My daughter keeps fainting all the time
OUR 52-year-old daughter has been diagnosed with neurocardiogenic syncope. She continually faints and often hits her head. We are in our late 70s and find it difficult to help. Her GP seems to imply it is something she will have to live with. Is there a cure?
Jackie Parkins, Clevedon, Somerset.
FIRsT, I should explain that the term ‘syncope’ means fainting — sudden, but short- term loss of consciousness, with spontaneous recovery. It is always alarming to witness, as well as potentially damaging to the patient.
The key question is, what is the cause? syncope is one of the most common dramatic events we see in clinical practice, and though the tendency is to think of it as a neurological — or brain — problem, it is usually cardiovascular, to do with the circulatory system.
The two main causes are an abnormality in heart rhythm or in the system that controls the size of the smaller arteries, and therefore the flow, when it is typically known as neurocardiogenic or vasovagal syncope.
In neurocardiogenic syncope, the blood vessels throughout the body dilate. This allows blood to pool in the legs as you stand or start moving, causing a drop in blood pressure, which means less blood reaching the brain, resulting in fainting.
The problem lies with inefficient or faulty control mechanisms in the autonomic nervous system — this is the nervous system that runs body functions that aren’t under our conscious control, for instance, blood pressure.
THe artery walls are made of smooth muscle and their diameter can vary, according to what the autonomic nervous system tells them.
The symptoms of neurocardiogenic syncope occur under certain conditions, such as prolonged periods of standing — such as queuing, for example.
Hot conditions will make it more likely, as blood vessels dilate even more to help lose excess body heat. Other triggers include emotional stress and sudden, vigorous exercise.
What causes it is unclear, though a person’s genetic make-up is one factor, as is their overall mental state. Mental state is the most difficult factor to assess and measure, but may be the most important.
It is difficult to give advice specific to your daughter, but some general points may help.
Increasing salt and water intake is essential: taking fluid regularly is important — aim to drink at least two litres a day, as this will go some way to maintaining blood pressure.
Adding salt to meals can also help, which I know flies in the face of much advice that we issue these days, with concern so much focused on high blood pressure rather than low.
Avoid standing in queues. This means shopping, for instance, at less busy times.
Keeping cool is important. Avoid hot baths or showers, saunas and basking in the sun (despite the need for vitamin D).
Avoiding alcohol and minimising caffeine intake can only help — both tend to open up blood vessels and worsen the problem.
Light, regular exercise may be of value, though care is essential because over-doing it can make syncope more likely.
A point to reassure you: apart from the risks associated with fainting, such as injuring yourself in a fall, there is no other threat to health from this condition.
There is no risk to the heart, brain or any major body systems — it is a worry, but syncope does not shorten life. MY SON, who is 53, has just been diagnosed with polymyalgia rheumatica. He is on medication, which I believe is steroids and vitamin D. Some days he is stiff and in pain and looks very tired.
He has been very active until now, so this is a great shock to him. What is the cause of this and can it be
Mrs B. Thompson, by email. POLYMYALgIA rheumatica (PMR) is the most common inflammatory rheumatic disorder affecting the elderly.
Other such disorders include rheumatoid arthritis and lupus — these are diseases involving inflammation and pain in the joints, muscles or fibrous tissues. It is unusual to see PMR in people under 50.
PMR was first described in the Fifties, but the cause and exact nature of what is happening in the body remains obscure.
The diagnosis is clinical, which means it is based on the patient’s description of their symptoms.
The onset may be quite sudden or symptoms can emerge gradually over many weeks. It is characterised by severe pain in the muscles of the neck and shoulders, hips and pelvic area.
Typically the pain and stiffness are more severe in the morning after waking, or after inactivity.
There may be general symptoms such as weight loss, fever and even depression. Blood tests usually show raised levels of inflammatory markers, but other tests, such as for rheumatoid arthritis, are negative. There may be a degree of anaemia, too.
The condition is associated with an inflammatory process affecting the walls of arteries, giant cell arteritis (gCA), where medium and large arteries, usually in the head and neck, become inflamed.
Many doctors think the two disorders are part of the same inflammatory process, as 20 per cent of those with polymyalgia rheumatica develop gCA.
The risk with gCA, as good Health reported last week, is that it can affect blood supply to the eye, causing blindness if not treated promptly (warning signs include headache, a sore jaw or tongue and tenderness in the scalp).
A remarkable feature of polymyalgia rheumatica is a rapid and gratifying response to just a small dose of steroids.
Prednisolone is prescribed at a dose of 12.5 mg to 15 mg daily, with calcium and vitamin D (these are needed to mitigate the raised risk of osteoporosis from taking steroids long-term).
With this treatment, if the diagnosis is correct, the patient will be symptom-free within days.
It is a slight worry that your son is stiff and in pain at times, which may be because of too rapid a reduction in the dose of prednisolone: the treatment has to be tailored to individual need.
A COMMON regimen is to maintain the initial level of steroids for a month at least, then gradually reduce the daily dose by 1mg each month. In this way it is possible to stop the steroids after a couple of years with the PMR having resolved — though relapses are not uncommon.
The long-term prospects are good: there is no increased mortality from the condition and no structural damage to joints, ligaments or muscles.
It is important that the patient is monitored to maintain a level of steroid treatment that keeps the symptoms at bay, which minimises side- effects. As well as checking bone density, this means regular monitoring of blood sugar levels, as prolonged steroid use is linked to type 2 diabetes.
The steroids can also cause weight gain, indigestion, insomnia and irritability — though less so at these doses. I very much hope your son is receiving suitable support and supervision.
WRITE TO DR SCURR
TO CONTACT Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — including contact details. Dr Scurr cannot enter into personal correspondence. His replies cannot apply to individual cases and should be taken in a general context. Always consult your own GP with any health worries.