Severe dizziness or fainting can occur from relatively common things like dehydration, a sudden change in position, or a vasovagal episode. But in some cases, it can also be a sign of a heart problem (e.g., an arrhythmia). The difference is in the context, the accompanying symptoms and certain alarm data.
The most important
- A fainting spell is not always serious, but if it is new, is repeated, occurs with effort or comes with chest pain, shortness of breath or palpitations, medical evaluation is required.
- It is urgency if fainting occurs during exercise, if there is significant injury, if there is prolonged confusion, or if accompanied by chest pain/pressure, shortness of breath, severe palpitations or marked weakness.
- There is no single test that “says it all”: the study is decided based on your history, vital signs and a electrocardiogram (ECG).
What is syncope?
The syncope is a brief loss of consciousness (fainting) due to a temporary decrease in blood flow to the brain. It usually lasts seconds or a few minutes and the person usually recovers relatively quickly.
Not everything that looks like fainting is syncope. There can also be:
- Presyncope (feeling of “I'm going to faint” without losing consciousness)
- Vertigo dizziness (sensation of everything spinning around)
- Sugar crashes or other metabolic causes
- Seizures (have different characteristics)
When to go to the emergency room
Seek immediate attention if fainting or severe dizziness occurs in any of these scenarios:
- During the exercise or right at the end (not “by heat” clearly identifiable)
- With chest pain or pressure or lack of air
- With palpitations very fast or irregular before fainting
- With fainting at rest without warning (no “I felt sick before”)
- With confusion prolonged after the event
- With severe weakness, very altered vision or slurred speech
- If there was a fall with a severe blow to the head, bleeding or major injury
If there is also chest pain, refer to the article by acute myocardial infarction and, if applicable, in chest pain: common causes and when is it an emergency? (if it is already published in your blog).
Frequent causes (and how to distinguish them)
Common non-cardiac causes
Vasovagal syncope (most common)
It usually occurs by a reflex of the body lowering the pressure and/or pulse. Typical clues:
- Occurs with heat, prolonged standing, pain, stress or the sight of blood.
- Before fainting there may be nausea, sweating, pallor, “I got cloudy” or tinnitus.
Orthostatic hypotension (due to change of position)
Happens when you get out of bed or out of a chair quickly. May be associated with dehydration, diarrhea/vomiting, low intake or some medications.
Dehydration and heat stress
More frequent with high temperatures, exercise, low water, alcohol or illness with fever.
Anemia or other systemic causes
They can cause dizziness, fatigue and shortness of breath on exertion. Not always detected “with the naked eye”.
Cardiac causes (to be carefully ruled out)
Arrhythmias
Beats that are too fast, too slow or irregular can lower cardiac output and cause fainting. If you notice heart “skipping,” check for palpitations: common causes and when to worry about them and, if applicable, arrhythmias and atrial fibrillation.
Structural or pumping problems
Some heart conditions may be associated with fainting, especially if it occurs with exertion or is accompanied by shortness of breath. If you already have a diagnosis, check cardiac insufficiency.
What may be included in the cardiological study of syncope?
The evaluation usually goes in this order (from the most basic to the most specific):
- Directed clinical history
- What were you doing (resting, standing, exercising)?
- If there was prior warning (nausea, cold sweat, blurred vision)
- Medications (for blood pressure, diuretics, etc.)
- History (hypertension, diabetes, cholesterol, arrhythmias) and family history
- Examination and vital signs
It includes checking blood pressure and pulse, sometimes in different positions (lying down and standing). - Electrocardiogram (ECG)
It is the basic study to check the heart rhythm. You can see what it consists of here: electrocardiogram (ECG). - Studies on a case-by-case basis
Depending on the suspicion, the cardiologist may consider rhythm monitoring (if the symptom is intermittent), echocardiogram or other studies. If your episodes appear with activity, it may make sense to assess a stress test.
If there is also suspicion of poorly controlled pressure or significant variations, the following should be checked blood pressure: goals and measurement at home and, if applicable, the article of hypertension.
What to do before the consultation (to take advantage of it)
Carry this information (even if it is in cell phone notes):
- Date and time of the event
- What you were doing and what position you were in (standing, sitting, lying down).
- If there was previous warning (nausea, sweating, blurred vision, palpitations)
- Approximate duration and recovery
- If there was a blow or injury
- List of medications and dosages
- Recent pressure readings (if available)
If you want a general preparation guide, you may also find the article by blood pressure: goals and measurement at home.
When to schedule a consultation (even if it is not an emergency)
Schedule cardiologic evaluation if:
- It was your first fainting spell without clear cause
- Repeats (more than one episode)
- Happens with effort or limits your activities
- Accompanied by palpitations, shortness of breath or chest pain/pressure
- Have risk factors (hypertension, diabetes, high cholesterol) or relevant family history
For a complete review you can review the cardiological check up o schedule an appointment.
References
- European Society of Cardiology (ESC). 2018 ESC Guidelines for the diagnosis and management of syncope.. See source
- ACC/AHA/HRS. 2017 Guideline for the Evaluation and Management of Patients With Syncope.. See source
- Mayo Clinic. Fainting (syncope). See source
- NHS. Fainting. See source