This past year at one of the morning Sunday Masses that I attended, one of the altar servers was kneeling during the consecration and violently fell forward, smashing her face against the marbled floor. She was out cold, and hearing the violent way she hit the floor compelled me to run up to the altar and make sure this was not a serious event. As I got to her side she remained unconscious, and our deacon swooped her up into his arms and carried her to a room behind the altar. As soon as she was laid down on a couch she began to wake up. I asked her what she remembered before she passed out. She told me she became warm and lightheaded for about 30 seconds, then her ears began to ring and she lost her vision. She remembered nothing else until waking up on the couch. This history suggested to me her syncope (sudden loss of consciousness) was likely benign. If you have gone to enough church services in your lifetime you’ve likely been there when someone has passed out. It is always scary and concerning when it happens, but most of these episodes that happen in church are faints.
Syncope is one of the most common reasons to be evaluated in an emergency room. A physician who is a skilled clinician knows that diagnosing the etiology of a passing-out episode is all about taking a good history. The young lady that passed out at church had experienced an episode of vasovagal syncope. This is the fancy medical term for what some still call the “common faint.” Some people are born with a propensity to have these episodes. For example, you may be able to think of somebody you know who frequently has passed out when they have had their blood drawn. Another example is somebody who has passed out right after a painful injury or just at the sight of blood. These episodes are driven by the vagus nerve, which is the 10th pair of cranial nerves. This nerve runs from the brain down to many of the organs of the body, including the heart, and is very important in heart rate and blood pressure control. When the vagus nerve becomes overstimulated by a certain neural input, like the sight of blood, there are several mechanisms that can lead to loss of consciousness. The heart rate can inappropriately slow and sometimes actually stop for a period of seconds, causing one to lose consciousness; or the vagus nerve can make the blood pressure plummet to about nothing, causing someone to pass out. When someone has vasovagal syncope it is frequently a combination of both a slow heart rate and a low blood pressure. Getting that person on the ground — where they usually fall to anyway — is key to their recovery. One of the worst things you can do to somebody who passes out is to hold them upright or keep them sitting in a chair. The proper initial treatment is to lay them flat and elevate their legs to increase blood flow back to the heart.
Vasovagal syncope rarely happens suddenly. Almost always, the person can relate a series of symptoms that occur before the actual event. This is called a prodrome. Our young server had some of the classic early symptoms, which included lightheadedness, warmth and dimming vision. Other typical symptoms include sweating, nausea and a ringing or buzzing in the ears. If you have had vasovagal syncope in the past, you may be able to abort an episode by recognizing the early symptoms and immediately laying down on the floor. Unfortunately, many people will just not do this in public because they don’t want to embarrass themselves. (I would say that crashing to the floor is pretty embarrassing as well!)
I almost crashed to the floor in front of hundreds of people years ago, on a very hot day in June. I was waiting for my bride to walk down the aisle at St. Stanislaus Kostka Church just outside of South Bend. The temperature had exceeded 90 degrees, and the church at that time did not have air conditioning. As the music began, I got a glimpse of my beautiful wife-to-be on the arm of her father. I suddenly became extremely warm, began sweating profusely, got lightheaded and then lost my vision. I was in medical school at the time so I should have known what I had to do (get down). Thankfully I fought through it and did not face-plant in front of hundreds of friends and family. After the ceremony my wife remarked that I did not look so good when she arrived at the altar and I had to explain what had happened and reassure her that yes, I really did want to marry her!
The type of syncope that is very concerning, and may even be life-threatening, is an episode that is very sudden and unexpected, with no warning symptoms. I will tackle this subject in another article in the future.
I have counseled many young men and women over the years who have a history of recurrent fainting spells. The best preventive measures include drinking lots of water and to purposefully eat a significant amount of salt in the diet. Salt actually can be your friend in this situation. It expands the blood volume and helps prevent sudden drops in blood pressure to reduce the chances of vasovagal syncope.
If you have high blood pressure or a history of congestive heart failure, though, the old adage to restrict salt still applies to you.
Dr. David Kaminskas is a board-certified cardiologist and member of The Dr. Jerome Lejeune Catholic Medical Guild of Northeast Indiana, www.fortwaynecma.com.
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