Sunday, October 6, 2002
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Sunday, October 6, 2002 |
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Simple maneuver may help those prone to fainting By
MARY JANE HOLT
Today's column is not for everybody and, in fact, may be applicable to only a handful of readers, specifically those who are prone to fainting (syncope episodes). I occasionally get lightheaded when I bend over and stand back up, or even sometimes when I am in a sitting position and stand up quickly. This irritating little symptom has been worse since my August surgery. Perhaps some of you have experienced such symptoms as well. If so then you might be interested in a study I just learned about. Please, please, please if you have just developed symptoms of lightheadedness, or only recently become prone to fainting, see your doctor before you try what I am about to describe. But, if the fainting has been a longtime problem, this might interest you. It seems a combination of leg crossing and muscle tensing may help prevent fainting, providing a simple solution for people prone to fainting during emotional stress or prolonged standing. The counter-maneuver could prove a simple, inexpensive alternative to medication or pacemaker implantation, says study senior author Wouter Wieling, M.D., Ph.D. associate professor of internal medicine and head of the syncope unit at the Academic Medical Center of the University of Amsterdam, the Netherlands. According to an article in Circulation magazine (September 2002), vasovagal syncope, or fainting, results from a neurological reflex that originates in the brain. In response to a physical or emotional trigger, the brain emits signals that cause blood vessels to dilate and causes blood to pool in the legs. The heart rate also slows. Subsequently, the brain does not receive enough oxygen-carrying blood, leading to fainting. Standard treatment includes educating patients about the causes of the condition, instructing them how to avoid situations that trigger fainting, and maintaining adequate salt and fluid intake. Several drugs have been studied as treatment, but results have been inconsistent. "Leg muscle crossing and tensing should be part of an intense nonpharmacological regimen for patients with vasovagal faints," says Wieling. Physical counter-maneuvers such as leg crossing and muscle tensing have been developed in patients with low blood pressure when rising from a reclining position (orthostatic hypotension) a condition caused by rare diseases of the autonomic nervous system. Wieling and colleagues in Amsterdam and the United States theorized that the same maneuvers might help people who have vasovagal syncope. The researchers evaluated the maneuver in 20 patients (ages 17 to 74) who had a history of vasovagal syncope, but were otherwise healthy. The number of lifetime syncope episodes ranged between one and 200. Patients learned to cross their legs while in a standing position and tense the muscles of the legs, abdomen, and buttocks. In a controlled test setting, the counter-maneuver stabilized blood pressure and heart rate in all patients. Symptoms disappeared shortly after blood pressure became stable, and none of the patients lost consciousness while performing the counter-maneuver. In five patients syncope was prevented. The remaining 15 patients either could not prevent fainting or asked to be tilted back to a horizontal position, but the counter-maneuvers delayed the faint by an average of 2.5 minutes. During the counter-maneuver, systolic blood pressure increased by an average of about 40 points and heart rate by an average of nine beats per minute. Patients had an almost "instantaneous increase" in blood pressure when they performed the counter-maneuver. Each patient received a follow-up phone call several months after the study. Only two had fainted since the test. The researchers conclude that the counter-maneuvers "can abort or delay impending faints in subjects prone to vasovagal reactions." "You often see people standing with their legs crossed at cocktail parties, and we call this the cocktail party posture," says Wieling. "In our experience patients will do this automatically after awhile. A great advantage of leg crossing is that it can be done almost unnoticed." "In case crossing the legs alone does not provide sufficient relief during prolonged standing, we advise patients to perform leg muscle tensing as an additional measure, and then if the symptoms are mild, to uncross their legs and walk with tensed muscles to a safe place to sit down. If the symptoms are overwhelming, subjects are advised to crouch down immediately." If you have any questions or concerns about trying this maneuver, be sure to talk to your doctor first. But if you have a history of fainting and you decide to give this a try I would love to know if it works for you. You can write to me at P.O. Box 246, Gay, Ga., 30218 or you can leave me a message at 770-460-5000.
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