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What causes occasional episodes of feeling like fainting?

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Posted on Tue, 26 Jul 2016
Question: I occasionally experience faint like feelings last about 30 seconds sometimes 10 to 12 times a day then it goes away and comes back in about three weeks or so had them yesterday quite a few times and this morning upon waking up I could not recall things from yesterday also recently I will go somewhere that I have been in the past and don't recall the area at all/
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Answered by Dr. Dariush Saghafi (47 minutes later)
Brief Answer:
Faint like feelings

Detailed Answer:
Good afternoon and thank you very much for your question. I am a neurologist and commonly am asked to see patients for these types of problems.

I agree that feelings of faintness can be associated with either heart or blood pressure problems. Most commonly what you're talking about is due to medications either as side effects or interactions between different drugs. You didn't say whether or not you were taking any medications prior to all this starting. Therefore, one of the first things I would check in a patient complaining of these types of feelings are the medications after getting a good solid history on the nature of these events. For instance when did they start happening? When they first started, whenever this was, for example...was is the same frequency of 10-12 times a day or was it only 1-2 times a day and now it has gotten significantly worse?

You say you feel faint...does this mean LIGHTHEADED or ZONED OUT or do you mean suddenly unbalanced, SPINNING SENSATIONS, as if you are going to pass out? What do you do NOT to pass out? Do you sit, do you lie? How does the episode terminate? Does it come on out of nowhere or do you seem to get some kind of warning? Do people around you ask you if "You're OK?" Do they tell you that you seem to have a stare or glazed look on the face when these are happening? Do these ALWAYS happen when you are sitting or standing? What brings them on in your opinion? These are examples of questions I would ask you if you were my patient in the office.

Next, I would do a thorough NEUROLOGICAL evaluation including what's referred to as a MODIFIED AMINOFF ORTHOSTATIC PROTOCOL measuring blood pressures and heart rate in the positions of lying (following 5 minutes of quiet repose), IMMEDIATE standing bedside, and then, after you've been STANDING for 2 minutes.
I would document both BLOOD PRESSURE and HEARTRATE in all these positions and I would take these measurements at least a couple of times daily at different times to see if there were any relationship to when you've just taken medications, after an hour or 2 of having taken medications, or around meal times.

I may also do what is known as a hyperventilation test on you though your presentation doesn't strike me as being due to stress, anxiety, fear, or sudden breathlessness induced by panic or distress. Nevertheless, the test itself is easy to do in the office, only takes about 3 minutes and if positive can tell us a lot of information. Also, I might have you do a hyperventilation maneuver we often ask patients to do to see if we can induce a subtle (or sometimes noticeable) change in mental status that could be suggestive of a seizure disorder. Again, I'm not terribly suspicious for this sort of problem in your case but I would do the test anyways to see what would happen...and if there were any doubts in my mind I'd consider sending to get an EEG performed (electroencephalogram).

I would also make very sure that metabolically you have been thoroughly looked at as far as blood chemistries, thyroid panel tests such as FT4 and TSH, maybe even T3 and Reverse T3, and if necessary microsomal enzyme assays. I might also go for a blood cell count to make sure we're not dealing with a low hemoglobin and hematocrit as well as liver and kidney function tests to make sure those organs are working properly. I would make sure all electrolytes are in order, be sure that Vitamin D, and cortisol levels were normal and if anything were significantly off I would make sure those items would be corrected before anything else.

The memory issues could be looked at by doing the EEG since seizure disorder could certainly account for that phenomenon. I might even consider doing a prolonged 60 minute sleep deprived EEG after getting a good history on the basis of the memory complaint.

By the way, I agree that if you don't really have HYPERTENSION (high blood pressure) as defined by the following consensus of numbers which should be REPEATABLE on at least 3 separate occasions and under conditions of either absolute or relative rest and relaxation away from having just ingested medication, caffeine, or smoking cigarettes:



Stages of High Blood Pressure in Adults Stages
     
Systolic (top number)             Diastolic (bottom number)

Prehypertension       120–139       OR      80–89

Hypertesnion Stage 1      140–159       OR      90–99

Hypertension Stage 2      160 or >      OR      100 or >


If you do not possess these numbers as I've indicated above then, you do not likely have diagnosable HYPERTENSION that requires treatment. If so, then, you probably should be on the medication but your numbers need to be monitored to make sure you're not going too low and thereby making the faint like spells worse.

I'm going to stop at this point and either let you respond to anything you'd like to say or perhaps, study what I've written and decide what information may be worth discussing with your primary provider and whether or not it would be worthwhile asking your doctor for a referral to see a NEUROLOGIST for this problem because I think there is definitely room for a workup based upon what you've told me.

