Syncope: What to Do When Someone Faints While Sitting

Syncope while sitting?

Hello Doctor: A few days ago, my father fainted, which has caused me a lot of worry.
I was originally going to the hospital to pick up a relative who was being discharged, but the discharge process took longer than expected.
My father had been walking in the hospital for nearly two hours.
While chatting in the ward, he suddenly sat down on a chair, removed his mask, and his chest was visibly rising and falling.
Less than ten seconds after sitting down, he suddenly rolled his eyes back and became unresponsive.
I’m not sure if this is considered fainting.
His breathing was noticeable and somewhat rapid.
I quickly called for the nursing staff, who first tried to wake him and then moved him to a nearby bed.
The entire process took less than 30 seconds, and he woke up, able to respond to his name.
He was then taken to the emergency room, where blood tests and an echocardiogram were performed, both of which were normal.
However, his blood pressure was recorded at 192/85, and the nursing staff did not seem overly concerned.
About 20 minutes later, his blood pressure was 180/80, and after taking antihypertensive medication, it decreased to 172/80.
Is this considered hypertension? My father had also undergone several health check-ups a few days prior, all of which were normal.
After waking up, he mentioned feeling very tired in the morning, experiencing dry mouth and thirst without drinking any water.
He felt strange before fainting, which is why he sat down.
After regaining consciousness, he was able to converse normally, shake hands, and lift his legs, but he did not remember fainting.
I often hear that standing up from a seated position can cause fainting, so I’m puzzled as to why my father fainted after walking for two hours and then sitting down to chat.
This is the first time something like this has happened, and it has made me very scared and worried.
I would appreciate your assessment of whether we should be concerned about anything or if you have any recommendations, as well as your estimation of what might have occurred.
Thank you very much.

Xiao Zhi, 20~29 year old female. Ask Date: 2024/04/02

Dr. Jiang Junyi reply Neurology

Dear Mr.
Hsiao,
You mentioned that your father exhibited "chest rise and fall with noticeable and somewhat rapid breathing, and then hurriedly called the nursing staff, who first called out and then moved him to the adjacent bed, with the entire process taking less than 30 seconds." Typically, fainting occurs due to insufficient cerebral blood flow, clinically presenting as low blood pressure.
Your father's blood pressure increased and there was a change in consciousness, suggesting the need to consider issues such as arrhythmia, abnormal electrical discharges in the brain, or stenosis of the basilar artery, among others.
Additionally, I would like to inquire if your father has metabolic syndrome (characterized by abdominal obesity, hypertension, elevated fasting blood glucose, dyslipidemia, etc.).
If so, he would be at a higher risk for stroke.
Furthermore, smoking can contribute to cerebrovascular disease.
It is crucial to manage these conditions actively.
I recommend accompanying your father to the same hospital's emergency department for evaluations and follow-ups with both the neurology and cardiology departments, prioritizing neurology.
Thank you for your inquiry, and I welcome further discussion.
Wishing you and your father good health, safety, and happiness.
Dr.
Chien-Ju Jiang
Department of Neurology, Taoyuan Hospital

Reply Date: 2024/04/02

More Info

Syncope, commonly known as fainting, is a sudden, temporary loss of consciousness and muscle strength, often due to a decrease in blood flow to the brain. It can occur in various situations, including while sitting, standing, or even during physical activity. Understanding the underlying causes and appropriate responses to syncope is essential for ensuring safety and preventing future episodes.

In the case you described, your father experienced a fainting episode after walking for an extended period and then sitting down. This scenario can be attributed to several factors. One possibility is orthostatic hypotension, which occurs when a person stands up or sits down quickly, causing a sudden drop in blood pressure. However, since your father was sitting when he fainted, it may also be related to other factors such as dehydration, fatigue, or even a vasovagal response, which is a common cause of syncope triggered by stress, pain, or prolonged standing.

The symptoms you mentioned, such as chest heaving and rapid breathing, could indicate that your father was experiencing a moment of distress or anxiety before fainting. The fact that he regained consciousness quickly and was able to respond to questions is a positive sign, suggesting that the episode was likely not due to a severe underlying condition. However, his elevated blood pressure readings (192/85 and later 180/80) warrant attention. While these values indicate hypertension, it is essential to consider the context. Stress, pain, or anxiety can temporarily elevate blood pressure, and it is crucial to monitor his blood pressure over time to determine if he has chronic hypertension.

Given that your father had normal results from previous health checks, it is possible that this episode was an isolated incident. However, it is essential to remain vigilant. Here are some recommendations for managing and preventing future episodes of syncope:
1. Hydration: Ensure that your father stays well-hydrated, especially if he is active or in a warm environment. Dehydration can significantly contribute to fainting episodes.

2. Gradual Position Changes: Encourage him to change positions slowly, especially when moving from sitting to standing. This can help prevent sudden drops in blood pressure.

3. Monitor Blood Pressure: Regularly check his blood pressure, especially during times of stress or after physical activity. If readings remain consistently high, consult a healthcare provider for further evaluation.

4. Diet and Lifestyle: A balanced diet, regular exercise, and maintaining a healthy weight can help manage blood pressure and overall cardiovascular health.

5. Follow-Up with Healthcare Providers: Since this was your father’s first episode of syncope, it is advisable to follow up with his healthcare provider. They may recommend further tests, such as an electrocardiogram (ECG) or Holter monitor, to assess his heart rhythm and rule out any underlying cardiac issues.

6. Educate on Warning Signs: Teach your father to recognize early signs of fainting, such as dizziness, lightheadedness, or unusual fatigue. If he feels these symptoms, he should sit or lie down immediately to prevent injury.

In conclusion, while your father's fainting episode may not indicate a severe health issue, it is essential to monitor his condition closely and take preventive measures. If he experiences another episode or if his blood pressure remains elevated, seeking medical advice is crucial. Understanding the triggers and responses to syncope can help manage his health effectively and alleviate your concerns.

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