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Is fainting linked to sudden death?

New Delhi: On October 2011, 32-year-old Anand (name changed) who had no history of any disease and was in his usual good state of health suddenly lost consciousness and collapsed at his home. After a physical examination conducted by a neurologist, Anand was put on medication for epilepsy.

For over three years, Anand continued with epilepsy medication but he witnessed several episodes of unconsciousness.
His situation remained the same for four more years until March 2017 when another episode of fainting happened after which his doctor recommended him to get an ECG done.

Anand’s ECG showed an irregular heart rhythm and required an immediate heart surgery. He underwent a dual-chamber pacemaker (a small device placed in the chest or abdomen to control abnormal heart rhythms) implantation successfully. Although Anand is recovering well now, it is important to note that he had to struggle for 7 long years before he finally received the accurate diagnosis and treatment.

In India, lifestyle diseases or chronic non-communicable diseases (NCDs) have become the leading cause of death. Most common of these are cardiovascular diseases, followed by chronic lung diseases, cancers and diabetes. Considering that our body gives early warning signals of any critical transitions during disease. The loss of consciousness could be a warning sign of an abnormal heart rhythm (arrhythmia) that can lead to medical emergencies such as sudden cardiac arrest and stroke.

Causes of Fainting
Fainting is the transient loss of consciousness with loss of postural tone, also referred as syncope in medical terms. It occurs when the blood pressure is too low and the heart doesn’t pump enough oxygen to the brain. Fainting is quite common and it is estimated that it occurs in 15-25% of the general population. One of the main causes of syncope can be due to arrhythmia- abnormal heart rhythm or an underlying severe heart disease. According to Dr. Balbir Singh, Chairman Electrophysiology and Pacing, Heart Institute at Medanta-The Medicity, it is very difficult to diagnose the real cause of syncope.

Take Fainting to Heart
If a person faints, he will be referred to a neurologist. While the causes of fainting are commonly believed to be neurological, the real reason is usually cardiac in nature. In an episode of syncope caused by neurological problem, the person gets a seizure attack. The symptoms include frothing in the mouth, moving of the hands, urination and unconsciousness for a longer period of time. However, he will be breathing normally and his pulse will also be normal.

Syncope is caused by a cardiac problem when the brain doesn't get the blood due to which the cells in the brain stop responding, resulting in unconsciousness. Cardiac or cardiovascular syncope is caused by various heart conditions, such as bradycardia, tachycardia or certain types of hypotension. It can also increase the risk of sudden cardiac death.

Referring to Anand’s case, Dr Singh said, “The patient was first taken to a neurologist who kept investigating the case to the best of his ability but a lot of time had already been lapsed. Now it has been 3 months post correct treatment and Anand hasn’t got any episode of syncope since then.”

Lack of Awareness
Today there is a gamut of patients in whom syncope is ignored and goes undiagnosed. According to Dr Singh, these patients mostly visit primary healthcare centres where the doctors often make two major mistakes: Firstly, they think most of them are common faints and may not be very dangerous.

The second mistake that doctors make is that without investigating the patient properly, they refer him to a neurologist while the problem may be related to heart. Research says that syncope and sudden death are interlinked and any prolonged syncope can be a sign of sudden death.

Role of Primary Healthcare in Diagnosis
The basic investigation done by primary healthcare physicians should include performing an electrocardiogram (ECG) and Echocardiogram (ECHO). Dr Singh believes that the first episode of syncope must be fully investigated. About 95 percent of the patients will be diagnosed just by ECG and ECHO, he further added. Syncope should not be ignored as no episode of loss of consciousness is normal.

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