Presyncope is the feeling of almost fainting without actually losing consciousness. It is like feeling like you're going to pass out and can last from a few seconds to several minutes.

How Common is Presyncope?

Presyncope is estimated to occur in about 19% of people in the United States at some point in their life.

What are signs and symptoms of Presyncope?

Signs and symptoms of presyncope include: - Fainting or feeling lightheaded - Feeling weak or unsteady - Blurred vision or tunnel vision - Nausea or feeling nauseous - Sweating - Palpitations or rapid heartbeat - Feeling hot or cold - Confusion or disorientation In addition, there are some specific precursors and characteristics of presyncope: - Vasovagal prodromes, which are precursors to fainting, often last more than five seconds and occur following a particular event. - Recurrent dizziness after standing up, known as orthostatic lightheadedness, can be a symptom of presyncope. - In cardiac causes, the prodromes typically last less than five seconds. - It's important to review the medications the patient is taking, as they may contribute to presyncope. - Vital signs are usually normal after symptoms have resolved, but healthcare providers may still check blood pressure and pulse, especially in elderly individuals or those suspected of being dehydrated. - If there is concern about gastrointestinal bleeding, a stool test for hidden blood may be performed. - A trauma examination may be performed if prompted by the patient's medical history.

How do you get Presyncope?

Presyncope can be caused by a variety of factors, including heart-related concerns, non-heart-related factors, and certain medications. Heart-related causes can include mechanical problems in the heart, heart valve diseases, and irregular heart rhythms. Non-heart-related factors can include reactions to stress or sudden emotion, low blood pressure when standing up quickly, side effects of medications, blood vessel concerns, and severe infections.

What else can Presyncope be?

Cardiac myxoma, cough syncope, defecation syncope, dysrhythmias, micturition syncope, postprandial syncope, sick sinus syndrome, sinoatrial block, sinus pause, swallow syncope.

What kinds of test are needed for Presyncope?

The types of tests that may be needed for presyncope include: - Vital sign checks, such as heart rate and temperature - EKG (electrocardiogram) to check for heart electrical activity - Finger stick glucose test to measure blood sugar level - Specific blood tests - Detailed imaging tests like a head CT scan or echocardiogram (if helpful based on symptoms and medical history) - Tilt table test to simulate standing up and check for postural hypotension - Additional tests may be ordered based on specific symptoms, medical history, and risk factors

How is Presyncope treated?

Presyncope is treated based on the underlying cause. If the patient appears dehydrated, they should be given fluids. If there is concern about sepsis, antibiotics should be administered. However, there isn't a standard way to confirm the diagnosis of presyncope, and it may not be possible to rule out heart-related causes. In some cases, patients with a presumed common faint or dehydration may be discharged with a follow-up appointment with their doctor. Ultimately, the decision to keep a patient in the hospital depends on the likelihood of complications if further examination or treatment is delayed.

What are the side effects when treating Presyncope?

When treating presyncope, there are potential side effects to consider. These include: - Overhydration: Giving fluids to a dehydrated patient may lead to overhydration, which can cause fluid overload and other complications. - Antibiotic resistance: If antibiotics are given to treat a potential sepsis infection, there is a risk of developing antibiotic resistance. - Adverse reactions: Any medication or treatment carries the risk of adverse reactions or allergies. It is important for healthcare providers to carefully assess the patient's condition and weigh the potential benefits against the risks when deciding on treatment options for presyncope.

Are there long term effects of Presyncope?

The prognosis for presyncope (near-syncope) can include negative outcomes or the need for intervention in about 20% of cases. Common negative outcomes associated with presyncope include sepsis, bradyarrhythmia, gastrointestinal bleeding, and sudden kidney failure.

What type of doctor should I see for Presyncope?

You should see a healthcare provider, such as a primary care physician or a cardiologist, for presyncope.

Presyncope

What is Presyncope?

“Presyncope” or “near-syncope” is a term used to describe the feeling of almost fainting, without actually losing consciousness. Different providers might have slightly different definitions, but most agree that it’s like feeling like you’re going to pass out. These sensations can last from a few seconds to several minutes. Along with feeling like they’re about to faint, people might also experience symptoms such as feeling lightheaded, weak, overheated, sweaty, nauseous, having heart palpitations, or experiencing blurry vision.

