YOUR HEALTH Dr James Le Fanu: fainting
Thursday, 15 November 2012

Dr James Le Fanu: 16 November

There are many causes for mild faints, which shouldn’t be confused with serious blackouts; torn muscles heal more slowly with age, and the medical mystery of a stitch

Written by Dr James Le Fanu
People faint for all manner of reasons – hunger, excessive heat after standing immobile too long, the sight of blood or similar stomach-churning spectacles, exhaustion, shock or dehydration. In the minute or two before it happens, and in quick succession, the victim feels nauseous, claustrophobic, dizzy, sweaty, spots dance in front of their eyes, then everything goes black. In popular terminology this is a blackout and no cause for alarm. Recovery is spontaneous and immediate and little further needs to be done other than to offer reassurance, a blanket and a glass of water.

If, however, an ambulance is summoned and the now-recovered fainter is transported to hospital, matters become more complex for, as a cardiologist puts it in the British Medical Journal: ‘While any ordinary person can recognise a common faint, doctors seem to fi nd the diagnosis diffi cult.’ The trouble is, they know too much. There is a long list of potential causes of blackouts for the concerned physician to consider, including narrowed heart valves, disturbances of heart rhythm, epilepsy and anything that reduces the flow of blood to the brain. It requires an extensive series of tests to investigate all these possibilities – all of which almost invariably turn out to be normal.

Rather, the distinction between a common faint and these other causes is best made by paying attention to the circumstantial evidence. Those common faints, precipitated by one or other of the physical or emotional factors already considered, are due to a fall in blood pressure, so oxygenated blood can no longer make it from the heart up to the brain. The victim collapses to the ground but, with the brain at the same level as the heart, blood fl ow is restored and recovery is immediate. The whole cycle – from premonitory symptoms to full recovery – usually takes two to three minutes.

By contrast, most of the more serious causes of blackouts come out of the blue for no apparent reason – they are instantaneous and recovery is slower. Thus the crucial clues in differentiating the serious from the less so, lies not in complex tests but listening to the patient’s description of what has happened.

THIS WEEK’S MEDICAL PROBLEM comes courtesy of a reader from Hertfordshire, now in her mid-80s, who recently tore a thigh muscle when over-reaching with a long-arm pruner. Are muscles more prone to such injuries in passing years, she wonders, and how long is her current discomfort when walking and climbing stairs likely to persist?

There are no precise statistics in this matter but the risk of this sort of muscular injury tends to increase with age. It can regrettably take rather longer than expected for the tear of the muscles and blood vessels to heal and may be six weeks or more before it is again possible to get around without discomfort.


The cause of crippling pain in the upper abdomen on the right side following exercise – known as a stitch – remains a medical mystery. It can be precipitated by eating a large meal, but more frequently by exercise that jolts the body, such as running on hard ground. It is common in horse and camel riders, but rare in swimmers, skaters and cyclists. The most plausible theory holds that a stitch is due to stretching of the ligaments that hold the gut in place – hence the advice that those who are prone to it should take no food or water for a couple of hours before exercise. For those who can do so, standing on one’s head apparently brings instant relief.

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