the sympathetic nervous reflex can compensate for it. By the time the patient is flat on the ground more blood reaches the brain and he/she soon regains consciousness. 

Metabolic Syncope or High/Low Blood Sugar Fainting 

May be ketoacidotic or hypoglycemic. Fasting or over dosage of diabetic medication may lead to drastically low blood sugar level and fainting attack. Lack of insulin in Type 1 diabetes may lead to very high blood glucose level and secondary high level of ketone bodies (keto acids). This leads to a more serious type of syncope where the patient may lapse into coma if not seen fast enough at the ER. 

Neuropathologic Syncope or Fainting from CNS Disease 

May be due to pressure from tumors or bleeding inside the brain (hematoma) 

Psychiatric Syncope or Fainting from Mental Illness 

Mostly hysteria and anxiety. 

Vasovagal Syncope or Situational Fainting 

Frequently emotional situations (like fear or anxiety) lead to heart racing, which triggers an oversized vagal parasympathetic response, which virtually grinds the heart to a halt. Inadequate blood output from the heart then causes the brain to respond with a fainting incident. 

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Syncope or fainting attack is a short-term loss of consciousness and balance, which occurs when the brain temporarily shuts down due to inadequate blood supply. There may be a short spell of seizure and after-faint confusion. The longer the fainting episode and the more convulsive the seizure, the more likely it is an epileptic attack. Having a sense of which it could be in emergency could make the difference between life and death. 

While a cube of sugar may be put under the tongue of a fainted person not having a seizure, no intervention is encouraged in a patient having seizure, other than making sure the person is breathing and the pulse can be felt. Although fainting may be more common among teenagers and seniors, the average person has a 40-50% lifetime chance of having a fainting spell. 

There are at least eight possible reasons why a person may faint. Knowing about these potential causes of fainting or syncope helps us to be pro active in preventing it. It will inform our First Aid and CPR intervention limits in an emergency It will also enhance our telephone reporting to the 911 operator when a person suddenly slumps to the ground. Some patients experience dizziness, palpitations, transient vision or hearing loss, or cold sweats, before they pass out. Quickly loosening neckties or laying down on a couch may abort an at attack at this presyncopal stage. 

Neurogenic Syncope or Fainting of Nervous Origin 

The most frequent reason why people faint is neurogenic syncope caused by the failure of the peripheral nervous system reflex that controls blood pressure. Physicians diagnose about 24 % of syncope as neural in origin. This usually happens in people with marginally low blood volume due to low sodium intake or high sodium loss through diuretics. Under stressful situations like very hot environment, the sympathetic nervous system reflexly dilates the veins to increase sweating and heat loss. 

The dilating of veins suddenly drops the venous return to the heart. The heart responds via the carotid sinus by pumping faster (tachycardia). It is the exaggerated attempt of the vagal parasympathic nervous system to control this tachycardia that slows the heart to the point of under-perfusion of heart muscles. Under-perfused heart then pumps inadequate blood supply to the brain, leading to the fainting experience. Once flat on the ground the patient soon gets increased blood supply to the brain and quickly recovers consciousness in a simple fainting episode. 

Idiopathic Syncope or Fainting of Unknown Origin 

Unfortunately, about another 24 % of fainting attacks end up with unknown diagnosis even after a full work up. Such fainting incidents are managed mainly by supportive treatment. 

Cardiovascular Syncope or Fainting from Circulatory Failure 

About 18 % of fainting attacks fall into this category. It may be due to structural abnormalities in the heart or blood vessels leading to under-perfusion of the heart and brain (ischemia). In other situations it may be due to abnormal heart rhythm (arrhythmia)   

Hypotensive Syncope or Postural Fainting 

About 11 % of fainting attacks are postural in origin. A sudden rise from lying to standing position drops the blood pressure faster the sympathetic nervous reflex can compensate for it. By the time the patient is flat on the ground more blood reaches the brain and he/she soon regains consciousness. 

Metabolic Syncope or High/Low Blood Sugar Fainting 

May be ketoacidotic or hypoglycemic. Fasting or over dosage of diabetic medication may lead to drastically low blood sugar level and fainting attack. Lack of insulin in Type 1 diabetes may lead to very high blood glucose level and secondary high level of ketone bodies (keto acids). This leads to a more serious type of syncope where the patient may lapse into coma if not seen fast enough at the ER. 

Neuropathologic Syncope or Fainting from CNS Disease 

May be due to pressure from tumors or bleeding inside the brain (hematoma) 

Psychiatric Syncope or Fainting from Mental Illness 

Mostly hysteria and anxiety. 

Vasovagal Syncope or Situational Fainting 

Frequently emotional situations (like fear or anxiety) lead to heart racing, which triggers an oversized vagal parasympathetic response, which virtually grinds the heart to a halt. Inadequate blood output from the heart then causes the brain to respond with a fainting incident.