Syncope, often referred to as a fainting spell, is a temporary loss of consciousness. Regardless of how often or how infrequent, when syncope occurs, it is not a normal event. Losing consciousness or almost losing consciousness should prompt you to contact your physician for further evaluation.

Causes of syncope

There are many different reasons for people to lose consciousness. In general, there are three categories of problems that can cause syncope: a problem with the heart, a problem with the brain and conditions or medications that cause low blood pressure.

Problems with the heart that can cause loss of consciousness include either the heart rhythm going too fast or the heart rhythm going too slow. Unfortunately, an individual’s symptoms are not reliable enough to make a diagnosis of whether the heart rate was too fast, too slow or normal at the time they lost consciousness and further testing is often needed to make a diagnosis.

Other causes of loss of consciousness that are due to low blood pressure include excessive medications or abnormalities of the nervous system, such as "autonomic insufficiency" or postural orthostatic tachycardia syndrome. Other neurological causes of syncope may include a seizure or a stroke.

Symptoms of syncope

Individuals with syncope often have warning signs that they are about to lose consciousness. These warning symptoms include lightheadedness, a sensation of dizziness or spinning, tunnel vision and hearing becoming distant. If you experience these symptoms, get into a flat position as soon as possible to protect yourself from an injury due to losing consciousness in an uncontrolled manner.

Why choose Ohio State for syncope treatment?

Patients who seek evaluation of syncope are cared for at Ohio State’s Ross Heart Hospital in the specialized Arrhythmia Unit, which is dedicated to the care of patients with abnormal heart rhythms. Patients who experience syncope are managed with a multifaceted approach, incorporating the expertise of several specialists. A specific plan for care is orchestrated by a heart rhythm specialist (called electrophysiologist) with assistance from a team of other cardiologists specializing in other aspects of heart disease (such as imaging of the heart or evaluation of valve disease), pharmacists and neurologists. Ohio State’s electrophysiology program is the largest program in Ohio, and one of the top three in the nation, with extensive experience in managing a wide spectrum of heart rhythm problems.

How Ohio State diagnoses syncope

In order to make a diagnosis, your heart rhythm needs to be recorded at the time of you have an episode or a diagnostic test needs to be completed to assess the cause of your syncope. The first step in evaluating your condition is a recounting of the events leading to your loss of consciousness. Based on your description of your loss of consciousness, your physician may prescribe one or more of the following tests:

• Electrocardiogram (EKG/ECG) – A test that records the electrical activity of the heart.
• Exercise stress test – A test performed on a treadmill or stationary bicycle to measure heart, lung and muscle function during physical activity. You are attached to an electrocardiogram (EKG/ECG) to record electrical activity of the heart.
• Echocardiogram (also called echo) – This test uses sound waves to assess the function and structure of the heart muscle and valves.
• Cardiac catheterization – A procedure to check for problems in coronary arteries. A long, thin tube (catheter) is inserted into an artery or vein in the groin, arm or neck, then threaded to the heart. The physician injects a contrast solution into the artery and takes X-rays to check for blockage and other abnormalities.
• Other evaluations that assess the health of the electrical system of your heart may also be recommended by your electrophysiologist to help diagnose the cause of your loss of consciousness. These tests may include:
• Tilt table test – A test used to determine if you are prone to sudden blood pressure drops or slow pulse rates when your position changes.
• Electrophysiology study - An invasive test performed in a cardiac catheterization lab where your doctor inserts a small catheter through a blood vessel in your leg into your heart to evaluate the health of your heart’s electrical system.

Implantable loop recorder (ILR) – A recording device that is implanted by a minor surgical procedure taking about 30 minutes. The device is about the size of a finger and is placed under your skin. The device has a battery that lasts about 2 years. The sole purpose of the implantable loop recorder is to provide a long term method of monitoring your heart rhythm to record the heart rhythm when a patient experiences loss of consciousness. Implantable loop recorders can also be used to detect other heart rhythm problems such as atrial fibrillation.

How Ohio State treats syncope

Once your physician confirms your syncope and is able to determine the cause, he or she will establish a treatment plan that will best meet your needs. This may include one of the following treatment options:

• Pacemaker – A small device implanted under your skin, most often below your collarbone on the left or right side of your chest. The device sends electrical signals to start or regulate a slow heartbeat.
• Implantable cardioverter defibrillator (ICD) – An implanted device, inserted under the skin that monitors and treats ventricular arrhythmias by providing a prompt electrical shock
• Catheter ablation – Ablation involves inserting catheters (narrow, flexible wires) into a blood vessel and positioning the wire into the heart. The catheters are then positioned at the site of origin of the abnormal heart rhythm and energy in the radiofrequency is delivered through the tip of the catheter to eliminate the arrhythmia.