Central  South  Dakota Medical News
The Clinical View
by P.E. Hoffsten, M.D.
12/13/2001

FAINTING SPELLS

             This past week I saw two individuals who had had “fainting spells”.  One had a very safe although alarming event while the other had had a problem that might have been fatal.  Separating those problems that are safe from those that are dangerous is a tricky business.

            The first person was an elderly lady who was a very healthy individual.  She was not diabetic, was not a smoker and did not have a high blood cholesterol.  She had had high blood pressure over several years time but this had been controlled with medication and she had done very well with this.

            She was struggling in a playful way with her grandson who had come up behind her and put his arms around her.  Somehow, she got her arm pressed up against her neck and squeezed tighter than either of them knew.  As they were struggling, she lost consciousness.  Their grandson thought that she was “faking” and loosened his grip slightly.  When he did this, she slumped to the floor still unconscious.  As might imagined this is a very alarming event for the others in the room.  Fortunately, she regained consciousness in seconds.  After she had regained consciousness, both arms and both legs worked.  She could see out of either eye.  She could speak normally.  There was no associated pain.  She had not vomited.  There was no observation of seizure-like activity and she had no pain.  This is an example of the so called “benign faint”.  It happens when there is pressure to a very sensitive part of the neck which controls the pulse and blood pressure.  When this area receives undo pressure, the pulse slows and blood pressure drops substantially.  The person will loose consciousness for a brief period of time until the pressure on the area of the neck is released.  This had accidentally happened to the lady in this story and there was no residual after she had regained consciousness.

            The second person was an elderly gentleman who got up in the morning and went to the bathroom as he normally would.  While there, he recalls having some loose stools which he recalls were quite black.  He stood up off of the commode, lost consciousness and fell forward striking his head on the edge of the door.  He suffered a cut to the area of his right forehead and bled quite profusely.  Minutes later, his wife returned to the area of the bathroom from her kitchen where she had been fixing breakfast.  She found him lying on the floor in a pool of blood and became quite alarmed as would be imagined.  He was brought into the hospital where the bump on his head and the cut were really very minor considerations.  The laceration to his head was sutured shut and healed without difficulty.

            He did, however, have another major problem and that was the very black diarrhea stool.  This is a sign of internal bleeding, most likely from the stomach.  His blood count was about 1/3 of normal and his blood pressure was very, very low because “all of the fuel was out of the tank”.  After transfusion, he was found to have a substantial ulcer that had been bleeding over days time.  Finally, it had bled enough that he didn’t have enough blood to keep him awake and he passed out when he stood up.  This is not a “benign faint”.  He was treated with medications to heal the ulcer and made an uneventful recovery.

            These are two examples of the type of problems presented by an individual who faints.  But in fact, 4 out of 5 people over age 60 who have a fainting spell that is unprovoked (such as wrestling with your grandson) have something wrong with their heart, the quantity of blood in their body, or the quality of the blood in their body.  The only way that a person looses consciousness is when the blood supply to the entire brain is shut off or becomes inadequate in it’s oxygen or sugar content.  Diabetics who get very low blood sugars, commonly have fainting spells secondary to the low blood sugar.  Low blood oxygen levels are very unusual but can occur in individuals who have severe chronic lung disease with coughing spells.  The most common cause of a fainting spell in an elderly individual relates to the clock that runs the heart.  When this clock makes the heart run way to fast or way to slow, the blood supply to the brain can drop suddenly and the person looses consciousness.  If the heart runs too slow, there is simply not enough blood getting to the brain to make it work.  If the heart runs too fast, it doesn’t have time to fill up between heartbeats and the amount of blood pumped with each heartbeat is so little that the brain will not get enough blood.  These type of fainting spells present a more ominous problem and require medical attention.  Sometimes, these problems can result from not enough blood getting to the heart and can be the preceding event for a heart attack.  These fainting spells may be one of natures little warnings that the person needs medical attention.

            There are many other causes of fainting spells including intoxications, side effects from medications, overwhelming infections, seizure disorders and liver or kidney failure.  These are much rarer than the three most common causes which are heart problems, low blood volume secondary to bleeding, or low blood sugars.

            Your local clinics are well equipped and knowledgeable to help separate out those individuals who have a benign, safe condition with a faint and those individuals who require more specialized medical attention and medical care.