[ back ]      

Focus on fainting

Despite being a common symptom in adolescents, fainting, or syncope, can be terrifying for teens and their families. The loss of consciousness triggers images of Celtics' great Reggie Lewis collapsing on the court. Stories of sudden cardiac death and unknown neurological problems begin to circulate. "A quarter of us or more may faint in our lifetime," says Children's Hospital Boston cardiologist Mark Alexander, MD. "Fainting is ridiculously common; the problem is that it looks like bad heart disease when most of the time it is not."

At the serious end of the spectrum are people like John Smith. (The patient's name has been changed to respect his privacy.) A high school sophomore, John first fainted without warning in second grade during gym. Some thought he was having seizures, so he went on medication, which caused a serious reaction requiring hospitalization. An alert ED doctor at Children's thought his story might indicate cardiac syncope and ordered an EKG. The test clearly showed long QT syndrome (LQTS), a cardiac ion channel defect that causes rapid, unstable arrhythmias that trigger fainting during exercise and put John at some risk of dying.

"We worry more if someone faints during or with exercise," says Dr. Alexander. "We also worry if there is a family history of sudden death or early heart disease in children or young people." There is concern for children, like John, who don't sense they are going to faint and especially those who look like they had a seizure, were injured or incontinent.

"A quarter of us or more may faint in our lifetime," says Children's Hospital Boston cardiologist Mark Alexander, MD.

Neurocardiogenic syncope, the most common benign form of fainting, is also know by many other names, including vasovagal, vasodepressor, neurally mediated syncope, simple faint, "church" syncope or a breath-holding spell. It is a disorder of teenage girls with a ratio of 8:1, girls to boys. A few toddlers may experience syncope, but it's unusual among grade school children between ages 6 and 11.

Patients with a typical fainting experience (usually feeling odd before and feeling bad after), and who have a normal physical exam and a normal EKG, rarely need additional testing. Still some families will get quite nervous. "Being nervous is reasonable cause to get checked out and a common reason for referral," says Dr. Alexander.

People who collapsed during exercise should get more testing, usually including an EKG and some form of rhythm monitoring, either an exercise test or Holter test. A few people will need event-monitoring or tilt table testing to confirm the diagnosis. With the tilt table, cardiologists can make teenagers faint very easily. "It gives them an opportunity to have the feeling [of fainting]," says Dr. Alexander.

When referred to a cardiologist, patients will undergo a family history, physical exam and EKG. If anything looks unusual, additional tests are ordered. "In most cases we give simple precautions," says Dr. Alexander, explaining that many people recognize the symptoms and figure out how not to faint. "Often the first time is the last," he adds. "If they can stop it, it essentially proves that it's not a bad heart condition."

When John's arrhythmias didn't respond completely to medication, he received an implantable defibrillator, which he has used multiple times to help manage his LQTS. He also takes two medications, twice daily, is conservative when it comes to exercise and avoids organized sports with his defibrillator. "I don't even remember I faint anymore," says John. "I just feel like a regular person."

Simple precautions to avoid fainting

• Recognize early symptoms
• Understand reversing the effects of gravity by sitting down, squatting, lying down with knees bent, or crossing legs and tensing abdominal muscles
• Increase salt intake
• Maintain hydration with decaffeinated beverages; even write a prescription for bringing water to school

Typical fainting triggers

• Standing at length on hot days
• Dehydration
• Fever
• Underweight. (Girls who are struggling with their weight are very prone to syncope. "Since the cure is to get their weight up, we like them to go to their primary care physician first," says Dr. Alexander.)
• Medicine—usually not at the doses being prescribed—can make certain people more prone to syncope
• Cardiac problems—while there are a variety, most become apparent with a physical, family history and EKG

For more information on Children's Hospital Boston's Department of Cardiology,
visit www.childrenshospital.org/heart. To schedule an appointment,
call (617) 355-2079.

Copyright ©2005, Children's Hospital Boston. All rights reserved.

Children's Hospital Boston
300 Longwood Avenue | Boston, MA 02115 | 617-355-6000
www.childrenshospital.org