Syncope: Causes, Symptoms, Diagnosis, and Prevention

Syncope, commonly known as fainting, is a sudden, temporary loss of consciousness that affects many people at some point in their lives. While often harmless, syncope can sometimes indicate a more serious underlying health issue. Understanding the causes, symptoms, and preventive measures for syncope is important for maintaining your well-being. In this article, we will explore the types of syncope, its potential triggers, diagnostic tests, and strategies to reduce your risk of experiencing a syncope attack. 

What is syncope? 

Syncope refers to a brief loss of consciousness due to a temporary reduction in blood flow to the brain. This decreased blood flow can result from various factors affecting blood pressure, heart rate, or the blood supply in certain parts of the body. Syncope accounts for approximately 1% to 3% of all emergency room visits and up to 6% of hospital admissions annually, making it a relatively common condition that requires attention and proper management. 

What are the types of syncope? 

There are several types of syncope, each with its own set of causes and triggers: 

1. Vasovagal syncope: The most common type, often triggered by emotional stress, pain, or the sight of blood. 
2. Situational syncope: Caused by specific actions or situations, such as coughing, urination, or defecation. 
3. Postural syncope: Occurs when changing physical posture, like standing up too quickly. 
4. Cardiac syncope: Related to heart conditions, including arrhythmias or valve problems. 
5. Neurologic syncope: Associated with neurological disorders like migraines or seizures. 

How common is syncope? 

Syncope is a relatively frequent occurrence, accounting for about 1% to 3% of emergency room visits and up to 6% of hospital admissions each year. While it can affect people of all ages, it is more common in older adults and those with certain medical conditions. 

What are the symptoms of syncope? 

The primary symptom of syncope is a brief loss of consciousness. However, before fainting occurs, you may experience: 

• Dizziness or lightheadedness 

• Nausea or feeling sick to your stomach 

• Sweating 

• Blurred vision or tunnel vision 

• Feeling weak or unsteady 

After regaining consciousness, you may feel confused or disoriented for a short period. 

What causes syncope? 

Various factors can trigger a syncope attack, including: 

• Dehydration 

• Low blood sugar 

• Intense pain or emotional distress 

• Sudden changes in posture 

• Certain medications 

• Alcohol or drug use 

• Cardiovascular conditions 

• Neurological disorders 

Let's explore some of the specific causes for each type of syncope: 

Vasovagal syncope causes 

Vasovagal syncope, also known as neurocardiogenic syncope, is often triggered by emotional stress, pain, or the sight of blood. It occurs when the vagus nerve overreacts to certain triggers, causing a sudden drop in blood pressure and heart rate. 

Situational syncope causes 

Situational syncope can be triggered by specific activities that strain the body, such as: 

• Coughing or sneezing 

• Urination or defecation 

• Swallowing 

• Laughing or crying 

These actions can temporarily affect blood pressure and lead to fainting. 

Postural syncope causes 

Postural syncope, or orthostatic hypotension, occurs when there is a sudden drop in blood pressure upon standing up too quickly. This can happen due to dehydration, prolonged bed rest, or certain medications that affect blood pressure regulation. 

Cardiac syncope causes 

Cardiac syncope is related to heart conditions that interfere with proper blood circulation. Some causes include: 

• Arrhythmias (irregular heart rhythms) 

• Structural heart problems, such as valve disorders 

• Blockages in the heart's blood vessels 

• Heart failure 

Neurologic syncope causes 

Neurologic syncope is associated with conditions that affect the nervous system, such as: 

• Migraines 

• Seizures 

• Strokes or transient ischaemic attacks (mini-strokes) 

• Parkinson's disease or other neurological disorders 

Postural orthostatic tachycardia syndrome (POTS) 

POTS is a condition that causes an abnormal increase in heart rate when standing up, which can lead to syncope symptoms. It is thought to be related to a dysfunction in the autonomic nervous system, which regulates blood pressure and heart rate. 

What are the unknown causes of syncope? 

In some cases, the exact cause of syncope may remain undetermined despite thorough evaluation. This is known as unexplained or idiopathic syncope. If you experience recurrent episodes of unexplained syncope, your doctor may recommend further monitoring and follow-up to identify any potential underlying conditions that may develop over time. 

How is syncope diagnosed? 

Diagnosing syncope involves a comprehensive evaluation of your medical history, a physical examination, and various diagnostic tests. Your doctor will begin by asking detailed questions about your syncope episodes, including any triggers, symptoms, and how long the episodes lasted. 

During the physical exam, your doctor will check your vital signs, including blood pressure and heart rate, both lying down and standing up. They may also listen to your heart and lungs and examine your neurological function. 

