Fainting

Fainting (syncope) is sudden brief loss of consciousness from temporarily reduced blood flow to the brain. Most episodes are from simple causes (vasovagal — from fear, pain, heat, standing long); some are from heart rhythm or structural heart issues that need urgent evaluation.

Common harmless patterns

• Vasovagal — triggered by emotion, pain, heat, standing long, hunger, sight of blood. Warning: nausea, sweating, visual darkening before the faint. Recovery within a minute.
• Orthostatic hypotension — standing up suddenly; BP drops; common in older adults, dehydration, some medicines.
• Situational — coughing, urinating (micturition syncope), swallowing.

Red flags — hospital evaluation

• Fainting during exertion — possible heart problem.
• No warning — sudden faint without any prodrome.
• Fainting while lying down.
• Chest pain, palpitations, breathlessness before faint.
• Injury from the faint — head, teeth.
• Family history of sudden death in young relatives or inherited heart conditions.
• Seizure-like movements during faint — distinguish from epilepsy.
• Prolonged confusion after the faint.

What to do during a faint

• If you feel one coming — sit or lie down immediately; elevate the legs.
• If someone faints near you — lay them flat on their back; lift the legs; loosen tight clothing; clear the airway.
• Don't pour water on their face while they're out; don't force them upright.
• Recover in the position for a few minutes before sitting up, then standing.

Evaluation

• History (triggers, warning signs, witness).
• ECG — always for a first unexplained faint.
• Blood tests — sugar, anaemia, sodium.
• Echocardiogram / Holter monitoring / tilt test — as indicated.
• Neurology work-up only if features suggest a seizure.

Management

• Vasovagal — hydration, salt, learn early-warning signs, counter-pressure manoeuvres (leg crossing, hand gripping).
• Orthostatic — rise slowly, stockings, review diuretics/BP medicines, adequate fluids.
• Cardiac causes — treat the specific arrhythmia or structural problem; pacemakers, ICDs in selected cases.