Medicine is made up of a host of rare, exotic diseases—things you see once in a lifetime of practice—and a handful of common, routine, even boring illnesses that you see every day. Of course, common and routine are not so comforting when they happen to you. This ran through my mind last week just before I lost consciousness lying on the ground next to a hiking trail in New Hampshire.
Fainting, also known colloquially as “passing out” and more technically as syncope, is by definition a sudden loss of consciousness. It’s one of those common and routine illnesses that make for good storytelling later on—from the fathers who pass out at a child’s birth to the kids whose worlds go black standing in line at the amusement park in the blazing summer sun. I’d guess every family must have at least one good fainting story.
These episodes make for good stories because the majority of them reflect no underlying health problem. In medical parlance, most of them would qualify as a case of neurocardiogenic or vasovagal syncope—that is, some shock, stress, or major event stimulated the parasympathetic nervous system, causing a slowed heart rate, low blood pressure, and decreased blood flow to the brain. Voilà, loss of consciousness.
Fortunately, that was the explanation for my little episode. I fell on the trail, cut my hand, and the confluence of pain, exhaustion, and the sight of blood (yes, I’m a doctor, but it’s different when the blood is my own) made me light-headed. I felt the series of sensations familiar to anyone who has fainted: a whirring in my ears, a sense of nausea, a blurring or narrowing of vision. I was back again almost as quickly as I disappeared, and back in command of myself.
But not all fainting is an effect of stress. Every internist and emergency room physician can tell you that sorting out the benign fainting from the worrisome kind, which might reflect heart arrhythmias or other major problems, is not all that easy. And while the most common answer is, “It’s benign,” the alternative diagnoses are pretty alarming: heart arrhythmia, vascular disease, seizure, or even stroke.
How do we sort it out? We order a battery of tests, from electrocardiograms to stress tests to a bizarre one called a tilt-table test. But there is one test we rely on first, and it’s the cheapest: We listen to the patient’s story.
If you’re young, and had some sort of shock preceding the incident, or if you had that prodrome of nausea before you fainted and woke up feeling OK again, chances are you’re fine. Situations that require more concern involve people over 50 as well as those who have heart disease or take heart medications, have no warning that a spell is imminent, or have repeated episodes or episodes that occur while lying down or during exercise. But for the doctor, the story is the first key. And if you’re like me, you’ll add your story to the list of family fainting tales, and tell it again—perhaps with a few extra touches each time.
(PHOTO: ISTOCKPHOTO)
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