• Jason Steadman, Psy.D.

Fainting, and what to do about it....


Syncope. Vasavagal Response. Reflex syncope. These are some of the medical terms for something experienced by as much as 40% of people at least once in their life - fainting or passing out. Syncope itself can have lots of causes, and if you do pass out you should consult a physician to make sure nothing serious is going on, as there can be other causes other than the type I'll describe here. In this post, I'll focus on vasovagal syncope, a specific type of fainting that is usually harmless, except for the fact that some people can hurt themselves if they pass out in the wrong places.


Vasovagal syncope often occurs in response to specific triggers - seeing blood, fangirling or fanboying out at the sight of your favorite celebrity, being intensely frightened. It is more common in females, and its incidence peaks at two different age ranges: before 20 and after 65. But, it can happen to anyone at any time.


In this blog, I'll describe what causes vasovagal syncope, what the symptoms are, and some simple, effective movements you can do to prevent yourself from passing out when you feel an episode coming on.


What is vasovagal syncope

Fainted. Passed out. Dropped to the floor. PTFO. Shinied out.



A medical (physiological) explanation of what causes vasovagal syncope can be found here:


"The mechanism of vasovagal syncope is explained by the Bezold–Jarisch reflex, which is triggered due to decreased venous return resulting in inadequate ventricular filling and vigorous cardiac contraction. It occurs by the action of mechanoreceptors (C fibers) preferentially located in the inferolateral wall of the left ventricle, but also in the atria and in the pulmonary artery, and manifests with hypotension and paradoxical bradycardia due to increased activity of inhibitory receptors and consequent parasympathetic hyperactivity"


In simpler terms, vasovagal syncope is a brain-controlled REFLEX that causes your blood pressure and heart rate to drop suddenly and dramatically, which causes you to pass out. Because it is a reflex, you can't stop it from starting. However, as we will see below, there are some things you can do if you feel an episode coming on to at least stop yourself from passing out. We'll come back to that.


We don't really know why some people are more susceptible to this than others. It just happens. Like any reflex, some people just have "faster" reflexes than others.


Common triggers of vasovagal syncope are sitting or standing for too long, emotional stress, pain, heat, getting a shot or blood drawn, seeing blood/gore, and dehydration. People will usually feel other symptoms before passing out, including nausea, vomiting, abdominal pain, sweating, pallor (going pale), changes in heart rate/palpitations, and dizziness. It is also common for people to complain of ringing in the ears or like hearing briefly phases out (like they are hearing from under water). Vision changes can also occur, such as blurry vision or unfocused vision. Some people express feeling a sort of "rush" from their gut up to their brain, like an electric shock went through them.


After fining, some people may twitch or have tonic-clonic muscle contractions. These are usually short (<15 seconds), but can make others thing you are having a seizure. However, during these episodes, you don't have an aura, headache, mental confusion, or loss of consciousness greater than 5 minutes, which occur with epilepsy or true seizures. In other words, after a real seizure, you still feel pretty weird and tired. This "after" feeling does not occur in vasovagal syncope. You may feel embarrassed. You may hurt from falling over, and you may feel slightly "woozy." But these feelings are not the same as what occurs with epilepsy.


Situational syncope is similar to vasovagal, but occurs in situations that trigger the Valsava maneuver. Forceful urination, defecation, weightlifting, coughing, or extreme pain can trigger this. Situational syncope, then, has a different etiology (cause) than vasovagal, and the exercises described below to treat vasovagal syncope would not work for the situational type. In fact, if you suffer from the situational type, these exercises may actually cause you to pass out, rather than prevent it.


What are some other types of syncope?

I won't go into details of these, here, but will list some other causes of fainting. It's important you be evaluated by a physician if you pass out, to make sure none of these other things are going on.


Reflex syncope includes several types. Vasovagal syncope is one type of reflex syncope, but other types include situational syncope, orthostatic hypotension, and carotid sinus hypersensitivity.


Cardiac syncope occurs due to a primary cardiac issue, such as structural heart disease, bradycardia (slow heart rate), or tachycardia (rapid heart rate).


Neurological causes. The most common neurological causes of syncope are cerebrovascular disease (e.g., stroke), autonomic dysfunction, and subclavian steal syndrome.


Lastly, other common causes are endocrine related (e.g., blood sugar) and substance reactions (either due to prescription medicine, drugs, or alcohol).


What can I do about it?

Many people will tell you that in order to avoid vasovagal syncope, you mainly need to avoid situations that trigger it. While this is true, it's not always possible or predictable. You can't predict when someone is going to bleed in front of you or when you're going to be frightened. Furthermore, if you know you've got a rare chance to see your favorite celebrity up close and in person, you may not want to pass that up just because you might faint.


Fortunately, there are some simple moves you can do to decrease your risk of passing out. These can be done in anticipation of the trigger or immediately after the trigger to slow or stop the cascade toward passing out. The moves I cover below have been studied and shown to decrease syncopal episodes by 50% to 70%.


The techniques below are called counter pressure techniques. You can find them online through a simple search. The Cleveland Clinic provides a nice handout too, which I share routinely with my patients who suffer from this condition.


Remember, these are not recommended for situational syncope (see definition above).


Handgrip

If you suffer from vasovagal syncope, it can be a good idea to carry around a rubber or other type of squeeze ball, which you can squeeze as needed. If you don't have a ball handy, you can just squeeze your hands together. The ball is mainly to keep you from hurting your hand from squeezing too hard. The ball can take the beating instead of your hand.




Arm-tensing

In this technique, you grasp your hands together in front of you and attempt to pull them apart. A variation is to press your palms together in front of you. Pull/press hard as long as you can or until symptoms disappear.





Leg-crossing and squeeze the glutes

Cross one leg over the other while standing and squeeze your legs, abdomen, and buttocks/glutes. This can help increase your blood pressure and push pressure up toward your heart, where you need it. Hold this position until symptoms disappear.




Whole-body tensing/Hulking out

I call this technique hulking out. I tell patients to pretend they are deadlifting an extremely heavy weight and having to hold it in front of them. It works just like the other techniques, by increasing blood pressure.

The downside of this technique is that it can look a little awkward if you're standing there stiff. Many sufferers don't want to call attention to themselves, and so prefer techniques that can be performed less obviously. Still, hulking out is better than passing out. So use it if you need it.


Squatting

Squat down and lean forward onto your toes, and put your hands on the ground. Your thighs and calves should be touching each other. This again will help to send pressure toward your heart. Squeezing your legs/glutes while doing this also helps. You can also lift yourself up and down on your toes like you're doing calf raises

It will also help that you are lower to the ground and in a favorable position should the technique not work and you do pass out.



Final disclaimer: Seriously, talk to your doctor if you're passing out. These techniques work well for vasovagal syncope, but there may be good reasons you can't or shouldn't do them. Some doctors may not know about these maneuvers, and that is okay, but they can at least rule out whether or not you should be concerned about other things.


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