If I've satisfactorily addressed your question then, could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback and a 5 STAR rating to our transaction if you feel the response has helped you? Again, many thanks for posing your question.

Do not forget to recontact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 44 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Dariush Saghafi

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Practicing since :1988

Answered : 2473 Questions

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What causes occasional episodes of feeling like fainting?

Brief Answer: Faint like feelings Detailed Answer: Good afternoon and thank you very much for your question. I am a neurologist and commonly am asked to see patients for these types of problems. I agree that feelings of faintness can be associated with either heart or blood pressure problems. Most commonly what you're talking about is due to medications either as side effects or interactions between different drugs. You didn't say whether or not you were taking any medications prior to all this starting. Therefore, one of the first things I would check in a patient complaining of these types of feelings are the medications after getting a good solid history on the nature of these events. For instance when did they start happening? When they first started, whenever this was, for example...was is the same frequency of 10-12 times a day or was it only 1-2 times a day and now it has gotten significantly worse? You say you feel faint...does this mean LIGHTHEADED or ZONED OUT or do you mean suddenly unbalanced, SPINNING SENSATIONS, as if you are going to pass out? What do you do NOT to pass out? Do you sit, do you lie? How does the episode terminate? Does it come on out of nowhere or do you seem to get some kind of warning? Do people around you ask you if "You're OK?" Do they tell you that you seem to have a stare or glazed look on the face when these are happening? Do these ALWAYS happen when you are sitting or standing? What brings them on in your opinion? These are examples of questions I would ask you if you were my patient in the office. Next, I would do a thorough NEUROLOGICAL evaluation including what's referred to as a MODIFIED AMINOFF ORTHOSTATIC PROTOCOL measuring blood pressures and heart rate in the positions of lying (following 5 minutes of quiet repose), IMMEDIATE standing bedside, and then, after you've been STANDING for 2 minutes. I would document both BLOOD PRESSURE and HEARTRATE in all these positions and I would take these measurements at least a couple of times daily at different times to see if there were any relationship to when you've just taken medications, after an hour or 2 of having taken medications, or around meal times. I may also do what is known as a hyperventilation test on you though your presentation doesn't strike me as being due to stress, anxiety, fear, or sudden breathlessness induced by panic or distress. Nevertheless, the test itself is easy to do in the office, only takes about 3 minutes and if positive can tell us a lot of information. Also, I might have you do a hyperventilation maneuver we often ask patients to do to see if we can induce a subtle (or sometimes noticeable) change in mental status that could be suggestive of a seizure disorder. Again, I'm not terribly suspicious for this sort of problem in your case but I would do the test anyways to see what would happen...and if there were any doubts in my mind I'd consider sending to get an EEG performed (electroencephalogram). I would also make very sure that metabolically you have been thoroughly looked at as far as blood chemistries, thyroid panel tests such as FT4 and TSH, maybe even T3 and Reverse T3, and if necessary microsomal enzyme assays. I might also go for a blood cell count to make sure we're not dealing with a low hemoglobin and hematocrit as well as liver and kidney function tests to make sure those organs are working properly. I would make sure all electrolytes are in order, be sure that Vitamin D, and cortisol levels were normal and if anything were significantly off I would make sure those items would be corrected before anything else. The memory issues could be looked at by doing the EEG since seizure disorder could certainly account for that phenomenon. I might even consider doing a prolonged 60 minute sleep deprived EEG after getting a good history on the basis of the memory complaint. By the way, I agree that if you don't really have HYPERTENSION (high blood pressure) as defined by the following consensus of numbers which should be REPEATABLE on at least 3 separate occasions and under conditions of either absolute or relative rest and relaxation away from having just ingested medication, caffeine, or smoking cigarettes: Stages of High Blood Pressure in Adults Stages Systolic (top number) Diastolic (bottom number) Prehypertension 120–139 OR 80–89 Hypertesnion Stage 1 140–159 OR 90–99 Hypertension Stage 2 160 or > OR 100 or > If you do not possess these numbers as I've indicated above then, you do not likely have diagnosable HYPERTENSION that requires treatment. If so, then, you probably should be on the medication but your numbers need to be monitored to make sure you're not going too low and thereby making the faint like spells worse. I'm going to stop at this point and either let you respond to anything you'd like to say or perhaps, study what I've written and decide what information may be worth discussing with your primary provider and whether or not it would be worthwhile asking your doctor for a referral to see a NEUROLOGIST for this problem because I think there is definitely room for a workup based upon what you've told me. If I've satisfactorily addressed your question then, could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback and a 5 STAR rating to our transaction if you feel the response has helped you? Again, many thanks for posing your question. Do not forget to recontact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others. This query has utilized a total of 44 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.