While this might seem less concerning than actually fainting (or “syncope”), studies suggest that near-syncope could have similar causes and outcomes. The main cause thought to be a lack of blood to the brain (or “cerebral hypoperfusion”). So, even though it’s not actual fainting, near-syncope should be taken seriously just like syncope.

What Causes Presyncope?

Presyncope, the feeling of faintness without actually losing consciousness, can have a variety of reasons, from the less serious to those that could be life-threatening. It should be noted that the causes of presyncope are the same as those that trigger syncope, a temporary loss of consciousness, and these include heart-related concerns as well as non-heart-related factors. People experiencing presyncope related to the heart may feel heart palpitations and it can come about whether they are sitting, lying down or exercising.

Most often, non-heart-related factors trigger presyncope, these can include a reaction to stress or sudden emotion (vasovagal or neurocardiogenic causes), as well as issues related to a shift in body fluid levels like low blood pressure when standing up quickly (orthostatic hypotension), side effects of some medications, blood vessel concerns, or a severe infection (sepsis). Vasovagal presyncope is actually quite common and can be characterized by signs such as nausea, sweating, blurry vision, and light-headedness. Certain types of medications that could put one at risk for presyncope include high blood pressure medications, certain heart medications, and certain psychiatric medications.

Orthostatic hypotension, or a sudden drop in blood pressure when standing up, can be caused by medications, disorders that affect nerve function such as neurodegenerative diseases, or extended bed rest, particularly in older people. It’s defined as a decrease of 20 mmHg or more in systolic blood pressure (the top number in a blood pressure reading), or a decrease of 10 mmHg or more in diastolic blood pressure (the bottom number) within three minutes of standing up. Other less common causes related to blood vessels include a pulmonary embolism (a blood clot in the lungs), issues with blood flow to the intestine, carotid artery disease (a condition that reduces blood flow to your brain), and problems with the aorta, the main blood vessel carrying blood from your heart to your body.

Heart-related causes, while being more serious, include mechanical problems in the heart such as fluid buildup around your heart or heart valve diseases, and irregular heart rhythms. Irregular heart rhythms often lead to reduced blood flow to the brain, due to a drop-in heart output; they are the most common heart-related cause. Slow heart rhythms are usually the most common irregular heartbeats, but fast, irregular heartbeats that affect the heart’s stroke volume (the volume of blood pumped from the heart with each heartbeat) can also cause presyncope and syncope. Diseases affecting the structure of the heart can cause presyncope when the heart cannot keep up with increasing demands for blood flow. The most common structural diseases are narrowing of the aortic valve and hypertrophic cardiomyopathy (abnormal thickening of heart muscle). Unusual heart-related causes of presyncope might be more likely in older people than in younger ones.

Risk Factors and Frequency for Presyncope

About 19% of people in the United States will faint at some point in their life, with it often happening in early adulthood or after the age of 70. Females make up nearly 58% of those who faint. Fainting accounts for about 3% of visits to the emergency room and up to 6% of hospital admissions in the United States.

It’s harder to estimate the number of people who experience near-fainting episodes because this data is often not included or is combined with fainting data. However, it’s thought that experiencing near-fainting is more common than actual fainting.

In one particular study that looked at near-fainting, the average patient was 56 years old, and 61% of patients were female. About 49% of these patients were admitted to the hospital, which is less than the 69% of fainters admitted. However, they had a similar risk of bad outcomes.

20% of the near-fainters experienced negative outcomes or needed an intervention.
The most common negative outcomes were infection throughout the body (sepsis), slow heart rhythm (bradyarrhythmia), gastrointestinal bleeding, and sudden kidney failure.

Signs and Symptoms of Presyncope

When evaluating a patient who has experienced presyncope, there are several key steps healthcare providers take.

A review of the patient’s medical history is undertaken. Particular attention is paid to any history of vascular and cardiac issues, such as diabetes, hypertension, and smoking history.
Medication review is done to check if the patient is on any drugs that might contribute to the condition, like antihypertensives, antidysrhythmics, cardiac medications or others that prolong the QTc interval on the ECG.
A physical examination is conducted, which includes listening to the heart and lungs, checking the circulation in the peripherals and carrying out a neurological examination.
An ECG (electrocardiogram) is performed, which is a test that measures the electrical activity of the heart.

