17536 Syncope

Overview

Syncope, commonly called fainting, is a sudden and brief loss of consciousness. It happens when there is a temporary drop in blood flow to the brain. You normally wake up within a minute or two and feel fine soon after, though you may feel tired or confused for a short time.

Yes. Syncope is very common. It affects people of all ages, and it is the reason for many visits to general practice and emergency departments.

Fainting can happen to anyone. It is especially common in teenagers and young adults, and also in older people. In older adults, it is often linked to drops in blood pressure or heart conditions.

Symptoms

Common symptoms

• Feeling lightheaded or dizzy
• Sweating and feeling warm or clammy
• Blurred vision or seeing spots
• Nausea or a churning stomach
• Ringing in the ears
• Feeling weak or unsteady
• Loss of consciousness for a short time
• Waking up quickly, often confused or tired

Symptoms in children

• Similar warning signs as adults, such as dizziness and looking pale
• Fainting often triggered by emotional upset, heat, hunger, or standing for a long time
• May cry or appear anxious just before fainting

Symptoms in older adults

• Warning signs may be less noticeable – fainting can happen without much warning
• More likely to be caused by changes in blood pressure when standing up or by heart rhythm problems
• May take longer to feel normal again after waking

Causes

Main causes

• Reflex fainting (also called vasovagal syncope) – triggered by pain, fear, stress, standing too long, or the sight of blood
• Orthostatic hypotension – a sudden drop in blood pressure when you stand up quickly
• Heart problems – such as an abnormal heart rhythm, heart valve disease, or after a heart attack
• Dehydration – not drinking enough fluids can lower blood pressure
• Low blood sugar, especially in people with diabetes
• Certain medications that lower blood pressure or affect the heart

Risk factors

• Being in a hot, crowded, or stuffy environment
• Standing still for long periods
• Not eating or drinking enough
• Strong emotions, pain, or fear
• Rising quickly from lying or sitting
• Age – older adults have a higher risk due to heart and blood pressure changes
• Family history of fainting or heart rhythm problems

When to see a doctor

See a doctor urgently if:

• You fainted and you are pregnant
• You fainted more than once in a short period
• You have chest pain, palpitations, or shortness of breath around the time of fainting
• You fainted during exercise
• You have a known heart condition and you faint
• You hurt yourself during the faint

Book a routine appointment if:

• You have fainted for the first time and are not sure why
• You have had fainting spells before but have not discussed them with a doctor
• You feel lightheaded or dizzy often when standing up
• You have any concerns about your health related to fainting

Diagnosis

A doctor will start by asking you detailed questions about what happened before, during, and after the faint. They will also examine you and check your blood pressure and heart rate, including taking blood pressure readings while you are lying, sitting, and standing.

Tests that may be done

• Electrocardiogram (ECG) – a quick test that records the electrical activity of your heart
• Blood tests – to check for anaemia, dehydration, or low blood sugar
• Holter monitor – a portable heart monitor you wear for 24 to 48 hours to check for irregular rhythms
• Tilt table test – a test that watches your blood pressure and heart rate as the bed tilts you from lying to upright
• Echocardiogram – an ultrasound of the heart to check its structure and function

What to expect at your appointment

Your doctor may not be able to find a specific cause, especially after one faint. In many cases no further tests are needed. If your doctor suspects a heart problem, you may be referred to a heart specialist (cardiologist) for more tests. The evaluation process is usually done in stages and is not painful.

Treatment

Treatment for syncope depends on the cause. For most people, the focus is on lifestyle changes to avoid triggers and learning to recognise warning signs. If an underlying condition such as low blood pressure, dehydration, or a heart rhythm problem is found, treatment will target that condition.

Self-care at home

• If you feel faint, sit or lie down right away – put your head between your knees or lie flat and raise your legs if possible
• Get up slowly from lying or sitting positions
• Drink plenty of water during the day unless your doctor tells you not to
• Avoid standing still for long periods – move your legs and flex your muscles
• Eat regular meals and avoid skipping meals if low blood sugar triggers your fainting
• Avoid heat and crowded spaces when you know you may be at risk

Medical treatments

Your doctor might recommend particular ways to manage blood pressure, such as adding more salt and fluids to your diet, or adjusting existing medications. If heart rhythm problems are the cause, treatments may include medications to control the rhythm or a device like a pacemaker. In some cases, your doctor may suggest physical counter-pressure manoeuvres, such as tensing your muscles when you feel faint. There is no one-size-fits-all medicine for syncope – any treatment is tailored to the cause and your overall health.

When is surgery considered?

Surgery is rarely needed for syncope. It may be considered if a structural heart problem, such as a faulty heart valve, is the underlying cause. A cardiologist will discuss this option with you if it becomes relevant.

Living with this condition

Living with syncope is mostly about becoming aware of your warning signs and acting quickly. If you feel lightheaded, do not try to 'push through' – sit or lie down immediately. This can stop a faint from happening and prevent a fall. It can also help to tell family, friends, or colleagues what to do if you faint.

Lifestyle tips

• Stay well hydrated – drink water throughout the day
• Avoid alcohol, which can lower blood pressure
• Do not skip meals, especially if you are prone to low blood sugar
• Take your time when standing up from sitting or lying down
• Wear compression stockings if your doctor recommends them for blood pooling in the legs
• Keep your living space free of trip hazards in case you do faint

Diet and exercise

A balanced diet with regular meals helps keep your blood sugar and blood pressure stable. Regular physical activity, such as walking or swimming, can improve circulation and heart health. In some cases, your doctor may suggest increasing your salt intake – but do not do this without medical advice, especially if you have high blood pressure or heart disease.

Mental health and emotional wellbeing

Fainting can be frightening, and some people become anxious about when it might happen again. This worry is normal. If anxiety is affecting your daily life, talk to your doctor – counselling or stress management techniques can help. You do not have to face this alone.

Prevention

Often, yes. Many fainting episodes can be prevented by avoiding your known triggers, staying hydrated, moving regularly, and rising slowly from sitting or lying. If you have a heart condition or blood pressure problem, managing it well with your doctor can reduce the chances of fainting.

Complications

If left untreated

• Injuries from falls, such as cuts, bruises, or fractures
• Head injury, if you hit your head when you fall
• Missing an underlying heart problem that could become more serious
• Anxiety or fear of fainting, which can limit your daily activities

Long-term outlook

For most people, the outlook is very good. Most fainting spells are harmless and do not point to a serious problem. Even when a cause is found, treatment is often effective. By working with your doctor and learning to manage your triggers, you can live an active and full life.

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