Presyncope

Presyncope is feeling like you’re about to faint, but you don’t. You may feel lightheaded, sick to your stomach or sweaty, among other symptoms. For many people, presyncope is a minor episode. But others may find that something serious is causing their issue. Many conditions, including some heart-related ones, cause this.

Overview

What is presyncope?

Presyncope is staying conscious while feeling like you’re about to faint. Some providers call this common condition near syncope. Syncope is a medical term for fainting.

Presyncope (pree-sing-kuh-pee) can last a few seconds to a few minutes. For most people, it doesn’t cause major problems. But for a small percentage of people who have it, what happens next is more serious. Some people faint after experiencing presyncope and may get hurt when they fall. Others have issues from the cause of their presyncope, like a heart issue.

Symptoms and Causes

What are the symptoms?

Presyncope symptoms include:

• Lightheadedness.
• Weakness.
• Sweatiness.
• Upset stomach.
• Heart palpitations.
• Pain in your belly (abdomen).
• Blurred vision or seeing black spots.

What causes presyncope?

The main cause of presyncope is a lack of blood flow to your brain. If blood flow to your brain stops for six to eight seconds, you pass out.

Presyncope causes include:

• Pain, anxiety, fear or upsetting events.
• Orthostatic hypotension. (Dehydration can cause this.)
• Vasovagal syncope.
• Certain medications, like those for high blood pressure and some heart issues.
• Pulmonary embolism.
• Pulmonary hypertension.
• Sepsis.
• Aortic dissection.
• Heart valve disease.
• Hypertrophic cardiomyopathy.
• Myocardial ischemia.
• Heart attack.
• Carotid artery disease.
• Cardiac tamponade.
• Abnormal heart rhythm (arrhythmia).
• Low blood counts from conditions like gastrointestinal (GI) bleeding.
• Postural orthostatic tachycardia syndrome (POTS).

What are the risk factors for presyncope?

Risk factors for presyncope include:

• Having high blood pressure.
• Having diabetes.
• Using tobacco products.
• Having a history of presyncope.
• Being female.

Diagnosis and Tests

How is presyncope diagnosed?

A healthcare provider will talk with you about your medical history and the medications you take. They’ll also perform a physical exam. They may ask you questions like:

• What were you doing when you started to feel symptoms?
• Have you experienced this before?
• What were you doing right before you felt symptoms the other times?
• Is there a history of fainting or heart issues in your family?

What tests will be done to diagnose presyncope?

Tests to diagnose presyncope may include:

• Electrocardiogram (EKG).
• Heart rhythm monitor like a Holter monitor or Zio® patch.
• Exercise stress test.
• Blood tests, especially for blood sugar (glucose).
• Tilt table test.
• Computed tomography (CT) of your head.
• Echocardiogram.

Management and Treatment

How is presyncope treated?

Treatment for presyncope depends on what’s causing it.

Presyncope treatment may include:

• Lying or sitting down.
• Tensing the muscles in your arms, legs or belly. Examples include crossing your legs or clenching your fists.
• Getting fluids (and possibly sodium) through an IV in your arm.
• Taking medicines like antibiotics or blood thinners.
• Having a procedure to remove a blood clot or fix a heart valve, for example.
• Getting a pacemaker or an ablation to stop an abnormal heart rhythm.

Outlook / Prognosis

What can I expect if I have presyncope?

If you seek medical attention, a provider may admit you to a hospital or send you home after treatment. Then, you’ll need a follow-up appointment with your primary care provider (PCP).

If a provider finds a serious issue, you’ll need to see a cardiologist or another specialist. The cause of your presyncope determines how serious it is.

A study found that even having one of certain issues predicts a serious outcome for people with presyncope. These issues are:

• Heart failure.
• Shortness of breath.
• Systolic (first number) blood pressure below 90 millimeters of mercury (mmHg). This is a number lower than normal.
• Abnormal EKG results.
• A hematocrit test result of less than 30%. This means you have a low percentage of red blood cells in your blood (anemia).

Prevention

Can presyncope be prevented?

Yes, you may be able to prevent presyncope if you know the cause. You can lower your risk in these ways:

• Drink fluids before giving blood or getting a vaccination. Sit while receiving a vaccine.
• Avoid upsetting things, like horror movies.
• Stand up slowly.
• Eat smaller meals.
• Get treatment for a medical condition that’s causing presyncope.

Living With

How do I take care of myself?

If you know what’s causing presyncope in your case, do what you can to prevent it. For example, if you know it happens in hot, crowded rooms, try to plan for that. Bring a small fan, get a seat near a window or take breaks to step outside for fresh air every so often.

If you feel an episode coming on, try sitting or lying down, clenching your fists or crossing your legs.

When should I see my healthcare provider?

You should follow up with a provider after having an episode of presyncope. In many cases, they can help you figure out the cause or refer you to someone who can. You should get immediate help if you pass out (lose consciousness). Someone with you should call an ambulance.

What questions should I ask my doctor?

Questions to consider asking your healthcare provider may include:

• What’s causing my presyncope?
• If a medical condition is causing it, do I need treatment for that?
• How soon can I get treatment for it?
• Are others in my family at risk for presyncope?

A note from Wockr

Whether it’s your first presyncope experience or not, it’s unsettling. You may wonder if you’re going to faint and get hurt. You may feel embarrassed when people keep asking if you’re OK. But you can take charge by finding out the cause and getting treatment for it.