Syncope (Fainting)

Treatment of syncope depends first on identifying the mechanisms and factors that cause or contribute to syncopal spells in an individual person. Since the most common form of syncope is orthostatic syncope, measures that minimize the effects of gravity are usually recommended. If one can sit or lie down when symptoms begin, syncope can often be prevented. If one must maintain an upright posture, the person should avoid standing still. Walking increases venous return via the pumping action of the leg muscles on the leg veins. Standing and straining at the same time should be avoided whenever possible. If one must strain to urinate interruption of straining every few seconds is helpful. Men who experience "bathroom syncope" should sit to urinate. Also placing a carpet in the bathroom can avoid injuries. Treatment of the primary problem, such as prostate surgery for urinary obstruction or treatment of bronchitis to eliminate cough may eliminate the trigger for the syncopal episodes.

Maintenance of adequate hydration is also important in the prevention of orthostatic syncope. Many healthy people follow very low sodium diets with the idea that salt restriction is a healthy way of eating. However, some of those people are actually chronically dehydrated and suffer syncopal episodes, especially if they engage in heavy exercise and sweat a lot. Diuretics given for the treatment of high blood pressure can also bring out a tendency for orthostatic syncope when the patient has not previously suffered an episode.

Medications are often involved in the genesis of syncope, but they may also offer options for the management of syncope. Blood pressure medications which dilate the arteries and the veins (ACE inhibitors, calcium channel blockers, angiotensin receptor blockers) can override the bodys mechanisms for preventing low blood pressure in response to changes in position. Changing medications may often be all that is necessary to prevent syncope, but in persons receiving drugs to lower blood pressure, some dizziness upon standing up may be the price to pay to protect oneself against the complications of high blood pressure. Because there are individual differences in the response to antihypertensive drugs, it may be possible to tailor drug regimens that minimize symptoms of low pressure when standing up. On the other hand, if the blood vessels are dilated inappropriately in the absence of medications, other medications (beta blockers or midodrine) may be used to constrict the vessels.

Syncopal spells related to arrhythmias require specific therapies. Diagnostic findings at electrophysiologic study often provide important therapeutic guidance. Supraventricular tachyarrhythmias may be cured by catheter-mediated (radiofrequency) ablation or treated with drugs. Bradyarrhythmias may require the implantion of a pacemaker. Ventricular tachyarrhythmias causing syncope are treated with implantable cardioverter defibrillators (ICD). These devices can also act as pacemakers and prevent syncope arising from slow heart rates (bradyarrhythmias).