No explanation for 2 years of blackouts
QMY father-in-law, 70, has had fainting episodes for the past two years. When he blacks out, it’s usually twice in two hours with little warning, and he is unconscious for 20 to 30 seconds. He broke his jaw in one of the falls — we are all concerned. Sara Brindley, Sheffield.
AI SuSPECT he is suffering from syncope, fainting caused by a temporary reduction in the flow of
blood and oxygen to the brain. It is usually triggered by a sudden drop in blood pressure and resolves itself once the blood flow resumes. However, this doesn’t mean it isn’t dangerous — as his broken jaw attests.
There are other causes of a sudden loss of consciousness, including seizures, intoxication, metabolic disturbances (e.g. low blood sugar) and conversion disorders (psychological conditions). But the fact your father-in-law is in generally good health, yet has suffered these sudden and worrying episodes for two years, leads me to conclude that these are not relevant in his case.
So, the questions remain: what is the cause? And how can these episodes be prevented?
In terms of the cause, there are three main possibilities: neurological syncope, also known as reflex syncope, caused by a glitch in the autonomic nervous system; orthostatic syncope, when the blood pressure drops on standing or when standing in a hot, crowded place; and cardiovascular syncope, which is related to heart problems.
Made up of the brain, nerves and spinal cord, the nervous system regulates heart rate and blood pressure. In those with neurological syncope, something as simple as a laugh or a sneeze can stop the nervous system working properly, resulting in blood pressure falling and the person fainting.
This could be the cause, but I think it is not the most likely.
The low blood pressure of orthostatic syncope is often due to other health conditions, such as diabetes or medication for high blood pressure or depression. In your longer letter, you describe your father- in- law as active and in relatively good health, which makes me suspect this is unlikely to be the cause, either.
Taking into account his age, I think it is most likely a heart problem is intermittently interrupting the blood supply to his brain and causing him to faint. If this is the case, it is surprising that it has gone undetected until now. You write that your fatherin-law had surgery for prostate cancer last year, and such a major operation would have been preceded by detailed tests, especially with his history of collapsing.
Cardiac syncope is usually caused by an abnormal heart rhythm, a common condition for which various treatments are available.
Investigations begin with a resting electrocardiogram (ECG), which records the rhythm of the heart while the patient is lying down. However, problems are more likely to be picked up by a continuous period of recording, so patients may also be given a small monitor to wear at home for up to a week (known as continuous ambulatory ECG monitoring) or even an implanted loop recorder (often called a Reveal device).
About the size of a lighter, this device is inserted under local anaesthetic into the chest wall just below the collarbone. It can stay in place for a year or two, so should record what is happening in your father-in-law’s heart when he faints. The results can be read simply by holding a scanner to the skin.
You are right to be concerned. I hope your father-in-law has been fully investigated by a cardiologist — if not, then that possibility must be discussed with his GP.
It is important that any heart rhythm problem is diagnosed and treated, not only to stop the fainting, but also for his overall health.