Syncope (fainting) triggered by standing, strong emotions, or common phobias to blood, injections, and injuries can be easily prevented with a number of safe, simple, effective exercises.
How to Prevent Fainting
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Syncope, otherwise known as fainting, is the sudden, brief loss of consciousness caused by diminished blood flow to our brain that occurs at least once in about one in five people, and in about one in ten may happen over and over, responsible for millions of emergency room visits and hospitalizations. Though sometimes fainting can be caused by heart problems, most often it’s triggered just by standing (because blood pools in our legs) or strong emotions, which are called vasovagal reactions. Under certain circumstances, such as blood donation, syncope has important medical and societal significance. More than 150,000 people experience fainting spells or near-fainting spells each year when they’re giving blood. So, it would be good to find a way to avoid it. But, if you think that has medical and societal significance, what about fainting when you’re driving? It goes without saying that losing consciousness while driving can pose a serious threat to the patient and society. Of a group of folks getting tested for it, 9% reported they had lost consciousness while driving.
When it happens over and over, drugs and surgery are used, installing a pacemaker. But such therapy is expensive, efficacy is questionable, and adverse effects are common. In fact, results of most drug treatment trials have been disappointing, and the value of implanting pacemakers has been repeatedly questioned, and now there is evidence for their lack of effectiveness. So, what do we do?
Well in Italy, evidently the older generation of general practitioners advised patients prone to fainting to carry a wooden egg (used in the old days for darning socks) and to apply muscle tension by gripping the wooden egg forcefully as soon as a faint was imminent. These folklore stories inspired an Italian cardiologist to apply arm muscle tensing to combat vasovagal fainting, but it wasn’t put to the test, until now.
About a minute before losing consciousness, most about to faint experience so-called prodromal symptoms—they feel dizzy, queasy, or break out into a sweat, signaling they’re just about to black-out. When that happens, there are a number of maneuvers shown to successfully abort the impending episode. One is called isometric arm counter-pressure, where you grip one hand in the other and exert pressure trying to pull your arms apart, and you keep it up until the symptoms go away. How successful is it? Patients were shown how to do it, and reported it was successful 99% of the time. Safe and effective, proposed to be the new first-line treatment for those who start to feel faint.
Leg crossing and muscle tensing has also been shown to work, where you cross your legs, squeezing them together as you tense your leg, stomach, and butt muscles. Safe, inexpensive, effective—they propose having patients try this before having a cardiac pacemaker surgically implanted. Squatting down is another maneuver, if all else fails.
Is there anything we can do to prevent the symptoms in the first place? Do we have to wait until we’re all dizzy, clammy, and nauseous? Well, speaking of cheap, safe, and effective, just drinking water can prevent it. So, if you know needles make you whoozy, five minutes before you get stuck, chug down two cups of water, which can dramatically bring pressures up within minutes in people who are predisposed to fainting, and has similar effects in normal healthy adults. The fact that water exerts such profound effects can be exploited by blood donation programs, for example, to help prevent people from fainting. It’s also the current recommended treatment for so-called blood, injury, or injection phobia, which is actually pretty common, affecting about 1 in 25 people, 75% of which report a history of fainting in response. The problem is not just that they won’t donate blood. Avoiding anything related to blood, injury, and injections could pose a particularly serious threat if people neglect to seek medical care when necessary, but all one has to do is preload with two cups of water. The knowledge that such simple self-help maneuvers are readily available, and could be lifesaving, should prove valuable and helpful in everyday life.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.
Please consider volunteering to help out on the site.
- L G Ost, U Sterner. Applied tension. A specific behavioral method for treatment of blood phobia. Behav Res Ther. 1987;25(1):25-9.
- M L Blitzer, B C Saliba, A E Ghantous, M A Marieb, M H Schoenfeld. Causes of impaired consciousness while driving a motorized vehicle. Am J Cardiol. 2003 Jun 1;91(11):1373-4.
- E S Ayala, A E Meuret, T Ritz. Treatments for blood-injury-injection phobia: a critical review of current evidence. J Psychiatr Res. 2009 Oct;43(15):1235-42.
- J Jordan, J R Shannon, E Grogan, I Biaggioni, D Robertson. A potent pressor response elicited by drinking water. Lancet. 1999 Feb 27;353(9154):723.
- M Brignole, F Croci, C Menozzi, A Solano, P Donateo, D Oddone, E Puggioni, G Lolli. Isometric arm counter-pressure maneuvers to abort impending vasovagal syncope. J Am Coll Cardiol. 2002 Dec 4;40(11):2053-9.
