Syncope (Fainting Spells) Can Be Prevented Without Medication
Anyone who has had a fainting spell knows that they don’t want it to happen again. These episodes tend to occur in clusters, and patients can go months or years between episodes. Taking a medication on a daily basis, sometimes 2 or 3 times a day can be a serious burden for those people who have infrequent episodes of passing out. Research studies have recently demonstrated that there are several things that patients can do to prevent fainting spells and these measures are even more effective than our best medical treatment at this point in time.
The two interventions to prevent episodes of syncope can be divided into those that a patient will do on a daily basis, and those that patients will do just at the time they feel an episode coming on. Before discussing this, it is important that everyone really understand what is involved with fainting spells. First of all, for most people, episodes of fainting spells do not represent a disease. Fainting spells happen because of temporary problem in which the heart rate and blood pressure are not regulated properly. People who have fainting spells should be able to live a long and happy life.
Daily measures to prevent syncope
As we think about what can be done on a daily basis to prevent an episode of passing out, it is important to remember that a fainting spell occurs because blood pressure drops so low that the brain does not get an adequate blood supply. Syncope patients can be protected against this happening by keeping plenty of fluids on board. A lot of people spend their lives being just a little bit dehydrated, in part because they don’t want to be disturbed by needing to leave their activity to get up to the bathroom. More often, I think people just forget to drink fluids throughout the course of the day. People with fainting spells should make a special effort to drink fluids with their meals and then also to drink in between meals.
Salt
It is also important to get plenty of salt in the diet. Salt helps the body retain fluid. When people have problems like heart failure, when the problem is too much fluid, the first thing we ask them to do is to eliminate salt. People with fainting spells have the exact opposite problem, so they need to be sure to get plenty of salt in their food. This can be in the form of food that is naturally salty, and by adding salt to their food as they cook it or with the salt shaker at the table. If one person in the family has high blood pressure or heart failure, and everyone eats a meal together, the proper thing is to avoid salt in cooking and then add salt at the table.
Water
For people who have the unusual condition of pure autonomic failure, even drinking one pint of water can raise the blood pressure by 30 to 50 mmHg, and prevent episodes of fainting. Those people should keep a glass of water by the bedside stand so they can drink water immediately before getting up in the morning. This is a very rare situation and hardly anyone else needs to take that precaution. However, people who have a problem with fainting spells after physical activity would do well to drink fluid just prior to exercise.
Support hose
For people who have frequent fainting spells, support hose may also be quite helpful. These come in various sizes and different lengths. Some people will benefit from over-the-counter knee high elastic stockings. Other people need to have specially fitted support hose. A more extreme measure is to wear a support garment that goes all of the way up to the waist.
Since fainting spells tend to occur in clusters, and patients may go months or years between episodes, it might be appropriate to emphasize these daily measures during periods in which there is a greater likelihood of fainting spell. For some people, travel, hot weather with resultant dehydration, sickness, or stress may increase the likelihood of passing out. If you enter into one of these tough periods in your life, it would be appropriate to be much more attentive to these daily measures.
Raise the head of the bed
One daily measure might be helpful for some people. Raising the head of the bed a few inches may help retrain the receptors in the body that maintain blood pressure upon standing. However, for those people who share a bed with another person, it represents a major inconvenience to that other individual and usually patients don’t stay with this in the long run!
Training and practice
No matter what we do, practice, training and exercise are beneficial. This is obvious when we see baseball players begin spring training, or we watch the start of the Red Wing training camp in Traverse City. At the same time, every successful musician spends a good deal of time practicing their instrument. Likewise, there are exercises and training programs that can be very effective for people who have fainting spells or POTS (postural orthostatic tachycardia syndrome).
Staying active and moving about is good for everyone who can do it. Regular aerobic exercise helps prevent heart disease, cancer and diabetes. It also helps to restore the nervous system back to normal function. It maintains the good balance between those parts of our nervous system that speed up the heart rate and those that slow things down.
For people who have fainting spells when they are upright, they can do special training exercises that help exercise the tiny little muscles that control blood vessels and help maintain our blood pressure. This is called “tilt training.” It is deceptively simple.
