My heart is fine. Yay! Now what?
September 1, 2011 5:39 PM   Subscribe

People who faint filter: I want to know about the exercise habits of folks with vasovagal syncope.

MeFi, thanks for alerting me to vasovagal syncope. I finally got my diagnosis-by-exclusion this week (no tilt table test) after lifelong syncope and pre-syncope episodes. As I told a cardiologist this week, I haven't actually passed out since 2002, but that's due in part to my learning to be more attuned to the sensations beforehand, and sitting or crouching down before they get too bad. This happens maybe once or twice a month right now, usually in the mornings after a brisk walk when I hit the crowded, hot train into work. I've got that part under control.

What I'd like to hear more about is how other folks who've had some overlap between exercise or overheating and fainting or almost-fainting deal with exercise. My cardiologist correctly guessed that I'd probably felt worse as a child/adolescent than I do now, because my blood pressure was lower. It's hard for me to say how much that played into my terrible attitude towards gym and sports as a kid, but I suspect spent a lot of time throttling back my activity and assuming that all non-athletes felt completely horrible when exercising.

Lately I can't get over how much more fit I feel than anytime in my life, and would like to get more in shape. But I'm still highly reluctant to push myself. I like hiking because I can stop whenever I want (and I've had recent pre-syncope episodes while hiking). When I've tried doing higher intensity activities in the past few years, I tend to stall out and want to quit as soon as I hit something that gets my heartrate up near max. I have a suspicion this could be a mental aversion - feeling overheated with blood rushing in my ears has been associated with me feeling nauseous and passing out, so anything that feels like that, I want to stop doing as soon as possible. But hey, assuming things is what led to me waiting until I was 28 to get this thing diagnosed.

People who faint: what are your attitudes towards exercise? How (if at all) do you modify your exercise program to compensate? Any activity recommendations, tips, or things to avoid?

YNMD note: I do not have issues with blood pooling in my legs, and my cardiologist gave me the all-clear after a normal heart ultrasound and ekg. She is not concerned about me exercising, and when I asked her if she had any recommendations for exercise, told me not to worry about it and to continue using common sense if I feel like I'm going to faint.
posted by deludingmyself to Health & Fitness (11 answers total) 7 users marked this as a favorite
After a near-miss at the gym, I've learned that I need to do exercises that feel like they're difficult. Treadmill is good for me. Tennis is good too, as long as I don't get too crazy chasing out-of-bounds shots. Elliptical is bad; it's so smooth, I don't know that I've over-exerted until I get off. YMMV. Take frequent breaks for water, and to catch your breath/cool down. And in general, I go for slow burn instead of high-intensity blasts.
posted by specialagentwebb at 5:54 PM on September 1, 2011

Best answer: People who faint: what are your attitudes towards exercise?

I faint fairly easily, and being overheated and falling suddenly/sudden pain (slipping on a floor, bumping an elbow) are triggers for me. I do not, absolutely do not, do anything like running if it's above 85 degrees out. I'll do other physical activities, like a sport or hiking, if it's super hot out, because there's more stopping and refreshment having and all that, but I'm still careful and I'm just much less active outdoors in the middle of a summer day. I'll stick to the gym. Also: no Bikram yoga for me. Not ever.

However, if temperature conditions are optimal, you should not be fainting unless you are letting your blood sugar get too low. Eat something small beforehand, a few nuts or a half peanut butter sandwich or something. If you're really worried, have a bit of fruit with you (along with water). A few times I got a bit dizzy after an especially hard workout, and all I wanted was JUICE JUICE JUICE which I think was my body's way of saying it wanted a little extra sugar, because I don't usually like juice.

Hope this helps. Oh and yes, it was worse when I was younger, but I think partially because I didn't know this was a thing for me and didn't know my triggers.
posted by sweetkid at 5:54 PM on September 1, 2011

Best answer: I have never fainted, but I have a condition that precludes a lot of the same exercises because otherwise the blood at my brain stem starts throbbing and I get The World's Most Awful Headache.

