Now, researchers in Spain have developed a simple protocol that may help physicians get a better handle on what to do when people swoon for reasons that have nothing to do with love.
The protocol tells doctors which tests to use on patients who have fainted, depending on their condition and medical history. The directions may end up being helpful, says Dr. Sidney Smith, former president of the American Heart Association and a professor of medicine at the University of North Carolina at Chapel Hill.
"Fainting is one of the toughest situations for the cardiologist to deal with. There are so many causes, and the ability to understand whether it's related to a benign problem or an underlying heart problem is very important," Smith says.
Concussions, seizures and even cases of fear or anxiety can cause fainting, and neurologists frequently handle those problems. But the heart is often at fault, says Dr. David G. Benditt, a professor of medicine at the University of Minnesota Medical School. That's when cardiologists enter the picture and try to figure out why blood flow to the brain got cut off. "This causes brief shutdown of major brain functions critical to being alert and maintaining muscle tone," Benditt says, leading to unconsciousness and falling.
The challenge is that fainting spells often leave no obvious sign of what's wrong, just like a malfunctioning car that works perfectly when you bring it to a mechanic. But even without signs, a fainting spell could be a sign of underlying defects in the heart's rhythm, Benditt says.
Unless doctors actually watch someone faint and observe the heart, "establishing the cause in retrospect is fraught with uncertainty," Benditt says. "One must not assume that an 'after-the-fact' detected abnormality was necessarily the cause. It may be, or may not."
Using a protocol they had developed, researchers at Hospital Clinico Universitario in Valencia, Spain, came up with diagnoses in three-quarters of 184 patients who reported having fainted. The researchers report their findings in the March 5 issue of the Journal of the American College of Cardiology.
Some patients went directly to the most extensive type of testing -- the implantation of electrodes in the heart to monitor its electrical activity -- if they were considered to be at the highest risk. These patients included those who had a history of heart disease, a relative who had died of sudden death, or other risk factors, including heart palpitations around the time of a fainting episode.
If doctors couldn't make a diagnosis, they implanted the patients with a recording device to keep track of their heart activity in case they had another fainting episode.
Patients at lower risk underwent testing on so-called tilt tables, which essentially create a fainting episode by making a patient's blood go to his or her feet.
Benditt, who wrote a commentary that accompanied the study in the journal, says the protocol is promising but more work needs to be done to help make certain the medical problems found are those that caused the fainting in the first place.
"Errors may either result in patients overlooking serious future symptoms (because they were erroneously reassured) or become excessively neurotic (because they were erroneously told they had a serious condition)," Benditt says.
For more about fainting, consult the American Heart Association or the National Institute of Neurological Disorders and Stroke.