You may have heard that people who feel dizzy should sit with their head between their knees, but is that true? And how do you know if you or someone else who has fainted should go to the emergency room or perhaps see a cardiologist?
Dr. Elijah Behr, a cardiologist at Mayo Clinic Healthcare in London, explains five important things to know about fainting. Fainting or blackout, also known as syncope, is a temporary loss of consciousness due to insufficient blood flow to the brain.
There are different types of fainting:
Vasovagal syncope is the medical term for the most benign type of fainting, a simple fainting spell without a serious underlying cause, says Dr. Behr. This type of fainting is fairly common.
“In some people, if there is a drop in blood pressure due to some emotional stress, pain, illness or dehydration, for example, or if the person generally has low blood pressure, any stimulus can trigger a reflex in the heart,” says Dr. Behr. “Instead of the heart speeding up and pumping harder to maintain blood pressure, it begins to slow down. Blood pressure drops, the heart rate slows further, and the heart can stop for many seconds — sometimes it can stop for about a minute in some people who have more severe fainting episodes.”
Usually, with this type of fainting, a person falls to the ground, blood pressure returns to the brain, and the person begins to recover; however, if someone faints in a susceptible location or vulnerable position, it can be dangerous to both the person and others, he notes.
The fainting that most worries health professionals is cardiogenic syncope, a blackout due to an underlying heart condition, such as a heart rhythm abnormality, or arrhythmia, he adds.
“This is usually a more abrupt loss of consciousness with a quicker return of consciousness compared to simply fainting. If you are older, you are more likely to have underlying heart disease that you may or may not be aware of. That is one reason to be more concerned about loss of consciousness in older people,” says Dr. Behr. “Younger people can also experience heart disease that can cause cardiogenic syncope, which can be a warning sign for something more serious to come, so it is important to investigate.”
“Other people for whom a blackout may indicate a warning sign of a serious heart problem include those with a family history of inherited heart problems, unexplained deaths, or sudden premature deaths; people whose fainting is related to physical exercise; and people whose fainting is associated with heart palpitations or a feeling that the heart is racing,” he adds.
Before a simple faint, you may have one or more signs that you should sit or lie down. “There will be a feeling of dizziness. There may be a feeling of nausea, ringing or ringing in the ears,” explains Dr. Behr. “Some people describe tunnel vision — vision closing in before passing out — and some may actually lose vision but remain conscious, without completely losing consciousness, and then recover. Other typical signs include feeling sweaty and clammy.” Some people have about a half-hour’s warning before passing out; others may have only 30 seconds, he adds.
What to do if you or someone else passes out:
Make sure the person is breathing and has a pulse. If not, call 911, and if you know how to perform CPR, begin it.
If the person is still breathing and has a pulse, make sure they are lying flat and have an open airway, using the recovery position, and call for help.
If you feel fainting coming on, place your head below the level of your heart: for example, between your knees.
Rest after you come out of fainting.
Drink water after fainting, adding electrolytes if available.
“If your blood pressure is dropping and you’re feeling these symptoms, that means blood isn’t getting to your brain, and if your heart is trying to push blood back to the brain against gravity, it means it’s straining itself. You need to place your head at or below the level of your heart to get blood pressure back to the brain; this will prevent all the symptoms and the vicious cycle that happens in turn,” explains Dr. Behr. “Put your head between your knees or lie down and put your head down and your feet up, depending on where you are and what’s feasible to do.”
Getting up and walking around right away will probably be the worst thing to do, he warns:
“Your blood pressure will drop even further, you’ll feel worse, you’ll collapse and fall, you may even hurt yourself,” says Dr. Behr. “The best thing to do is to stay where you are and stay still, and when you feel better, drink some water, perhaps with some electrolytes, in case you are dehydrated. As a general recommendation, we advise most people who have fainted to increase their water intake and occasionally add a little more salt to their food, since they generally have low blood pressure.”
Sometimes staying hydrated and adding salt to the diet may not be enough. Occasionally, people need to take medications to improve blood pressure control and increase blood pressure to prevent fainting episodes, says Dr. Behr.
When to seek medical help
“If someone has had a simple fainting spell with the triggers I described above, the best thing to do is to talk to their family doctor (their primary care physician) to discuss it. Especially if it’s the first episode of symptoms, it’s best not to ignore it,” Dr. Behr advises. “It’s common for people to seek emergency care after their first fainting spell, which I think is completely appropriate and even advisable.”
If a person has had simple fainting spells before and knows the circumstances that cause them, as well as having been evaluated by their primary care physician or a cardiologist, going to the ER for every episode may not be necessary, he adds.
The most alarming situations involve older people who faint, when other conditions may also be playing a role; people with frequent fainting spells, despite being well hydrated; cases where fainting causes injury; and when blackout occurs suddenly, with other signs of possible heart problems.
“It’s essential to make sure these people are treated and that no other problems are overlooked,” Dr. Behr says. “Also, in some cases fainting spells can resemble seizures. They can cause convulsive movements, and to know how to differentiate a seizure and epilepsy from fainting, you need to involve a cardiologist and a neurologist.”
If you faint at the sight of blood, it’s possible to condition yourself not to faint “This situation is very common, but it can be overcome in a variety of ways,” says Dr. Behr. For example, cognitive behavioral therapy (CBT) can help, he suggests. In CBT, you work with a mental health professional (such as a psychotherapist or therapist, for example) to become aware of negative or inappropriate thoughts, so that you can see challenging situations more clearly and know how to respond to them more effectively.