Things that are right out:
-lifting anything more than 15 pounds
-anything that requires tilting my head up or reaching above my head
-anything that requires moving my head/torso up and down (toe touches, situps)

Things that are recommended for people with the thing that I've got:

Turns out that I can't swim because I become completely disoriented when my sense of balance is thrown off, so that's out, too. I also haaaate biking with a seething rage. So what actually happens is that I don't exercise (though I do walk an awful lot and always opt to take the stairs instead of an elevator).

But those (the swimming and the cycling) are two things that may work for you. Make sure you always take a buddy (who has a cell phone!) along when trying new activities, and always make sure someone knows exactly where you are when you strike out alone, just in case you do have a medical emergency.
posted by phunniemee at 6:18 PM on September 1, 2011

the best thing ever is water exercise in a cold pool. i was never much of a swimmer, but there's various types of water aerobics classes that can get pretty intense, depending on the class. i was capable of so much more exercise in water than out of it--it was dramatic.

here's a book i used sometimes for solo water workouts.

i have postural orthostatic hypotension, and the feeling of being immersed in cool water is amazing. i can't work out like i used to these days (other health probs screwed up my stamina), and i fantasize about water.

when i was diagnosed, mayo recommended strength training for my legs and core. the reasoning behind that, though, is blood pooling. (i did a ton of strength stuff for a while but honestly couldn't tell--it was prob a subtle difference)
posted by JBD at 6:43 PM on September 1, 2011

Best answer: I faint if I get too hot, or if I get fairly hot and do a lot of kneeling and standing (gardening). I have found that I can do Couch to 5k if I must do cardio exercise, and I do it indoors (to avoid heat) on a treadmill; because it's interval training and starts at a basic level, it's difficult to over-tax yourself before you're ready. I repeated several of the same weeks in a row just to feel safe about moving on to the next.

For the most part, though, if I do anything, I stick to anaerobic activities (weights), and I do them indoors. Like you, I also tend to do hiking and walking provided it's not too hot out. You can do better in heat if you get some hiking clothes specifically designed to keep you from getting too hot; a good tip I got while being a volunteer gardener was that I would be less hot wearing a long-sleeved shirt of that special material than wearing a tank top, and it was true!

Like you, it's rare that I actually faint because I recognize the warning signs; I've only actually fainted a few times. The shower is way worse for me than anything else, and even when I've pushed myself exercising I've never fainted. It's mostly the shower and gardening in extreme heat that do it to me. I don't know about you, but when I'm on the verge of fainting I get a wave of extreme vertigo and nausea combined, and I'm okay if I abruptly sit down (or get out of the shower) and remove myself from heat ASAP. It's a really obvious sign in my case. I generally feel comfortable trying whatever exercise and assuming I won't faint, knowing that if I turn out to be wrong, it will be obvious before it turns into a real fainting episode.
posted by Nattie at 8:29 PM on September 1, 2011

I'm a fainter (probably fainted 30-40 times in my life...mostly due to having a fever, seeing blood, or standing up too quickly) and it doesn't impact my exercise habits at all. I jog, bike, and play soccer, and pretty much exercise however I want and it's never even crossed my mind that it could lead to fainting, because it hasn't. The only time I can recall feeling woozy after exercise was after doing a bunch of sprints at the end of high school sports practice and I didn't actually faint.

As long as you are aware of your pre-fainting symptoms (for me, it's muffled hearing), I think you're fine to push yourself and get that heart rate pumping. I can see what you mean about things that remind you of fainting turning you off- I don't like wearing earplugs because the muffled hearing makes me feel fainty. But give it a try!
posted by emd3737 at 9:52 PM on September 1, 2011

I faint with some frequency, and I'm a runner. I think I'm only echoing others, but here are the things I do to deal with this:

1. I make sure I'm well-hydrated and well-rested. I try to eat something before I run.
2. I carry ID on me, as well as a little card that says what to do if you find me in a heap on the ground.
3. I usually bring some sort of watered-down juice or gatorade with me.
4. I don't run if it's hotter than about 75 degrees.
5. I mostly run on grass. I've passed out while running on concrete and while the passing out wasn't bad, the injuries to my face were.
6. I stop the moment I feel a little off. Not just slow down - stop. Sit down, if you can. If you're comfortable with it, ask someone for help, just so that you're not alone.