- K H Kim, J G Cho, K O Lee, T J Seo, C Y Shon, S Y Lim, K H Yun, I S Sohn, Y J Hong, H W Park, J H Kim, W Kim, Y K Ahn, M H Jeong, J C Park, J C Kang. Usefulness of physical maneuvers for prevention of vasovagal syncope. Circ J. 2005 Sep;69(9):1084-8.
- C T Krediet, N van Dijk, M Linzer, J J van Lieshout, W Wieling. Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing. Circulation. 2002 Sep 24;106(13):1684-9.
- C C Lu, A Diedrich, C S Tung, S Y Paranjape, P A Harris, D W Byrne, J Jordan, D Robertson. Water ingestion as prophylaxis against syncope. Circulation. 2003 Nov 25;108(21):2660-5. Epub 2003 Nov 17.
- A L Peterson, J A Cigrang. Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing. Circulation. 2003 May 27;107(20):e198; author reply e198.
- T O Cheng. Simple self-help maneuvers are effective in aborting vasovagal syncope. Circulation. 2004 May 11;109(18):e217; author reply e217.
- W N Kapoor. Is there an effective treatment for neurally mediated syncope? JAMA. 2003 May 7;289(17):2272-5.
- H Li, M Weitzel, A Easley, W Barrington, J Windle. Potential risk of vasovagal syncope for motor vehicle driving. Am J Cardiol. 2000 Jan 15;85(2):184-6.
- L Y Chen, D G Benditt, W K Shen. Management of syncope in adults: an update. Mayo Clin Proc. 2008 Nov;83(11):1280-93.
- F Croci, M Brignole, C Menozzi, A Solano, P Donateo, D Oddone, E Puggioni, G Lolli. Efficacy and feasibility of isometric arm counter-pressure manoeuvres to abort impending vasovagal syncope during real life. Europace. 2004 Jul;6(4):287-91.
- D G Benditt, J T Nguyen. Syncope: therapeutic approaches. J Am Coll Cardiol. 2009 May 12;53(19):1741-51.
Images thanks to The Clear Communication People via Flickr.
Syncope, otherwise known as fainting, is the sudden, brief loss of consciousness caused by diminished blood flow to our brain that occurs at least once in about one in five people, and in about one in ten may happen over and over, responsible for millions of emergency room visits and hospitalizations. Though sometimes fainting can be caused by heart problems, most often it’s triggered just by standing (because blood pools in our legs) or strong emotions, which are called vasovagal reactions. Under certain circumstances, such as blood donation, syncope has important medical and societal significance. More than 150,000 people experience fainting spells or near-fainting spells each year when they’re giving blood. So, it would be good to find a way to avoid it. But, if you think that has medical and societal significance, what about fainting when you’re driving? It goes without saying that losing consciousness while driving can pose a serious threat to the patient and society. Of a group of folks getting tested for it, 9% reported they had lost consciousness while driving.
When it happens over and over, drugs and surgery are used, installing a pacemaker. But such therapy is expensive, efficacy is questionable, and adverse effects are common. In fact, results of most drug treatment trials have been disappointing, and the value of implanting pacemakers has been repeatedly questioned, and now there is evidence for their lack of effectiveness. So, what do we do?
Well in Italy, evidently the older generation of general practitioners advised patients prone to fainting to carry a wooden egg (used in the old days for darning socks) and to apply muscle tension by gripping the wooden egg forcefully as soon as a faint was imminent. These folklore stories inspired an Italian cardiologist to apply arm muscle tensing to combat vasovagal fainting, but it wasn’t put to the test, until now.
About a minute before losing consciousness, most about to faint experience so-called prodromal symptoms—they feel dizzy, queasy, or break out into a sweat, signaling they’re just about to black-out. When that happens, there are a number of maneuvers shown to successfully abort the impending episode. One is called isometric arm counter-pressure, where you grip one hand in the other and exert pressure trying to pull your arms apart, and you keep it up until the symptoms go away. How successful is it? Patients were shown how to do it, and reported it was successful 99% of the time. Safe and effective, proposed to be the new first-line treatment for those who start to feel faint.
Leg crossing and muscle tensing has also been shown to work, where you cross your legs, squeezing them together as you tense your leg, stomach, and butt muscles. Safe, inexpensive, effective—they propose having patients try this before having a cardiac pacemaker surgically implanted. Squatting down is another maneuver, if all else fails.
