13 November 2018
At least half of the population will suffer a collapse during their lifetime. Most of these collapses are either simple fainting (which is troublesome, not worrisome) or heart (cardiac) in origin; however there is sometimes confusion as to whether there is a brain cause. The following gives a brief outline of what to look for and what the likely cause is.
What should my GP do to investigate the collapse?
Alongside taking a detailed account of the collapse and examining for any specific findings such as a heart murmur, the recommendation is for all patients to have a heart tracing performed on an ECG. If the collapse requires specialist assessment then patients should be advised not to drive whilst waiting for this review.
What features would suggest a cardiac cause?
Any of the following suggests a heart cause and urgent referral to a cardiologist (heart specialist): a collapse without any warning symptoms, collapse causing injury (such as broken bones, need for stitches), collapse during exertion (rather than immediately following exercise), a past history of any heart problem or a family history of premature heart disease (before 60 years of age) or sudden death.
What features suggest a seizure?
Unusual behaviour or a sense of deja-vu just ahead of the collapse, blood in the mouth, incontinence, confusion on recovery and seizure/major shaking like activity early in the event (as opposed to later in the collapse-even prolonged simple faints can eventually trigger seizure like activity).
What features suggest simple fainting?
Clear warning symptoms of dizziness, clamminess, nausea, ringing in the ears or blurred vision, typical situation (standing, after baths or showers, hot environments or during heavy meals with alcohol), prolonged recovery (taking at least 15 minutes or longer to feel well) or immediate repeat collapse.
What should I do to avoid simple fainting?
Unless there are any red flag signs then a diagnosis of simple fainting/vasovagal syndrome can often be made based on symptoms alone, and in the presence of a normal heart tracing. Provided none of the attacks occur whilst driving, you can drive. Patients who suffer simple fainting should avoid caffeine and drink 2.5-3 litres of water a day. If despite these manoeuvres symptoms persist (and only after discussion with your doctor); adding 5-10 grams of salt a day can help (1-2 teaspoons).
If you have any concerns, please contact your GP.
The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional.