About Fainting

INFORMATION SHEET FOR FAINTING (SYNCOPE)
FOR PATIENTS AND FAMILIES

Fainting, near fainting and lightheadedness are problems that any normal person might have at one time or another. Some perfectly healthy people, for one reason or another, have significant problems with this. It is a somewhat peculiar part of our human body and its physiology that we sometimes faint. In general, it results when the brain sends signals out to the body that lower the heart rate, lower the blood pressure, or some combination. Paradoxically, the brain often does this at a time when it is least tolerated by the body, and because of decreased blood flow up to the brain, the fainting or near fainting occurs. This is because the brain is a very needy, fastidious organ that does not function well if its supply of nutrients and oxygen is slowed down even a little bit.

A common factor that predisposes people to having this problem is some degree of dehydration. This does not need to be dehydration as severe as someone who has had vomiting or diarrhea, for instance, but simply a relative dehydration which prevents the heart from filling well before each beat. The poor filling itself can initiate the series of events that leads to fainting. Even if dehydration is not a particular issue, improving one’s hydration status by taking in more salt and water may alleviate the symptoms without need for any medicines.

It is important to bear in mind that both salt and water are needed. Our body fluids are salt water. In the old days, athletes were often given salt pills but this is not necessary and can be unsafe. In a nutshell, one adds salt to food, or eats salty foods, and drinks water. Water is in fact the best form for the fluid, although sports drinks, juices, and other drinks are fine as well. Milk should really be considered a food and not a liquid per se. Any drink that has alcohol or caffeine may cause more loss of fluid, so those do not count either. One must also be careful about soft drinks and juices, and even some sports drinks that contain a lot of sugar.

In order to make a significant difference, a typical teenager may need to add 2 – 3 or even more liters of fluid to his or her intake per day. If this is a high sugar fluid, this is a great deal of empty calories and can make weight gain a real issue. These also suppress appetite for more substantial food. This is why I recommend water unless a low calorie sports drink tastes so much better to an individual that he or she is willing to drink the one but not the other.

Skipping breakfast is a common problem in adolescents, or eating a breakfast that consists just of some simple carbohydrates like bleached flour and sugar. This is not the sort of morning meal that provides a steady blood sugar level throughout the day or facilitates a good intake of fluid. Start the day right with a good breakfast. In susceptible individuals salty snacks like pretzels and so forth may even be useful in addition to salted foods, spaced as needed throughout the day. If one eats enough salt, it is easy to drink enough because one feels thirsty naturally.

It is important to remember that although fainting in certain situations can be of concern, in the great majority of situations it is a normal, human thing to do. It does not indicate any underlying heart disease. It does not put on at any danger unless it is occurring while one is driving a car or in other situations where decreased alertness might itself be dangerous.

Some of the situations in which fainting would be taken much more seriously include
1. Fainting that clearly occurs after an unusually fast or slow heart rate,
2. With known structural or functional heart disease,
3. Fainting in response to an adrenaline surge. Examples of an adrenaline surge include during exercise, in response to emotion, excitement or fright, and so forth.
4. Fainting would also be taken more seriously if it occurred in an individual whose family had individuals with sudden death under the age of 50, known rhythm disturbances, or other heart conditions that might potentially be passed down in the family.

Almost all typical situations are not worrisome, on the other hand, and include after standing up after lying down or sitting, a minute or two after activities (but again, not during), after standing still and upright for a long time, after kneeling for a long time, in a hot or stuffy room, following illness involving poor intake or vomiting and diarrhea, at the sight of blood or while watching surgery on the Discovery channel, etc.

When the story suggests the usual, normal type of fainting, lots of testing and doctor visits are seldom helpful. An EKG is often done, but assuming this is normal the main focus is usually on the salt and water intake to prevent more issues.

Occasionally, medical treatment is needed because fainting is still an issue. A few important points need to be made, however. First of all, even if fainting is persistent, it does not make it any more dangerous, simply more annoying and disruptive to one’s life. The root causes are the same. The medicines that are given in problem cases will only work if a solid foundation of good salt and water intake has been instituted; the effectiveness of the medicine will be much less if this is not being pursued. Most importantly, when we use a medicine, it is because fainting is an annoying symptom, not because it is dangerous. We do this in the same way that we might take something to help reduce a cough or nasal congestion while we have a cold, a condition which we will otherwise get through perfectly fine, whether we take medicines or not.

If one is trying to increase salt and water and is wondering about if enough is being done, young people should need to urinate at least a couple of times in the morning, and a couple of times in the afternoon. The urine should be clear, not yellow or orange. The one exception is that a couple of hours after taking a vitamin pill that has B vitamins, the urine is often very yellow because of the vitamins passing out in the urine.

When first trying to add salt and water to see if it is enough to prevent fainting, a very concerted effort for 2-4 weeks may be needed. One may need to go a little overboard on the salt and water to test the theory properly. If it does seem to help, one can then back down a little bit and see what it takes to avoid the symptoms…then maintain that level into the future.

If you have any questions or concerns about any of the information in this handout, please speak with your primary care physician, or if need be, your physician can communicate with me as well. This is particularly true if you have concerns that the fainting in your case may fall into one of those unusual but alarming categories I listed above.