It’s also important to note a few other details.

Precursors to fainting or ‘vasovagal prodromes’ often last more than five seconds and occur following a particular event.
People might also experience recurrent dizziness after standing up, which is called ‘orthostatic lightheadedness’.
In cardiac causes, these prodromes typically last less than five seconds.
Medications the patient is taking should also be closely reviewed.
Even though vital signs are usually normal after symptoms have resolved, healthcare providers usually take them. It’s a bit controversial, but checking the patient’s blood pressure and pulse when they move from lying down to standing up can be helpful, especially in elderly people or anyone suspected of being dehydrated.
If there’s any concern about gastrointestinal bleeding, a stool test for hidden blood may be performed.
If prompted by the patient’s medical history, a trauma examination may be performed.

Testing for Presyncope

When dealing with a symptom like presyncope, or the feeling that you might faint, the first steps a doctor takes is to check vital signs, such as heart rate and temperature. They will also likely perform an EKG, which is a test that checks for problems with the heart’s electrical activity, and a finger stick glucose test to measure your blood sugar level. There isn’t a single, best test for presyncope, so your doctor relies on these general checks to understand your situation better.

Specific blood tests and detailed imaging tests like a head CT scan or an echocardiogram would only be ordered if they’re helpful based on your specific symptoms and medical history. Routine blood tests generally confirm what your doctor suspects based on examining you. A head CT is only recommended if you have signs of trauma, complaints about your nervous system, or deficits in your neurological functioning such as weakness, numbness, or coordination problems. An echocardiogram, which is like an ultrasound for your heart, is usually only suggested if a new heart murmur is heard.

A tilt table test could also be used in an outpatient setting. This is a test where you are strapped onto a table which is then tilted to simulate standing up. The goal is to see if your faintness is due to postural hypotension, where your blood pressure drops when you stand up causing you to feel faint or dizzy.

There are several things that may hint that more tests need to be done. These include histories of heart or heart valve diseases such as irregular heart rhythms or heart failure; if there’s been a recent change in your EKG; low red blood cell count or severe loss of body fluids possibly due to a gastrointestinal bleed; fainting while lying flat or with exertion; complaints of heart palpitations or chest pains; unusually abnormal vital signs that stay abnormal; or a family history of sudden death.

Treatment Options for Presyncope

Patients who experience near fainting, or presyncope, are just as likely as those who faint (syncopize) to encounter critical complications. However, such patients are less likely to be admitted to the hospital. Treatment of presyncope depends on what seems to be causing it. If the patient looks dehydrated, they should be given fluids. And if there is a worry about sepsis, which is a life-threatening reaction to an infection, they should be given antibiotics.

The decision to keep a patient in the hospital should be based on how likely it is that there will be complications if further examination or treatment is delayed.

Most diagnoses of near fainting are made based on the patient’s symptoms and there isn’t a standard way to confirm the diagnosis. It also may not be possible to rule out heart-related causes, which could be serious. This can make emergency department doctors consider extensive testing for many patients who come in with presyncope symptoms.

A piece of guidance called the Boston Syncope Criteria has found to be accurate in predicting which patients are at risk of complications within 30 days. It suggests admitting patients who have high-risk factors such as symptoms of heart disease, a history of heart or valve disease, a family history of sudden death, signs of heart conduction issues, persistently abnormal vital signs, or extreme fluid loss such us due to gastrointestinal bleeding. If the cause of presyncope is thought to be a common faint or dehydration and everything else appears normal, these patients may be discharged with an appointment for close follow-up with their doctor.

There are other scoring systems to help decide who should be admitted and who can be treated as an outpatient. But most of these have not included near syncope patients due to the differences in defining this condition. As a result, these scoring systems do not provide a clear guideline on whether near syncope patients should be evaluated as inpatients or outpatients.

Finally, the patient’s social circumstances and their ability to manage at home safely must also be considered when they come to the emergency department with presyncope. Regardless of the reason for near fainting, patients who are discharged should have a follow-up appointment with their doctor or heart specialist, ideally scheduled before they leave the hospital.

When discussing certain medical conditions, it’s important to consider a range of potential issues, including: