What is Syncope (Fainting), What are its Types, and When Should You See a Doctor?

Syncope, commonly known as fainting, is a temporary loss of consciousness caused by a brief decrease in blood flow to the brain.

Syncope is a condition that occurs due to a temporary reduction in blood flow to the brain, commonly referred to as fainting. Syncope can have various underlying causes. Since it may be a sign of a serious underlying condition, individuals experiencing fainting episodes should consult a well-equipped healthcare facility.

What is Syncope (Fainting) Known as Fainting?

The brain receives 15-20% of the blood pumped by the heart. When there is a decrease in blood flow to the brain for various reasons, a condition known as syncope occurs. Syncope, or fainting, is often accompanied by temporary loss of consciousness. After a syncope episode, the person usually regains consciousness immediately, although they may feel slightly confused and disoriented.

Syncope is a common condition in the population. Approximately 3.5% of women and 3% of men experience fainting at some point in their lives. The frequency of syncope complaints increases with age, and the incidence can rise to 6% in people over the age of 75.

What are the Types of Syncope (Fainting)?

Syncope is a health issue that can develop due to various underlying causes. Depending on the cause, syncope can be classified into different subtypes:

1. Vasovagal Syncope (Cardioneurogenic Syncope)
   The most common type of fainting is vasovagal syncope, which occurs when a sudden drop in blood pressure reduces blood flow to the brain. Due to human anatomy, blood naturally pools in the lower part of the body when standing. The heart and autonomic nervous system work to counteract this and stabilize blood pressure. If there is an issue in this compensatory mechanism, blood pressure drops, blood flow to the brain decreases, and syncope occurs.

   Vasovagal syncope can be triggered by both physical and emotional factors, including:

   • Dehydration
   • Intense emotional stress
   • Anxiety
   • Fear
   • Pain
   • Alcohol or substance use
   • Hyperventilation (rapid breathing)
   • Severe coughing or wearing tight collars (carotid sinus hypersensitivity)
   • Urination (micturition syncope)

   Common situations that may activate the vasovagal reflex and lead to syncope include:

   • Seeing blood
   • Getting an injection or blood drawn
   • Standing up too quickly
   • Standing for extended periods
   • Experiencing an unexpected event, such as an accident
2. Postural Syncope (Positional Hypotension)
   Postural syncope can occur due to changes in blood pressure associated with a change in body position, such as standing up too quickly from a lying position. Dehydration or certain medications can also trigger postural syncope. Postural syncope generally occurs when systolic blood pressure (the top number) drops by at least 20 mmHg and diastolic blood pressure (the bottom number) drops by at least 10 mmHg with position changes.
3. Cardiac Syncope
   Fainting caused by issues related to the heart or blood vessels leading to reduced blood flow to the brain is known as cardiac syncope. Heart-related diseases that can lead to cardiac syncope include:
   • Abnormal heart rhythm (arrhythmia)
   • Structural problems in the heart affecting blood flow
   • Blockages in blood vessels supplying the heart (as in heart attacks)
   • Heart valve disease, such as aortic valve stenosis
   • Blood clots
   • Heart failure

   Individuals with known heart issues who experience fainting should consult a cardiologist. Those without a known condition but exhibiting symptoms of heart problems should also be evaluated for cardiovascular disease.

4. Neurological Syncope
   Syncope that occurs due to neurological conditions, such as seizures, stroke, or transient ischemic attacks, is referred to as neurological syncope. Rarely, conditions like migraines or hydrocephalus can also cause syncope.
5. Postural Orthostatic Tachycardia Syndrome (POTS)
   When the heart rate becomes abnormally high after standing up from a sitting or lying position, this is known as postural orthostatic tachycardia syndrome. In POTS, the heart rate can increase by 30 beats or more from the normal rate. POTS usually occurs within the first 10 minutes of standing and is more common in women than in men.

What Causes Fainting?

Syncope can develop due to various cardiovascular, neurological, and mental conditions. To understand the cause of syncope, other accompanying symptoms are assessed, and a detailed examination of the patient is conducted. Despite all these investigations, the exact cause of approximately one-third of syncope cases remains unclear.

What Does Fainting Affect in the Body?

The symptoms that accompany fainting vary depending on the type of syncope. For instance, in fainting caused by arrhythmia, additional symptoms such as palpitations and sweating may occur. In cases of fainting due to stroke, symptoms like changes in mental state, speech disturbances, and reduced motor strength may appear.

Common symptoms often seen with syncope include:

• Loss of consciousness
• Dizziness
• Unexplained falls
• Feeling weak or fatigued
• Worsening after meals or exercise
• Feeling unsteady when standing up or while standing
• Visual disturbances, such as tunnel vision or seeing black spots
• Headache

When to See a Doctor for Fainting?

People with known conditions like arrhythmia, epilepsy, or orthostatic hypotension, which can cause syncope, may experience fainting episodes from time to time. If these episodes are under a doctor's supervision and the person takes necessary precautions against fainting, syncope may not be an urgent issue. However, if fainting occurs suddenly and without an apparent reason, if previously known fainting episodes become more frequent, or if there is no underlying condition to explain the fainting, a doctor should be consulted as soon as possible.

How is the Cause of Fainting Diagnosed?

Patients experiencing fainting are given a thorough medical history and physical examination. Blood pressure is measured while the patient is lying down, sitting, and standing to investigate possible postural blood pressure changes, which can provide insights into whether the syncope is positional.

To investigate possible causes of syncope, diagnostic methods like 24-hour blood pressure monitoring, ECG, or echocardiogram (ECHO) for heart function assessment, as well as blood tests to check blood sugar and electrolyte levels, may be used. Imaging methods, such as brain tomography, can also help identify neurological causes like stroke or seizures.

What Are the Treatment Methods for Fainting?

The treatment for fainting (syncope) is aimed at addressing the underlying condition that causes the syncope. Without correcting the underlying cause, it is not possible to fully resolve the syncope. Some of the methods used in the treatment of fainting are as follows:

• Changing the medications currently being used
• Wearing compression stockings or garments to improve circulation
• Being cautious when standing up
• Avoiding situations that trigger fainting
• Surgical or other treatments for structural heart diseases
• Implantation of a pacemaker for rhythm regulation
• Consuming frequent small meals, increasing salt intake, drinking plenty of fluids, and limiting the consumption of caffeinated beverages

The treatment of fainting should be tailored to the patient's specific condition, age, and gender. Even if the cause of syncope is the same, a treatment that benefits one patient may not be suitable for another. It is beneficial for individuals experiencing fainting episodes to seek diagnosis and treatment at a well-equipped healthcare facility. It is important to remember that fainting may be a symptom of a serious condition that can pose a life-threatening risk, so individuals with syncope should not delay seeking medical attention. Wishing you good health.