Why fainting can be a cause for concern – The Telegraph

Unpredictable and distressing, recurrent fainting requires attention on its own account
People faint for all manner of reasons, thirst, hunger, heat, the sight of blood, dehydration and so on. In quick succession the victim feels nauseous and dizzy, spots dance in front of their eyes – and everything goes black. In popular terminology this is a blackout and no cause for alarm. Recovery is spontaneous and little needs to be done for the person who fainted other than offering reassurance and a glass of water.
Recurrent fainting is a very different matter. There is a longish list of possible causes, but by far the most common is a fall in blood pressure on standing – known technically as orthostatic hypotension (OH). This may be age-related, due to disturbed functioning of the autonomic nervous system that ensures a constant flow of blood to the brain, irrespective of posture. It is also a well recognised side effect of blood pressure-lowering medication.
Recurrent fainting requires attention on its own account as these episodes are unpredictable and distressing, and there’s a heightened risk of fracturing a bone on falling. Theoretically the diagnosis should be straightforward – when measuring the blood pressure, first on sitting and again on standing, results in a sustained drop of more than 20mm of the upper (systolic) reading or 10mm of the lower (diastolic) reading.
The difficulty is that the fall in pressure on standing is not invariable and so may not occur when measured in the doctor’s surgery. The obvious way round this would be for the patient to take the two measurements with an automatic device at home several times a day. This approach has recently been shown to be reliable but has also revealed OH to be considerably more prevalent than previously realised, occurring in as many as a third of those taking anti-hypertensive drugs. The significance of this finding requires no elaboration, indicating it may be necessary to reduce the dosage of medication or discontinue it altogether, under the guidance of your doctor.
Several readers have understandably taken issue with my recent comments on the value (or otherwise) of most blood tests. A gentleman troubled for some time with fatigue, muscle weakness and sensitivity to cold describes how a ‘home’ blood test revealed this to be due to an underactive thyroid, requiring lifelong medication with thyroxine supplements. Or again, a woman reports that her mother, afflicted with general malaise and a pain in the temple, attended her surgery eight times before her doctor eventually performed the relevant blood tests. This showed she had the serious inflammatory condition of Giant Cell Arteritis, requiring treatment with high-dose steroids.  
In both instances the pattern of symptoms was strongly suggestive of an important medical condition, but whose definitive diagnosis required the appropriate confirmatory blood test. So, no disputing their value here – nor in ascertaining what might be amiss in those with non-specific complaints of tiredness, weight loss, bowel disturbance and so on. They can also be useful in screening for prostate cancer or high cholesterol levels and identifying those rare but treatable causes of some common conditions – such as an overactive thyroid resulting in atrial fibrillation (an irregular heartbeat) or iron deficiency in unexplained itchiness.
The point of issue concerns the utility of the vast majority of blood tests nowadays routinely performed by family doctors or promoted by commercial companies, but for which there is no clinical indication. These may, if very occasionally, point to some hidden abnormality, but whether this justifies the considerable cost and time expended in pursuing ‘borderline’ results is increasingly questioned.  
Finally, a further instance where a painful left shoulder accompanied by abdominal pain may, as mentioned a fortnight ago, provide an important clue to a disorder involving the diaphragm.
Derby surgeon Richard Hall reports this may be a sign of a ‘rolling’ hiatus hernia, where a gap in the muscular diaphragm permits the stomach to herniate up into the chest. “Such hernias can be dangerous”, he notes – warranting further investigation with a view to corrective surgery.  
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