and Managing Occasional Fainting: Causes and When to Seek Help - Family Medicine

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Idiopathic syncope


Hello, doctor.
Recently, I have been increasingly troubled by an intermittent issue, which is fainting.
I feel like I'm about to pass out, with a dry mouth and my vision gradually darkening.
Usually, when I rest to the side, I start to sweat a little, and then I feel better.
If this occurs after blood draw, in addition to sweating, I also experience full-body shaking and a rapid heartbeat (which is very uncomfortable).
I've been observing closely and noticed that this can happen even when I am feeling very calm.

The situations where this occurs more frequently include:
1.
Standing still in one place indoors
2.
After a blood draw
3.
In crowded indoor spaces (even while sitting)
4.
Lifting heavy objects or climbing uphill
5.
Standing while wearing a mask
6.
Walking outdoors for a long time
I recall that as a child, I was prone to heat exhaustion, and there were also 1-2 instances in winter when I was outdoors and suddenly felt very tired in my lower back, followed by my vision darkening.

Could you please tell me what might be causing this? If I need to see a doctor, which specialty should I consult? What should be the order of the consultations? Thank you!

Liao, 20~29 year old female. Ask Date: 2021/10/28

Dr. Ye Qianyu reply Family Medicine


Hello! It is recommended that you first visit a cardiology clinic.

Reply Date: 2021/10/28

More Info


Fainting, or syncope, is a temporary loss of consciousness often related to insufficient blood flow to the brain. It can be triggered by various factors, and understanding these causes is crucial for effective management and when to seek medical help.

Based on your description, it seems that your fainting episodes are becoming more frequent and are associated with specific situations, such as standing for long periods, being in crowded places, or after blood draws. These triggers suggest that you might be experiencing a form of vasovagal syncope, which is the most common type of fainting. This occurs when your body overreacts to certain triggers, leading to a sudden drop in heart rate and blood pressure, resulting in reduced blood flow to the brain.

Here are some potential causes for your symptoms:
1. Vasovagal Syncope: This is often triggered by stress, pain, or prolonged standing. The body's response can cause blood vessels to dilate and heart rate to drop, leading to fainting.

2. Orthostatic Hypotension: This condition occurs when you stand up quickly, causing a drop in blood pressure. It can lead to dizziness or fainting, especially if you have been sitting or lying down for a while.

3. Dehydration or Low Blood Sugar: Both conditions can lead to fainting. If you are not drinking enough fluids or if you skip meals, your blood pressure may drop, leading to symptoms like dizziness and fainting.

4. Anxiety or Panic Attacks: These can also cause physical symptoms that mimic fainting, including sweating, rapid heartbeat, and feelings of impending doom.

5. Cardiac Issues: Although less common, heart problems can lead to fainting. Conditions such as arrhythmias or structural heart issues can cause inadequate blood flow to the brain.

Given the frequency and nature of your symptoms, it is essential to seek medical advice. Here’s how you can approach this:
1. Start with a Primary Care Physician (PCP): They can perform an initial evaluation, including a physical examination and a review of your medical history. They may also check your blood pressure and heart rate in different positions (lying down, sitting, and standing) to assess for orthostatic hypotension.

2. Referral to a Specialist: Depending on the findings from your PCP, you may be referred to a cardiologist if there are concerns about heart-related issues or to a neurologist if there are concerns about neurological causes.

3. Diagnostic Tests: Your doctor may recommend tests such as an ECG (electrocardiogram), echocardiogram, or blood tests to check for anemia or electrolyte imbalances. A tilt table test may also be performed to evaluate how your body responds to changes in position.

4. Lifestyle Modifications: In the meantime, consider lifestyle changes that may help manage your symptoms. Staying well-hydrated, avoiding prolonged standing, and learning to recognize early signs of fainting (like dizziness or sweating) can be beneficial. If you feel faint, sitting or lying down can help prevent a full fainting episode.

5. Monitor Triggers: Keeping a diary of your episodes, noting the circumstances, duration, and any preceding symptoms, can provide valuable information for your healthcare provider.

In summary, while occasional fainting can be benign, the increasing frequency and associated symptoms warrant a thorough evaluation. Starting with your primary care physician is a good first step, and they can guide you through the necessary assessments and referrals. Remember, it’s always better to err on the side of caution when it comes to your health.

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