Can fainting spells be life-threatening?

Bengaluru: Fainting is a temporary loss of consciousness (TLoC) that results in a fall if a person is upright and it is referred to as "syncope" in medical terms. The onset of syncope occurs suddenly, may or may not be associated with warning signs, the duration is usually brief, lasting few seconds or few minutes unlike seizures where the length is prolonged and the recovery is spontaneous, complete.

The warning signs before an attack of fainting may be in the form of sweating, feeling of weakness, blackness in front of the eyes, butterflies in the stomach, palpitations in the chest and at times, it can happen without warning. Fainting occurs because of insufficient blood flow to the brain and is almost always due to a cardiac cause.

Fainting/syncope is quite common and it is estimated that it occurs in 15-25 per cent of the general population. Fainting is often recurrent, may lead to poor quality of life, may result in injuries and in some patients, may point to an underlying severe heart disease.

Fainting can occur both in patients with a healthy heart as well as those with heart disease. People who have an underlying heart disease especially those with a weak heart (low ejection fraction) are at an increased risk of fainting/syncope. Fainting may be the only warning sign of abnormal heart rhythm (arrhythmia).

Rapid heartbeats such as ventricular tachycardia or ventricular fibrillation or slow heartbeats that result in the temporary stopping of the heart for a few seconds, causing a temporary cessation of blood flow to the brain can result in fainting/syncope. Another common cause of faint/syncope is the sudden and brief fall in blood pressure in upright position causing a decreased blood supply to the brain.

Often, fainting is improperly diagnosed as a fit/epilepsy and the afflicted person undergoes unnecessary tests such as CT scan, MRI and neurological evaluation and improper therapy. Specific causes of fainting have good long term outcomes while some others may result in fatalities if not diagnosed and treated correctly.

Fainting /syncope occurs across age groups but the causes vary depending on the age of the person. While fainting may not have severe outcomes in certain conditions, it can be fatal especially those with underlying cardiac ailments. Hence, identifying syncope and its underlying cause is very crucial.

People with an increased risk of death are those with a family history of sudden death, underlying heart disease with poor pump function such as coronary artery disease and heart muscle disease (cardiomyopathies), congenital heart defects and those with a condition in the electrical conduction system of the heart. It is most important to differentiate between dangerous faints from harmless causes, as fainting can be a harbinger of sudden cardiac death in some conditions.

Accurate diagnosis of the cause is crucial, as the treatment is determined based on the underlying disease. Syncope can be managed by lifestyle changes, medications and electrical therapies depending on the underlying cause. The diagnostic evaluation of a faint is based on the detailed history, thorough physical examination, electrocardiogram (ECG), long term rhythm monitoring to correlate the symptoms with the ECG abnormality and specific test to evaluate the electrical conduction system.

Syncope should not be ignored as no episode of loss of consciousness is normal. While the causes of fainting are commonly believed to be neurological, the real reason is usually cardiac in nature. Therefore, one must visit a cardiac electrophysiologist, ie a heart rhythm expert, for proper diagnosis and proper treatment.

*Disclaimer: This article has been contributed by Dr Jayaprakash Shenthar, Consultant Electrophysiologist from Bengaluru. The facts and opinions appearing in the article do not reflect the views of The Asian Age and The Asian Age does not assume any responsibility or liability for the same.