Fainting (Syncope) - Diagnosis

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After fainting, what medical tests and exams did you have? What was the diagnosis?

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How is fainting (syncope) diagnosed?

As with most medical conditions, the history is the key in finding out why a patient faints. Since most episodes of syncope do not occur while the patient is wearing a heart monitor in front of a medical provider, it is the description of how the patient felt and what bystanders or family members witnessed that will give clues to the diagnosis.

Physical examination will try to look for signs that will give direction to the potential diagnosis. Heart monitoring may be done to look for heart rhythm disturbances. Blood pressure may be checked both lying and standing to uncover orthostatic hypotension. Examination of the heart, lung, and neurologic system may uncover a potential cause if these are abnormal.

Initial diagnostic tests may include an electrocardiogram (EKG) and screening blood tests like a complete blood count (CBC), electrolytes, glucose, and kidney function tests. Thyroid blood tests may be performed.

Heart rhythm disturbances may be transient and not always evident at time of the examination. On occasion, a heart monitor (Holter monitor) can be worn as an outpatient for 24 or 48 hours or for up to 30 days (event monitor). Abnormal heart rhythms and rates may be uncovered as the potential cause of syncope.

A tilt-table test can be used to uncover orthostatic hypotension and is usually done on an outpatient basis. The patient is placed at an angle on a table for 30-45 minutes (every institution has its own protocol) and blood pressure and pulse rate are measured with the patient in different positions.

Depending upon the suspicions of the health care provider, imaging may be done of the brain using computerized tomography (CT scan) or magnetic resonance imaging (MRI).

Often these tests are normal and a presumptive diagnosis is made of a non life-threatening event. However, the medical care provider may decide, in consultation with the patient, whether further testing is required and whether testing should occur in the hospital or as an outpatient. It may be reasonable in some cases to take a watchful waiting approach and not proceed with any further evaluation.

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See what others are saying

Comment from: monsie, 65-74 Female (Patient) Published: June 10

After fainting the ambulance took me to the hospital where they only focused on the heart to reassure me that my heart was alright after giving me tests and that. There is no indication that my heart is about to collapse any way. I know that I may have chronic Addison's disease since I have been looking after my health and taking care of myself for the last 50 years. In the hospital, doctors had no interest in giving me the tests I need for Addison's which I was treated during pregnancy 25 years ago.

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Comment from: Skidog, 55-64 Female (Patient) Published: May 13

After fainting while seated in a restaurant, my husband called 911. The paramedics performed an EKG, which was normal, but suggested that I still get checked out. After a 4 hour emergency room visit, the heart checked out fine and I was diagnosed with vagal syncope and was asked to follow up with physician. I saw my internist two days later. While waiting in the emergency room waiting room, I had the need to go to the bathroom and had an explosive, yet normal bowel movement. I told my doctor about it as well as describing that the next day I was sick with a stomach flu. The doctor assured me, after my describing the onset flu symptoms, that with my sip of a beer, being overheated and dehydrated coupled with my low blood pressure, I was suffering from a vagal reaction and it should be an isolated event. I happened to experience a few triggers at once. He advised me to lie down if feeling faint and elevate my legs, or sit with my head between my knees to prevent the blackout. I have been fine after getting over the stomach flu and have resumed all normal activities. I feel much better knowing my heart health is good; fainting can be very serious.

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