Fainting - What causes it?

©Copyright by Jaye Denman. All rights reserved.

I have fainted several times during my life, beginning when I was 12 years old and fainted in a department store. That first "swoon" probably happened because I'd been standing in a stationary position for some time with my knees locked.

Since then I've fainted twice during advanced pregnancy, twice also when I got overheated outdoors in the hottest time of summer, once from shock when I learned of a friend's sudden death, several times following panic attacks that caused hyperventilation until I learned to breath into a paper bag, and a couple of times when ill with a virus. Therefore, I'm personally acquainted with those reasons for fainting.

Hitherto, for me, there was some measure of warning that I was about to faint: breaking out in a cold sweat, muffled hearing or a buzzing in my ears, a feeling of faintness before I actually fainted, everything slowly turning dark. In every case, this either gave me time to lie down or allowed someone nearby to stop me from hitting the floor.

Now I'm recently released from the hospital after fainting several days ago and hitting my head and face on everything hard and/or sharp-cornered in my vicinity on my way to the floor (as well as the floor). I've learned a few more potential reasons for fainting and that you don't always get even a one-second warning.

I've been known to brag about my healthy style of eating (ranging over several decades from vegetarian to vegan to ovo-pescetarian), and how I rarely get sick, which I attribute to my healthy diet. I almost never have a cold, stomach upset or "bug"--haven't for years. Er...better change that to "hadn't", since this recent sick-and-fainting episode may have begun with a pesky, down and dirty virus. After that sick-sick-sick experience, I don't feel quite so invulnerable to virus-bugs.

One should never boast, as that is surely the best way to tempt fate.

The attack of sickness woke me suddenly at 6:00 a.m. on a recent Tuesday. It was harsh and swift. I have tried to avoid throwing up as much as possible throughout my life. I even went through three pregnancies in my young womanhood with almost no morning sickness at all. This time, however, there was no thwarting the violent urge.

Gross-out alert: Let me tell you that one way to avoid the unpleasantness of throwing up is to faint just as it begins so you aren't actually aware of the unpleasant part. Then...let me also warn you that the aftermath of fainting--while vomiting--and falling on a hard tile bathroom floor, possibly bouncing off the door frame and a small shelving unit with sharp corners on the way down, and lying in the...well, you-know-what...does not make up for missing the action part! Also, if you're going to faint and fall while tossing your cookies, it is best to fall forward (as I did), so you don't aspirate the stuff into your lungs or choke to death.

A friend tells me that falling forward is not the best option if you fall headfirst onto a bathtub and get a bad concussion, as she once did. The cautionary caption accompanying the fainting couch image is true--it's preferable to be standing near something soft when you faint. Then fall forward so you won't choke. However, now that I've fainted without advance warning, I know you aren't guaranteed a soft landing.

The unconsiousness experienced when one faints is of short duration--usually just seconds. Regaining consciousness to the horrendous pain in and on my head, face, shoulder, neck, arm, etc. and discovering what I was lying in on the floor was shocking, to say the least.

I managed to regain my footing, first concentrating on some essential, though not entirely thorough, cleanup tasks. I still felt very bad, so did only what had to be done in order to tolerate myself. That accomplished, I finally looked into the bathroom mirror over the sink, only to nearly faint again. (Just kidding! But I was shocked mightily, let me tell you.)

There were smears of blood seeping from my hairline and across the "goose-egg" quickly growing on my forehead. Another smear of blood highlighted my left cheekbone, and there was one on the edge of my lip. These bits of color were the only hues in the chalky pallor of my complexion, which is usually rosy. I had to hang onto the bathroom sink for support. I wet a washcloth, squeezed it mostly dry and fumbled my way back to my bed, where I threw the wet cloth over the left side of my face and gave in to the fierce headache pounding through my head.

Nausea soon reared its ugly head again, but I was lucky to have some promethezine (generic phenegrin) in my pharmacopeia. It squelched the rising nausea and pushed it down to a bearable queasiness. Normally, this medication will put me to sleep like a light being turned off, but this time the intensity of the headache overcame any possibility of sedation.