Just stand so that you face away from a wall with your heels about 12 inches from the wall. Then, lean back against the wall. Keep yourself perfectly still. Try to hold that position for at least 10 minutes each day. (If you have had a tilt table test this will feel a little bit familiar! We do tilt table testing to find out how effective these little blood vessel muscles are.)
Exercise
Many people who have fainting spells can’t remain upright long enough to do much exercise. Or, exercise may make their heart race so much that they just can’t tolerate it. For these people, swimming represents an ideal form of exercise. First of all, the person is horizontal while they are exercising, so blood pressure control is much better. Also, the pressure of the water against the body helps return blood in the veins back toward the heart and this helps maintain blood pressure.
For those people who do not like swimming, or who don’t have access to a swimming pool, other forms of exercise are still beneficial. One of the best is a recumbent bicycle. Pedaling a bicycle with your feet at or above heart level is not only great exercise but it automatically helps maintain a stable blood pressure with exercise. Other forms of floor exercise are also beneficial.
This exercise program can be very frustrating for people who have serious limitations caused by their episodes of fainting or almost fainting. None the less, it represents one of the most important things that people can do to help protect against future problems.
Maneuvers to stop an episode when it is starting
Most people who have fainting spells have at least a short period of warning before the episode happens. In that case, they can do a few simple maneuvers that have been proven to elevate the blood pressure quickly and head off a fainting spell at least for a long enough period of time that the person can get to safe place.
Don’t just stand there
The first thing to do is not to stand still! We do tilt table tests to try to provoke people into fainting. People might faint while cooking, working a drugstore counter, etc if they stand perfectly still. Don’t just stand there – shuffle! Just simply moving about, even if it is just a few inches at a time and flexing your knees helps prevent a drop in blood pressure that can cause a fainting spell. Consider this, why do the guards at Buckingham Palace not pass out? (When they do, it is so rare it almost always becomes a photo op.) The answer is that they are trained to shift their weight from one foot to another, to sway gently at the pelvis and to periodically flex and relax the muscles in their legs. You should do the same thing if you find yourself standing for any period of time whether in line at a store, on the subway or in a crowded room.
Countermeasures
If you are standing and you feel an episode of fainting coming on, the best thing to do is to cross your legs over. Keep your feet pretty close together and then squeeze your thighs together. (Some people call this the cocktail party pose.) This can typically be done without drawing any attention to yourself. Squeezing your legs like this will raise your blood pressure 30 to 50 points. It should counteract the onset of an episode of fainting at least long enough that you can find your way to a chair or some other place to sit down.
If you are by yourself, or it doesn’t matter what other people think, squatting is one of the best things that you can do. Alternatively, if you are seated, crossing your legs by bringing your ankle up over your thigh also helps to increase your pressure. Or, putting your foot on the seat of a chair or barstool also helps raise pressure. These postures are illustrated in the diagram shown.
If an episode comes on and you have tried these maneuvers, or you don’t have a safe spot to go and sit down, tensing the muscles in your arms also helps. If you reach your hands across your chest and grab your fingers you can squeeze your hands tight and tense the muscles in your arms. This can raise your blood pressure 30 or 40 mmHg. An alternative is to squeeze a rubber ball with one or both hands. This may raise your pressure 20 or 30 mmHg.
Summary
There is a lot to be done that can prevent patients from having episodes of syncope. Do your best to work on these daily measures that relate to getting plenty of fluids, and salt in your diet. The daily use of support stockings and exercise will prevent many episodes from coming on. If a fainting spell does seem to be on the horizon, try the countermeasures described above. Like everything else, it may take a little practice to become really expert at these things.
DCC, December 2007
This figure illustrates the four postures that can be used to stave off an episode of passing out once you get the warning signs. The fellow has exaggerated the pose for crossing his legs. Practice this on your own and you will be reassured that it can be done very casually, without anyone even noticing! This gentleman is a research subject. He posed for these pictures after he made a blood pressure recording of what actually happened during each one of these maneuvers. That blood pressure response is demonstrated on the graphs that are next to each picture. If you can see it clearly, skip your next scheduled visit to the eye doctor!
Felix J. Rogers, D.O.
Downriver Cardiology Consultants, P.C.
5400 Fort St. Suite 200
Trenton, Michigan 48183
DCC, December 2007