heart and blood vessel disorders
Fainting
Evaluation of Fainting
If possible, someone who witnessed the faint should provide the doctor with a description of the event because the person who fainted may not remember. In people who have fainted, certain symptoms and characteristics are cause for concern. They include Fainting during exercise Several episodes within a short time Sudden fainting without any warning symptoms or any apparent trigger Fainting preceded or followed by possible heart symptoms such as chest pain, palpitations, or shortness of breath Older age Significant injury as a result of fainting Family history of sudden unexpected death, fainting during exercise, or repeated episodes of fainting or seizures for which a cause has not been found Although most causes of fainting are not serious, a doctor's evaluation is needed to distinguish serious causes from relatively harmless ones. People who fainted should see a doctor right away, especially if they have any warning signs. Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What doctors find during the history and physical examination often suggests a cause of the fainting and the tests that may need to be done. Doctors ask about the events leading up to the fainting episode. They ask whether the person was exercising, arguing, or in a potentially emotional situation. They ask whether the person was lying or standing, and, if standing, for how long. They also ask about symptoms that occurred immediately before or after the event, including whether the person felt light-headed or dizzy or experienced nausea, sweating, blurred or tunnel vision, tingling of lips or fingertips, chest pain, or palpitations. Doctors also ask any witnesses to describe the episode. A sudden, abrupt faint without any warning symptoms or apparent trigger suggests a heart disorder. If fainting is preceded by a brief period of symptoms such as light-headedness, nausea, yawning, blurred vision, or sweating and occurs during a painful or unpleasant situation, it is probably vasovagal syncope, which is not dangerous. Doctors ask about previous episodes of dizziness or fainting and about other disorders, drugs, or symptoms that may be related to fainting. Doctors also check the person for injuries resulting from the fainting episode. Then doctors measure the person's vital signs. Heart rate and blood pressure are measured with the person lying down and after 1 to 3 minutes of standing. Doctors listen to the heart for signs of an abnormal heart valve or abnormal blood flow. They do a neurologic examination for signs of a stroke. Testing typically is done unless people have an obvious, harmless emotional trigger and otherwise feel well. Doctors choose tests based on the suspected cause. Electrocardiography (ECG) Continuous ambulatory ECG (Holter monitor or event monitor) Measurement of oxygen in the blood (pulse oximetry) Fingerstick blood sugar measurement Sometimes ultrasonography of the heart (echocardiography) Sometimes tilt table testing Sometimes blood tests Rarely imaging of the central nervous system (brain and spinal cord) In general, if fainting results in an injury or has happened several times (particularly within a brief period), more intensive evaluation is warranted. Imaging of the heart and brain are not routinely done unless the doctor suspects a heart or brain problem. People with suspected heart disorders, including heart attack, abnormal heart rhythm, or heart valve abnormality are usually admitted to the hospital for evaluation. Electrocardiography None Oxygen in the bloodis measured. Pulse oximetry is done during or immediately after an episode to identify low levels of oxygen in the blood (which may indicate a blood clot). If the level of oxygen in the blood is low, doctors do computed tomography (CT) angiography (using intravenous contrast) or a lung scan to check for a blood clot. Laboratory testsare done if physical examination findings suggest they are needed. However, all women of childbearing age should have a pregnancy test. Echocardiography and Other Ultrasound Procedures None Tilt Table Testing None Stress Testing None Electrophysiologic Testing None Electroencephalography None Computed Tomography (CT) None 