Depending on your individual case, your doctor may order one or more of the following syncope tests: 

• Electrocardiogram (ECG) to assess your heart's electrical activity 

• Echocardiogram to evaluate your heart's structure and function 

• Tilt table test to monitor your blood pressure and heart rate while changing positions 

• Holter monitor or event recorder to track your heart rhythm over an extended period 

• Blood tests to check for anaemia, diabetes, or other conditions that may contribute to syncope 

• Neurological tests, such as an EEG or MRI, if a neurological cause is suspected 

What is the treatment for syncope? 

Syncope treatment depends on the underlying cause. In many cases, lifestyle changes and preventive measures can help manage syncope symptoms. These may include: 

1. Staying hydrated and maintaining a balanced diet 
2. Avoiding triggers, such as prolonged standing or exposure to heat 
3. Rising slowly from a seated or lying position 
4. Wearing compression stockings to improve blood circulation 
5. Adjusting medications that may contribute to syncope under your doctor's guidance 

In some cases, medication or other medical interventions may be necessary. For example: 

• If you have a heart condition, your doctor may prescribe medications to regulate your heart rhythm or blood pressure. 

• If you have neurological syncope, treatment will focus on managing the underlying condition, such as migraines or seizures. 

• In severe cases of cardiac syncope, a pacemaker or other device may be implanted to help regulate your heart's function. 

What medications/treatments are used in syncope? 

The specific medications used to treat syncope will depend on the underlying cause. Some common medications include: 

• Beta-blockers to regulate heart rate and blood pressure 

• Fludrocortisone to increase blood volume and blood pressure 

• Midodrine to narrow blood vessels and increase blood pressure 

• Antiarrhythmic drugs to control irregular heart rhythms 

What are the side effects of the treatment? 

As with any medication, there is a potential for side effects. Some common side effects of syncope medications include: 

• Dizziness or lightheadedness 

• Fatigue 

• Headache 

• Nausea 

• Low blood pressure 

It is important to discuss any side effects with your doctor, as they may need to adjust your dosage or try a different medication. 

How to reduce the risk of syncope? 

You can take several steps to lower your risk of experiencing a syncope attack: 

• Stay well-hydrated, especially during hot weather or physical activity. 

• Eat a balanced diet and avoid skipping meals. 

• Rise slowly from a seated or lying position. 

• Avoid standing for prolonged periods. 

• Manage stress through relaxation techniques, such as deep breathing or meditation. 

• Be cautious when changing positions, especially if you have low blood pressure. 

How to prevent syncope? 

In addition to the risk-reduction strategies mentioned above, you can help prevent syncope by: 

• Identifying and avoiding your syncope triggers 

• Informing your doctor about any medications you take, as some may contribute to syncope 

• Wearing compression stockings to improve blood circulation in your legs 

• Engaging in regular exercise to maintain cardiovascular health 

• Monitoring your blood pressure and heart rate regularly, especially if you have a history of syncope 

What is the outlook for syncope? 

The prognosis for syncope depends on the underlying cause. In most cases, syncope is not life-threatening and can be managed with lifestyle changes and appropriate treatment. However, if syncope is caused by a serious heart or neurological condition, prompt diagnosis and treatment are essential to prevent complications and improve outcomes. 

Is syncope life-threatening? 

While most cases of syncope are not life-threatening, it can sometimes indicate a serious underlying condition. Syncope caused by cardiac issues, such as arrhythmias or structural heart problems, can potentially lead to more severe complications if left untreated. Additionally, syncope episodes can result in falls or accidents, which may cause injury. 

When to see a doctor? 

It is important to consult a healthcare professional if you experience syncope, especially if: 

• You have never had a syncope episode before. 

• You have frequent or recurrent syncope episodes. 

• You experience syncope during physical activity or exertion. 

• You have a history of heart disease or neurological conditions. 

• You suffer an injury during a syncope episode. 

• Your syncope episodes are accompanied by chest pain, palpitations, or shortness of breath. 

Conclusion 

Syncope, while often harmless, can be a sign of an underlying health issue that requires attention. By understanding the causes, symptoms, and preventive measures for syncope, you can take steps to reduce your risk and manage your overall health effectively. If you experience syncope or have concerns about your risk factors, don't hesitate to consult a healthcare professional for personalised guidance and support. 

At Metropolis Healthcare, we offer comprehensive diagnostic services to help identify the underlying causes of syncope. Our team of skilled phlebotomists can perform at-home blood sample collection for your convenience, and our state-of-the-art laboratories ensure accurate and reliable results. With the Metropolis TruHealth app, you can easily access your test reports and take charge of your health journey. 

Remember, prioritising your health is essential for living your best life. By staying informed, making positive lifestyle choices, and seeking expert medical care when needed, you can navigate the challenges of syncope and other health concerns with confidence and peace of mind.