The 17-year-old sat for two hours when he got up to go to the bathroom, it happens: After a few quick steps, he gets dizzy. He leans against a wall. His vision is disturbed, he hears a low humming sound.
The mother of the young man is nearby and therefore experiences what happens next. The body of the 17-year-old slackens. He falls to the ground where he twitches for about 20 seconds. She notices that his arms and legs are limp and the jerks are not rhythmic. Besides, her son is very pale.
About a minute later, he comes to consciousness again, shortly after he is again completely oriented and clear. He does not feel exhausted or ill, he can stand and walk normally.
Immediately after his fainting, the patient is examined in an emergency room in Wisconsin. Among other things, the doctors measure cardiac activity by ECG. The heart rhythm is normal. However, his heart beats faster and his blood pressure drops as he gets up. The doctors send the patient, who is now well again, with the note home, that he should make an appointment with his family doctor.
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This event will take place one month later, according to Alexa Beversdorf of the University of Wisconsin in the Journal of Pediatric Health Care. Although he is already 17, the case falls into the pediatric and adolescent medicine.
No illnesses, no drugs
There the patient tells that he has never fainted before the event. He did not hurt his head and never had a seizure. The young man plays basketball. He has had no health problems, has never undergone surgery, has no allergies, does not take any medications and is vaccinated according to the vaccination plan. He does not smoke, does not drink, does not use drugs.
His mother and grandmother suffer from cardiac arrhythmias, which, however, do not need to be treated, the mother also has an elevated cholesterol value. There are no other special diagnoses in the family.
At the doctor's appointment, the 17-year-old is healthy and relaxed. Again, an ECG is made lying down and then standing up. The values are in the normal range. A blood test confirms that the patient is not taking any drugs.
What could have triggered his powerlessness? Cardiac arrhythmias or other heart complaints could be a possible reason. But the inconspicuous ECG excludes this cause.
Did he have an epileptic seizure? As the mother describes the event, this may not be the case. Because such seizures typically last longer than a minute. Also, the patient recovered quickly after fainting - after an epileptic seizure, sufferers often have a longer period of disorientation, confusion, and exhaustion.
The diagnosis is
After the exclusion of these causes for the doctors only one diagnosis in question: The 17-year-old has suffered a so-called neurokardiogene fainting. This is not uncommon especially in children and adolescents. It occurs more often in girls than in boys. The cause is not fully understood. The symptoms, however, fit.
Before the boy lost consciousness, he was dizzy, he could not see properly and hears a low humming sound. Also, the ECG from the emergency room helps with the diagnosis, because there the heart rate increased and the blood pressure dropped when the patient should get up.
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Probably in the fainting by a wrong nerve regulation, the blood vessels are greatly dilated, whereupon the brain is not sufficiently supplied with blood, so get too little oxygen. This then leads to loss of consciousness.
A treatment with drugs is not necessary in the 17-year-olds. He is sent home with some advice for everyday life. If he feels the symptoms of fainting, he should sit down or lie down. He should also eat more salty foods and drink two to three liters of water a day.
It is important for those affected not to get up abruptly, but rather slowly, explains Klinikum Augsburg in a patient information. They should also avoid prolonged standing. If this is necessary, certain maneuvers help to cross over the legs and press them together, clawing the toes in the shoes and tensing the abdominal and gluteal muscles from time to time.