Is there anything we can do to prevent the symptoms in the first place? Do we have to wait until we’re all dizzy, clammy, and nauseous? Well, speaking of cheap, safe, and effective, just drinking water can prevent it. So, if you know needles make you whoozy, five minutes before you get stuck, chug down two cups of water, which can dramatically bring pressures up within minutes in people who are predisposed to fainting, and has similar effects in normal healthy adults. The fact that water exerts such profound effects can be exploited by blood donation programs, for example, to help prevent people from fainting. It’s also the current recommended treatment for so-called blood, injury, or injection phobia, which is actually pretty common, affecting about 1 in 25 people, 75% of which report a history of fainting in response. The problem is not just that they won’t donate blood. Avoiding anything related to blood, injury, and injections could pose a particularly serious threat if people neglect to seek medical care when necessary, but all one has to do is preload with two cups of water. The knowledge that such simple self-help maneuvers are readily available, and could be lifesaving, should prove valuable and helpful in everyday life.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.
Please consider volunteering to help out on the site.
- L G Ost, U Sterner. Applied tension. A specific behavioral method for treatment of blood phobia. Behav Res Ther. 1987;25(1):25-9.
- M L Blitzer, B C Saliba, A E Ghantous, M A Marieb, M H Schoenfeld. Causes of impaired consciousness while driving a motorized vehicle. Am J Cardiol. 2003 Jun 1;91(11):1373-4.
- E S Ayala, A E Meuret, T Ritz. Treatments for blood-injury-injection phobia: a critical review of current evidence. J Psychiatr Res. 2009 Oct;43(15):1235-42.
- J Jordan, J R Shannon, E Grogan, I Biaggioni, D Robertson. A potent pressor response elicited by drinking water. Lancet. 1999 Feb 27;353(9154):723.
- M Brignole, F Croci, C Menozzi, A Solano, P Donateo, D Oddone, E Puggioni, G Lolli. Isometric arm counter-pressure maneuvers to abort impending vasovagal syncope. J Am Coll Cardiol. 2002 Dec 4;40(11):2053-9.
- K H Kim, J G Cho, K O Lee, T J Seo, C Y Shon, S Y Lim, K H Yun, I S Sohn, Y J Hong, H W Park, J H Kim, W Kim, Y K Ahn, M H Jeong, J C Park, J C Kang. Usefulness of physical maneuvers for prevention of vasovagal syncope. Circ J. 2005 Sep;69(9):1084-8.
- C T Krediet, N van Dijk, M Linzer, J J van Lieshout, W Wieling. Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing. Circulation. 2002 Sep 24;106(13):1684-9.
- C C Lu, A Diedrich, C S Tung, S Y Paranjape, P A Harris, D W Byrne, J Jordan, D Robertson. Water ingestion as prophylaxis against syncope. Circulation. 2003 Nov 25;108(21):2660-5. Epub 2003 Nov 17.
- A L Peterson, J A Cigrang. Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing. Circulation. 2003 May 27;107(20):e198; author reply e198.
- T O Cheng. Simple self-help maneuvers are effective in aborting vasovagal syncope. Circulation. 2004 May 11;109(18):e217; author reply e217.
- W N Kapoor. Is there an effective treatment for neurally mediated syncope? JAMA. 2003 May 7;289(17):2272-5.
- H Li, M Weitzel, A Easley, W Barrington, J Windle. Potential risk of vasovagal syncope for motor vehicle driving. Am J Cardiol. 2000 Jan 15;85(2):184-6.
- L Y Chen, D G Benditt, W K Shen. Management of syncope in adults: an update. Mayo Clin Proc. 2008 Nov;83(11):1280-93.
- F Croci, M Brignole, C Menozzi, A Solano, P Donateo, D Oddone, E Puggioni, G Lolli. Efficacy and feasibility of isometric arm counter-pressure manoeuvres to abort impending vasovagal syncope during real life. Europace. 2004 Jul;6(4):287-91.
- D G Benditt, J T Nguyen. Syncope: therapeutic approaches. J Am Coll Cardiol. 2009 May 12;53(19):1741-51.
Images thanks to The Clear Communication People via Flickr.
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How to Prevent Fainting
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This is the final installment (for now!) of an extended video series I’ve done on water and proper hydration. Quench your curiosity by checking out the earlier videos:
- How Many Glasses of Water Should We Drink a Day?
- Does a Drink of Water Make Children Smarter?
- Can Dehydration Affect Our Mood?
- Treating Dry Eye Disease with Diet: Just Add Water?
- Club Soda for Stomach Pain and Constipation
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