Fainting: The Final Frontier ( and Neurally Mediated Syncope)

Fainting. 
The final frontier. 
These are the voyages of the vertically impared, set out to reach new heights of embarassment - flashing panties and falling where no one has fallen before. 

(Dooo-do-do-do-duh-duh-dum dhuuuduum!) <----That was Star Trek Next Generation music/refernece for those of you that happen to not be nerds.

So lets talk fainting.  I have been writing furiously for the new Non-Profit I am helping co-found (Dysautonomia International - website coming soon!), and by far the most difficult subject to summarize into a consise, easy to understand format was syncope and NMS (neurally mediated syncope).

So, here is a brief run down on fainting and fainting related dysautonomia disorders.

Syncope = Fainting = Passing out.  This means you have lost consciousness, or have come close and have gotten horizontal in time to prevent the actual faint, otherwise known as "pre-syncope."  This happens because there is not enough blood in your brain.  Many perfectly healthy peeople faint during their life time, and it is a one or two time event - and they have no other health issues causing it or as a result.  Or - it can be a sign of something serious.  There are many types of fainting, the most common being vasovagal, or reflex fainting.
According to the Mayo Clinic (all linked info in this post is from the Mayo Clinic site, I have found it very easy to read and understand):

"Vasovagal syncope (vay-zo-VAY-gul SING-cuh-pee) is the most common cause of fainting. Vasovagal syncope occurs when your body overreacts to triggers, such as the sight of blood or extreme emotional distress. The trigger results in vasovagal syncope — a brief loss of consciousness caused by a sudden drop in your heart rate and blood pressure, which reduces blood flow to your brain.

Vasovagal syncope is usually harmless and requires no treatment. However, you can injure yourself during a vasovagal syncope episode. Also, your doctor may recommend tests to rule out more serious causes of fainting, such as heart disorders."

But - if you faint or come close to fainting regularly, there is something going on.  Recent news stories and the medical community have also focused on the fact that if you faint only once, you should still go to the ER and follow up with your doctor to make sure it is not a sign of something more serious.

According to Mayo:
"Before a faint due to vasovagal syncope, you may experience some of the following:

• Skin paleness
• Lightheadednes
• Tunnel vision — your field of vision is constricted so that you see only what's in front of you
• Nausea
• Feeling of warmth
• A cold, clammy sweat"

Not all fainting is vasovagal.  My fainting/pre-fainting is a bit different, everyone's is - but your specific symptoms before fainting can clue your doctor in as to what is going on, so make sure to write them down after it happens.  Mine include:

• Feeling the blood leave my head, literally
• Impending feeling of, "Oh God, oh God, I'm going to die"
• Legs get weak
• Face sometimes flushes and gets hot
• Sweaty hands
• Pain in feet/legs
• I start to feel my arms and face go numb, and tingle like they are falling asleep to the extreme - which is weird - but that is my first big clue that I need to be flat RIGHT NOW
• For the record - I supposedly don't have NMS, just good old POTS, Orthostatic Hypotension, and Autonomic Neuropathy currently of unknown origin.  I have had vasovagal events where my blood pressure and heart rate drop, but I was pregnant, and now that I have a pleasantly empty uterus (and healthy gorgeous baby), my heart rate doesn't plummet.  But my BP will fluctuate and sometimes crash.  I am lucky to have warning - and I can get flat before completely passing out or collapsing.  My upright time is about 2 minutes before it gets bad right now.

If you pass out, or come close, your doctor should recommend a full cardiac work up to rule out structural problems with your heart that can sometimes be fatal.  Some of these tests include:

• An EKG/ECG - otherwise known as an Electrocardiogram.  This reads the electrical rhythms of your heart, and can find abnormalities.
• An ECC - or an Echocardiogram.  This is an ultrasound of your heart.  They may even perform a Bubble ECC (I've had one!) to watch the blood flow through your heart as it beats.  This can help detect holes, valve issues, etc...
• A Tilt Table Test - to see what your blood pressure is doing when you go from laying to standing.  An orthostatic set of vitals (or a "poor man's tilt") may be performned in a doctors office instead. 
• Exercise stress test. This test studies heart rhythms during exercise. It's usually conducted while you walk or jog on a treadmill. 
• Blood tests. Your doctor may look for conditions, such as anemia or hypoglycemia, that can cause or contribute to fainting spells.  Also - they can check your blood to make sure you are not having a heart attack (that's an important one!).

So what the heck is Neurally Mediated Syncope (NMS)?

NMS used to be called NCS - or Neurocardiogenic Syncope.  It was renamed because the term is inaccurate - cardiogenic implies heart involvement, when it is actually caused by your nervous system (hense the term neurally mediated) triggering the event. 

In a nutshell - NMS is when you chronically (repeatedly) have vasovagal fainting episodes.  So your heart rate AND blood pressure drop, causing you to faint.  This is thought to be caused by blood pooling in the extremeties.  This is different from POTS and Orthostatic Hypotension.

POTS is an increase in heart rate of 30 beats per minute uppon standing, within 10 minutes, with or without changes in blood pressure.  Remember that POTS is just a syndrome - or collection of symptoms, and something else is causing you to faint.  POTS does not cause you to faint per say, but can make you feel awful in many ways, and very lightheaded.  The Mayo Clinic doesn't even have a section for POTS on it's main website, or any variation of the name, because they tend to focus on the cause.  They do have a podcast and YouTube series about POTS, and resources here. 

If you are fainting and have been told you "just have POTS," it's time to get a new doctor.   Please see FIND YOUR POTS CAUSE.

Orthostatic Hypotension (OH) is a drop in blood pressure upon standing, without a significant drop in heart rate. Can cause fainting or dizziness, and can be very mild or very severe - or indicating a serious condition.

So, in summary:
NMS is when you faint or come close to fainting because your heart rate and blood pressure drop (probably due to blood pooling in your legs - numerous things can cause that!). Not to be confused with POTS or OH.  You can have both POTS and NMS, or POTS and OH.

All of these conditions require finding out WHY THEY ARE HAPPENING, especially if you are fainting and don't know why.   


Some resources regarding fainting and NMS:

• Vanderbilt (very science based explanations)
• Mayo Clinic
• NDRF
• Texas Heart Institute
• NYU Lagone Medical Center

Hope this helps clear up some of the confusion.  Have a great day!
Claire