Throughout the day, members of my family suggested, nay, insisted, that I needed to go to the hospital emergency room. That had been my first thought when I saw my scary-looking visage in the mirror, but after I got back into bed, I just wanted to stay there. The headache and queasy feeling lasted most of the day, and in the late afternoon, I dozed for a short time.

When I awoke, I looked at the clock on my bedside table lit by the lamp beside it, and saw the time: 6:00. Wasn't this where I came in? Was I reliving Groundhog Day? Then I thought I must have slept through a night and it was the next morning. Guess my brain did get a bit scrambled in that fall! I was soon alerted to the fact it was the same day, twelve hours since my faint-and-fall episode and, "Mother--you really need to go to the hospital!" So I complied.

When you arrive at the hospital emergency department, if you fit into the senior citizen category, and one side of your face looks like you were mugged, there's no waiting for you in the room with all the chairs and people. A check-in staff member gets the minimum facts about you (which was superfast because I'd had thyroid surgery in that hospital six months previously, and my info was in the computer), then push you in a wheelchair back to one of the examination cubicles.

As the "patient", you get to lie on an uncomfortable gurney with no pillow, but at least you're lying down. The people who brought you, on the other hand, get to sit in very hard uncomfortable chairs for the next six-and-one-half hours while tests are taken to ascertain how or whether you are injured. (It's my theory that every piece of furniture in an ER is purposely uncomfortable so that people won't go there unless it's really, really necessary.)

At 2:30 a.m., an ER nurse told me I was being admitted to the hospital, and I sent my family members off into a stormy night while I was pushed on said gurney to my fourth floor room. By this time I was tired and even a bit sleepy, but you know what they say about trying to sleep in a hospital--impossible! Doctors' orders were for a nurse to take my blood pressure frequently three different ways: while lying down, sitting up and standing. In addition, I was tethered to an IV stand, and hooked up to a heavy portable heart monitor fastened to the front of my hospital gown and weighty enough to be irritating.

As for the bed, let it be known that I think the electronics of the modern hospital bed are marvelous. As for comfort, forget it! The mattress is one inch thick, and the patient feels every lump and bump of the marvelous gadgetry beneath the mattress. At least one light has to stay on all the time, and every time someone enters the room--which is frequently--the overhead light is turned on as well.

I don't mean to sound ungrateful--I'm not. I do appreciate that the staff quickly determined through modern biomedical devices that there was no brain bleed or swelling, my heart was okay, as were my carotid arteries, and I'd not broken any bones in my shoulder.

I stayed in the hospital for two days, my treatment overseen by staff physicians, and was released with no definitive diagnosis. An appointment was made for me with my primary care physician for followup in two weeks. She, I presume, will deign to tell me why she thinks I fainted.

In the interim, my own curiosity (and faint--pardon the pun--feeling of nervousness that it may happen without warning again) drove me to do some research about fainting on Web medical sites: what fainting is, various causes of fainting, treatment of fainting, prevention of fainting. This is what I learned (some of which I already knew).

Fainting, for which the medical term is syncope , is the sudden loss of consciousness due to a lack of blood flow to the brain. Most fainting is triggered by the vagus nerve, which connects the digestive system to the brain and manages blood flow to the intestines. Some people have an "over-excitable" vagus nerve, and they usually begin fainting around the age of 13 (I began at 12) and--oh, horrors!--continue fainting from time to time for the rest of their lives.

Actually, vomiting is one of the things listed as reasins that can cause the vagus nerve to pull too much blood from the brain. Other common causes for the vagus nerve to do this are straining in the bathroom, dehydration, electrolyte imbalance, anemia and psychological triggers (such as the person who faints at the sight of blood or when someone has a panic attack), as well as advanced pregnancy. Anything that causes blood pressure to drop can affect the vagus nerve.

