Syncope (Fainting): Causes, Symptoms, and Management

Syncope is a transient loss of consciousness due to temporary global cerebral hypoperfusion (reduced blood flow to the brain). It is characterized by rapid onset, short duration, and spontaneous complete recovery.

Common Causes

• Vasovagal (Neurocardiogenic) Syncope: Most common. Triggered by emotional stress, pain, prolonged standing, heat, or sight of blood. Causes sudden drop in heart rate and blood pressure.
• Orthostatic Hypotension: Blood pressure drops on standing due to volume depletion (dehydration, bleeding), medications (diuretics, antihypertensives), or autonomic dysfunction.
• Cardiac Syncope: Arrhythmias (bradycardia, tachycardia), structural heart disease (aortic stenosis, HOCM), or outflow obstruction. High risk—requires urgent evaluation.
• Situational Syncope: Cough, micturition, defecation, swallowing.
• Other: Anemia, hypoglycemia, pulmonary embolism, seizures (though distinct from true syncope).

Prodromal Symptoms (Pre-Syncope)

• Lightheadedness, dizziness, nausea
• Blurred or tunnel vision
• Palpitations, sweating, clammy skin
• Yawning, feeling warm
• Pallor

Evaluation & Treatment

Immediate: Lay patient flat, elevate legs. Check breathing/pulse. If no rapid recovery, call EMS.

Medical Workup: History, physical, ECG, orthostatic vitals, basic labs (CBC, glucose, electrolytes). Further testing (echo, Holter, tilt table, EEG) guided by suspicion.

Management: Treat underlying cause. Vasovagal: hydration, salt, compression stockings, counter-pressure maneuvers, avoid triggers. Cardiac: may need pacemaker, ICD, ablation, or medication adjustment. Orthostatic: fluid repletion, medication review, gradual position changes.