By being prepared, I've become less anxious about it, and my most recent fainting episodes have been less worrisome because by the time I passed out, I was already sitting on the ground and pretty sure that I would faint. Try to remove the worry and fear from the experience.
posted by punchtothehead at 5:23 AM on September 2, 2011 [1 favorite]

Best answer: I tend to faint after exercise, not during. The last couple times have been due to standing in hot, stuffy places after a couple hours of biking. Things I've been doing to prevent this from happening again: carry around sport beans/power bar and water, call a friend and have them bring me home, sit down immediately when the brain tinglies start, and stop doing stupid shit like biking for 4 hours on an empty stomach and then standing around in a hot bar watching world cup soccer games.

I don't have this problem after running because I'm too sweaty to hang out in public - it's straight home to the shower for me. I swam in high school and never had any issues with fainting there, either. I just think that for me, extended period of exercise + heat + standing around + low blood sugar + being tall + moderate dehydration = fainting. I bike all the time, so I'm more delusional about my limits there because my brain computes biking = transportation rather than biking = exercise.
posted by Maarika at 4:38 PM on September 4, 2011

Response by poster: You're all really best answers. Thank you. Even though the collective wisdom can probably be summed up as "don't be stupid and listen to your body," thank you. I'll see about (carefully) adding in some more strength training.
posted by deludingmyself at 9:14 PM on September 11, 2011

I'm 62 male, and have been a runner for 45 years. This year for the first time I have had 3 syncope episodes after (not during) a relatively short 1-mile warmup on a cold morning, a timed mile on a warm evening, and a 10-minute twilight park run/walk/jog on a warm evening. All are things I have done hundreds of times, even very recently, with no problems.

All brain, heart, blood, long-term monitor, CAT, MRI, etc. tests are fine -- currently my insurance won't pay for referral to the full-scale Exercise Physiology & Medicine lab (with the tilt table etc.) but I'm working on that. I want a diagnosis, primarily to show to the EMTs when they arrive, but also to explain to the friends and kids who have seen me hauled away.

This has been soooo life-changing I can't describe it. I now run where people are, usually carry ID, go slow and long and savor the excellence of it all, don't compete etc. When I get the tinglies, I make a point to keep running, because that's what feels best. Almost always it works, but... I have questions!

When I start out or go up any significant hill, I get "burps" that I think are caused by the stress but also induce pre-syncope feelings. I've found that that I have to clear the "burps" and when they are cleared (forced burping... sounds repulsive) I feel excellent. (Is this a cause-and-effect vicious circle?) Does anyone else have this problem?

What do the rest of you experience as you come out of the faint?
The 2 or 3 hours following a full syncope for me are extremely disagreeable, with cold sweat, tunnel vision, labored breathing, nausea if i move, fatigue, and a strong desire to sleep -- which seems to be the best thing. But it's difficult to stand and walk... therefore hard to get myself back to my car let alone drive home and 2 hours is too long to just sleep it off in the car. How do you handle times like this?

I'm soooo glad to hear from you all as to how you manage syncope and what you avoid. After maintaining 25-40 miles a week for decades, plus two dozen marathons and some ultras, I know what I'm doing as a runner but this doesn't appear to be an injury that I can deal with in the accustomed ways. I will continue to maintain leg tone (how better than by running?) and weight and eat right and try to develop ways to crouch etc. to stop the tinglies when they get too heavy, and stay hydrated, and keep protein bars handy and avoid hot places and make a better ID with instructions. And try to tune myself to when it'll get better if I keep going and when it'll get better if I stop and walk, that's a hard one because I'm trained to always keep going.
posted by morrc at 8:45 AM on September 15, 2011

punchtothehead: What instructions do you put on your ID telling people what to do (or not do) if they find you after a faint?

I see you're a runner, so what are the next hours like after you've fainted and how do you get yourself home?
posted by morrc at 3:11 PM on September 17, 2011

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