After a person faints, the vagus nerve reverts to its normal "behavior", the heart starts beating faster to normalize low blood pressure, and the person quickly regains consciousness.

If you're nearby when someone faints, you can help (if you're close enough) by preventing the person from getting hurt. Even if you can't stop the fall completely, breaking it and easing the victim to the floor may prevent injury. Here are some first aid steps you should take if you witness someone faint:

1. Check for signs victim is breathing. Movement of the diaphram, coughing, feeling or hearing breath from the person's nose or mouth--all these can alert you to continuing respiration. If it's absent, check the person's airway to be sure it's clear, then begin CPR. Call 911 or your local emergency number, and continue CPR until help arrives or the person responds.

2. If the fainting victim is breathing, you can help to restore blood flow to the brain. Do this by positioning the person on his or her back and raising the legs above heart level, which is about twelve inches. Loosen restrictive clothing, such as a collar, tie and/or belt. Don't let the person get up to quickly, as this may cause another fainting spell.

3. If the person was injured in a fall caused by fainting, use first aid or get the victim to a hospital emergency room. If scratches are cuts are bleeding, apply pressure to cause clotting. Clean the abrasions and bandage. However, more serious cuts and bumps require professional medical attention--particularly if they involve a possible head injury. If such a situation exists, don't delay--call for an ambulance and let the EMTs handle it.

It is important to discover whether or not the loss of consciousness is due to a simple episode of fainting caused by something triggering the vagus nerve to rush too much blood from the brain, or if it's the result of something such as shock from drastically lowered blood pressure (which may be caused by a variety of prescription drugs), heart rhythm changes, a heart attack or minor stroke.

Since some of the reasons for unconsciousness may be serious, anyone present when a person passes out should insist (and not take "no" for an answer) that a quick trip to the doctor's office or hospital emergency room is needed for safety. Waiting for hours before doing this is a risky idea. Some serious conditions must be treated quickly for best results and to prevent long-term health damage.

I have given a very simplified explanation of fainting--some of its causes and what happens. A more detailed medical description of what fainting (syncope) entails can be found on legitimate medical Web sites or by asking one's personal physician.

Can fainting be prevented? It depends on the cause. For example, if one is prone to the excitable vagus type of fainting and is aware of warning signs, there may be time to lie down before passing out and avert an actual fainting spell. At the very least, there won't be a crash to the floor.

Anyone who begins feeling faint while driving a vehicle should immediately pull over out of traffic and turn off the ignition. If a mobile phone is handy, it should be used to call for help. Don't start driving again, even if the feeling of faintness passes. It's much better to be safe and let someone else--a family member or friend--come to the scene and drive for you.

If medication is found to be the cause of lowered blood pressure, it may be adjusted by the prescribing physician. Older people and active younger ones should be sure to take in sufficient fluids to prevent dehydration.

The elderly are more at risk for fainting for many of the reasons listed (except pregnancy!). Anyone who feels dizzy when suddenly standing up should make it a habit to wait a few seconds before changing positions and do so slowly. Regular medical examinations can keep track of changes in heart rhythm, narrowing of the carotid arteries, and other conditions that may pre-dispose a person to fainting or loss of consciousness.

Now that I've fainted with no warning, do I feel nervous about the possibility it may happen again? Right now, I do, but I think this will pass. I'll be alert to the possibilities that may cause a fainting spell, and do what I can to prevent another one. Just as with everything else in life, there's no guarantee.

There's a line in the poem, FULL MOON SONG, by Georgie Starbuck Galbraith, that warns: "And the heart is richer that chances pain than the heart in cotton wool."

According to the poet, trying to protect one's self from a broken heart is not worth all that must be given up to do so. By the same token, I believe that figuratively wrapping one's body in cotton wool because possibility of injury exists is too great a price to pay for safety. I don't want to miss living my life and enjoying it because I'm cowering on a soft mattress to avoid hitting the floor again. Life's too sweet--even the mundane parts--to waste.

To YOUR good health! JAYE

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