Just Fainting Or A Serious Heart Warning?

KUALA LUMPUR, April 9 (Bernama) -- Fainting can happen for many reasons and is often perceived as harmless. Although many episodes are linked to stress, dehydration, prolonged standing, or overwhelming emotion, some collapses may in fact be the body’s first warning sign of a serious underlying heart condition.

Sunway Medical Centre Velocity (SMCV) Consultant Cardiologist, Electrophysiologist and Internal Medicine Physician Dr Lim Chiao Wen explained that cardiac syncope refers to fainting caused by a sudden drop in blood flow from the heart to the brain. Unlike common fainting, it is dangerous, often occurs without warning, and can be life-threatening if left untreated.

She said the causes may include irregular heart rhythms, structural problems affecting the heart muscle or valves, as well as serious circulation-related events such as a blood clot in the lungs or a tear in the body’s main artery.

Part of what makes this condition concerning is how easily it can be mistaken for an ordinary fainting episode. Dr Lim explained that when the heart beats too fast or too slow, blood pressure can drop suddenly, reducing blood flow to the brain and causing a sudden collapse.

She highlighted several structural conditions linked to cardiac syncope, including hypertrophic cardiomyopathy (thickening of the heart muscle), aortic stenosis (narrowing of the aortic valve), and myocarditis (inflammation of the heart muscle).

Dr Lim also pointed out that emotional stress may affect the heart more directly than many realise, as adrenaline surges can disrupt both heart rhythm and blood pressure. She cautioned that abnormal heart rhythms can occur suddenly and may not be detected during routine screening, meaning even seemingly healthy individuals may collapse without warning.

Meanwhile, SMCV Consultant Emergency Physician Dr Cyrus Lai Sin Nan said while fainting, or syncope, accounts for roughly one to three per cent of emergency department visits, cardiac-related syncope is significantly more dangerous due to its link to serious arrhythmias, sudden deterioration and even death.

“Although these cases are less common, their potential severity means they should not be dismissed, especially when the collapse occurs suddenly, recurs without explanation, or is accompanied by other concerning symptoms,” he said in a statement today.

He added that recovering quickly after a collapse does not necessarily mean the episode is harmless, as the underlying cause may still be serious.

“This is why the accident and emergency (A&E) department is a crucial point of assessment, as the immediate goal is not only to stabilise the patient but also to determine whether the collapse is linked to a serious heart condition requiring urgent attention.

“In A&E, the more common cardiac-related presentations include chest pain or acute coronary syndrome, arrhythmias, heart failure and uncontrolled hypertension,” he said.

He said cardiac syncope can occur at any age but is more concerning among older adults, particularly those with reduced blood flow to the heart, heart valve disease, abnormal heart rhythms, implanted pacemakers or multiple medical conditions.

“In younger patients, we are particularly alert if syncope occurs during exertion, is accompanied by palpitations, or if there is a family history of sudden death, as inherited arrhythmic disorders or structural conditions such as hypertrophic cardiomyopathy may be involved,” Dr Cyrus said.

Dr Cyrus said emergency assessment for cardiac syncope typically includes airway, breathing and circulation checks, vital signs monitoring, blood sugar testing, a focused medical history, physical examination, orthostatic blood pressure measurement where needed, and a 12-lead electrocardiogram to detect rhythm abnormalities or other warning signs.

He said patients with concerning features may require continuous cardiac monitoring, while further investigations may include cardiac blood markers, blood counts, kidney and electrolyte tests, and selected imaging based on the patient’s condition.

He added that early recognition in emergency settings is crucial, as some patients may appear stable initially but remain at risk of rapid deterioration.

From a cardiology perspective, Dr Lim said further evaluation may include echocardiography, which uses ultrasound to assess the heart’s structure and function; Holter monitoring, which records heart rhythm continuously over an extended period (typically more than 24 hours); as well as stress testing and selected coronary imaging where needed.

She said treatment depends on the underlying cause and may include medication, implantable devices such as pacemakers or defibrillators, or ablation procedures to correct abnormal electrical pathways in cases of life-threatening rhythm disturbances.

“When a heart attack is identified, urgent procedures such as coronary angioplasty and stent placement may be required to restore blood flow,” she said, adding that untreated cardiac syncope carries a high risk of death.

The hospital advised the public to adopt a healthy lifestyle and undergo regular health screenings, especially those with a strong family history of heart conditions, as early detection plays a key role in reducing the risk of serious cardiac events and improving long-term health outcomes.

It added that fainting should not be automatically dismissed as harmless, particularly when accompanied by chest pain, palpitations, breathlessness, or when it occurs during exercise, while lying down, or is followed by prolonged confusion or serious injury.

-- BERNAMA

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