Fainting is not uncommon. Occasional fainting spells are not a huge medical concern as the person recovers from the loss of consciousness quickly. People from all age groups can experience transient loss of consciousness, says Dr Vikas Naik, consultant neurosurgeon at Fortis Hospital, Nagarbhavi, Bengaluru. “It could be either due to lack of blood supply to the brain or an absent seizure – a seizure activity where the brain stops functioning for some time and again regains its state,” he says. Medically such fainting spells are called syncope, he adds.
According to the US National Institute of Health, syncope accounts for around 10 per cent of emergency department visits annually. However, research shows that the rate nearly doubles after age 70. Dr Naik says, “The elderly commonly experience a transient loss of consciousness or faints, especially after sitting or standing for long.” Frequent syncope in older people is a cause of concern as it increases their risk of falling and injury, as illustrated in the instances below.
There have been several examples of people who have experienced syncope that one needs to be aware of:
(Note: All names withheld on request)
- A 60-year-old man, fit as a fiddle, suddenly collapsed on the road one day.
- In another instance, a woman over 60 – an active blogger and member of a walking tour — collapsed on the pavement suddenly.
- Another gentleman aged 80 and above but very fit experienced four falls in three months. Surprisingly, the person did not feel pain after the fall.
It is hard to conclude the root cause of syncope as several underlying issues could exist. Sometimes, standing up after sitting for too long causes blood to pool in the legs due to gravity, explains Dr Thimmappa Hegde, neurosurgeon from Narayana Medical Centre, Bengaluru. At such times, the heart rate increases to compensate for the lack of blood flow; however, if it cannot, then syncope can occur within a few seconds to minutes of standing, he explains.
Other possible causes for dizziness could be a sudden drop in blood pressure, hypotension, anaemia or standing up too quickly from a sitting or lying position or vertigo (caused by issues in the inner ear. More about this in another article!). All these cause cerebral hypoperfusion – an insufficient blood flow to the brain. In turn, the lack of blood reduces the brain’s oxygen supply. In such situations, the brain ‘switches off’ temporarily to preserve itself until the supply is restored.
In other conditions like heart failure or a heart block, the heart’s ability to pump enough blood to the brain at normal pressures is impaired, as happened in another gentleman’s case. He had an unexplained fall in January 2024, ignored it and travelled to Malaysia. In February, he had another fall, after which he was diagnosed with a blood clot. On surgical removal of the obstruction, he recovered well and was rid of syncope spells. However, he was not allowed to travel back to India for the next eight weeks.
Other heart-related conditions such as bradycardia and tachycardia, issues with the heart valves, congenital heart defects and blood clots in the lungs can affect the oxygen delivery to the brain. Some studies found that dizziness and syncope episodes in women could be indicative of an underlying heart condition.
Triggered by situations
Sometimes extreme emotion, pain, anxiety or medical procedures can activate a syncope response. These reactions activate the autonomic nervous system, which dilates blood vessels and slows heart rate, reducing blood pressure. Even a regular relaxing activity, like a hot shower, can cause the blood vessels to dilate. If the blood pressure dips, it can lead to dizziness, says Dr George Cherian
Apart from reduced blood flow, other causes, like benign tumours in the brain, can cause fainting spells. Sometimes epileptic seizures, psychogenic seizures, low blood sugar, certain medications, chloroform inhalation and oxygen restriction can cause fainting.
Sometimes, coughing and urinating can also lead to situational syncope, says an elderly person who did not want to be named. He feels dizzy only at night while urinating, just before going to bed. However, he recovers from the episode quickly.
Studies have shown that a disruption in the ability of the body to control blood pressure leads to a condition called vasovagal syncope. It usually occurs after activities like urinating, defecating, coughing or laughing.
Dr Paul C Salins, managing director and vice-president of the Mazumdar Shaw Cancer Centre and Narayana Hrudayalaya Multispecialty Hospital, Bengaluru, says that one should often monitor their blood pressure before and after the dizzy spells to observe the dip in blood pressure.
“What happened to me?”
A fascinating aspect of syncope or fainting is that the person is unaware of and cannot recall the episode. “I don’t know what happened” is the oft-heard statement from the person. Syncope is accompanied by memory gaps: during the transient state, the brain has switched off, and its function may be temporarily disrupted.
Memory consolidation (converting short-term memories into long-term ones) can be impaired during these episodes. The brain’s hippocampus, responsible for memory formation, may not function optimally due to reduced blood flow or oxygen supply during a blackout. As a result, events occurring during the blackout period may not be encoded into long-term memory, leading to memory gaps. During cerebral hypoperfusion, a sudden drop in blood pressure causes the brain to prioritise vital functions over memory processing. The brain’s focus shifts to survival during the fall, potentially disrupting memory encoding.
Diagnosing syncope
When diagnosing syncope, doctors typically investigate presyncope symptoms, family history, medication use, past medical history, frequency and triggers to help determine the type of syncope. They then assess vital signs like blood pressure and heart rate while lying down and standing up. A neurological exam rules out seizure or stroke. Cardiac and vascular exam identifies any abnormalities. Typically, blood tests are done to check for anaemia, electrolyte imbalances, diabetes, and other conditions that may be factors.
Treating syncope
Treatment usually depends on the underlying cause but may include medication, pacemakers, avoiding triggers, surgeries, increasing fluid/salt intake, compression stockings, and physical counter-pressure manoeuvres. Preventative measures include:
- avoiding dehydration, managing medications, pacing activity, and utilising counter-pressure techniques when feeling presyncope.
- creating a safe environment, such as using anti-skid or rubberised mats and cushions or using walkers, can help prevent the impact of falls.
- if you are concerned that you could fall, keep objects that could break the fall. For example, a high stool in the shower. Also, try to control the direction of your fall to avoid hitting the back of your head.
Signs of fainting
Here are some warning signs that can alert you or your family:
- Light-headedness or dizziness: Feeling suddenly lightheaded or dizzy can be an early sign of impending blackouts.
- Paleness and sweating: Some people experience pallor (pale skin) and excessive sweating before losing consciousness.
- Nausea: Feeling nauseous can be an indication that a blackout is imminent.
- Visual disturbances: Blurred vision, tunnel vision, or seeing spots can occur before a blackout.
- Aura (in epileptic seizures): Some individuals with epilepsy experience an aura before a seizure. An aura can be a specific sensation, smell, or visual disturbance that precedes the blackout.
- Weakness or trembling: Feeling weak or shaky can be an early sign. It may indicate low blood sugar, dehydration, or other factors leading to blackouts.
Management mantras
Dr Naik says that a few lifestyle alterations can manage syncope. He suggests:
- Exercise moderately. Do not overstrain.
- If standing for long hours, try to sit briefly or walk around briefly.
- Try lying down and lifting the legs to restore circulation to the brain.
- Include more fluids to avoid dehydration.
- For some people, elastic stockings help by preventing blood pooling in the lower limbs. However, consult your doctor before using them.
