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The diagnosis
A young man keeps falling unconscious. The answer comes from a mini device
Loss of consciousness is one of the most common medical emergencies
© Katrin Funcke / Art Act / stern
He’s actually young and healthy, but a man in his mid-twenties keeps fainting. The doctors find nothing. Until an expert uses a small device for monitoring.
A friend called me because he was worried about his son. For four years, the twenty-something has been unconscious for a short period of time every few months. He was checked several times in the emergency room and each time he was released without having done anything. The only advice he was given was to drink less and party. A farce, because the young man had long lived a withdrawn life out of worry. Relationships had broken down because he had become so discouraged and believed he would die soon.
He confirmed what he had told me at the first meeting. The fainting always comes completely suddenly, and after a few seconds he is completely back. In the clinic, an ECG was done several times, blood pressure was measured and the heart was examined using ultrasound. All values were unremarkable.
Loss of consciousness is one of the most common medical emergencies. In addition to cardiac arrhythmias and low blood pressure, possible triggers include seizure disorders, i.e. epilepsy, or metabolic disorders such as hypoglycemia. The brain can also react to emotional stress such as disgust, shock or fear by fainting. It almost always occurs because the brain does not receive enough blood supply. Special receptors measure oxygen levels and blood pressure in the blood vessels that supply the brain. If the values drop, it switches off.
Cardiac arrhythmia despite young age
This week: Dr. Behrus Subin, practicing cardiologist in Hamburg
I checked the patient and found nothing. I ruled out psychological causes. Father and son had credibly assured me that that couldn’t be the reason. The young man was otherwise physically healthy and took no medication. That leaves the heart and circulation: If the twenty-something only fell unconscious every few months, we would have to monitor him over a longer period of time to find the real cause; a measurement over 24 hours was not sufficient. I suggested an “event recorder”. The device is similar to a USB stick and is implanted under the skin near the heart. A microchip records all events. He agreed to the harmless procedure and I carried it out.
On a Monday two months later, I found an alarm message from the event recorder in my emails. It was from the weekend. I was able to view the recordings online: On Saturday the man’s heart had stopped for 13 seconds; he had had a cardiac arrest. On the phone he said he passed out at a wedding. Because he knew that he wouldn’t be helped in the clinic anyway, he continued to party after he came to. In my head I went possible diagnoses. He almost certainly had what is known as sick sinus syndrome (SSS). This includes various cardiac arrhythmias in which the sinus node does not function properly. This is a collection of cells in the heart that set the rhythm of the heart’s beating frequency, similar to how the batsman rows. If the clock generator is damaged, the heartbeat can accelerate significantly or, as here, extremely slow down.
SSS usually occurs in older people when the sinus node tissue is damaged by heart failure, myocarditis, or coronary artery disease. Certain medications or illnesses such as diabetes are also possible triggers. The disease is extremely rare in young people. In this patient’s case we found no trigger. The best way to treat SSS with a slow heart rate is with a pacemaker. Since I put a pacemaker in the man, he hasn’t fainted. He has found new courage to live and even got married some time ago.
The diagnosis is also available to listen to: The podcast of the same name with stern editor Dr. You can listen to Anika Geisler music every two weeks for free via the RTL+ app or wherever podcasts are available.
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