Take Heart

I have a condition called neurocardiogenic syncope, which, for the most part, is not as bad as it sounds. The following is the best summary I could find:

Neurally Mediated / Neurocardiogenic Syncope

"The medical term for fainting is syncope. It comes from the Greek term 'syncopa,' meaning 'to cut short.' Syncope can occur due to many reasons, and figuring out the exact cause can be difficult. Over the last several years we have learned a lot about one particular cause of fainting: The disorder now known as neurocardiogenic syncope.

Neurocardiogenic syncope is also known as vasovagal syncope or neurally mediated syncope. It describes a transient failure of the brain to adequately regulate the body's blood pressure and heart rate. The exact reasons why this occurs are still unclear, but a basic understanding is evolving. The blood pressure control centers are located in the posterior parts of the brain (the brainstem or medulla). Every time a person stands, gravity pulls blood toward the lower extremities. The brain senses this change and compensates by increasing the heart rate and tightening (constricting) the blood vessels of the legs, forcing blood back upward to the brain. These centers in the brainstem (the autonomic centers), then work as a sort of thermostat to regulate blood pressure. In neurocardiogenic syncope, the system periodically breaks down allowing the blood pressure to fall too low, causing the brain to lose its blood supply resulting in loss of consciousness (fainting).

These episodes frequently begin in adolescence following periods of rapid growth, although they can occur at any age. While the mechanism by which one loses consciousness is benign, the consequences of suddenly hitting the floor may not be. As the American humorist Will Rodgers observed, "It's not the fall that hurts, it's that sudden stop at the end." While many people will have some sort of warning that syncope is imminent (lightheadedness, dizziness, etc.), some people will not.

Tilt table testing is used to determine a person's susceptibility to these episodes. A patient is strapped to a special table and slowly inclined upward to an angle of between 60 and 80 degrees, and kept up for around thirty minutes. This provides a constant low stress (gravity) that should be easily tolerated by a person with normal autonomic function. [Side note: I have had this test done, and it was NOT pleasant.]

However, in patients with poor autonomic control, this relatively mild stress will provoke a sudden fall in heart rate and blood pressure. Some centers will also use a synthetic form of adrenaline (isoproterenol) as an additional stress.

Therapy for patients with neurocardiogenic syncope has to be individualized to fit that person's needs. Many patients with
neurocardiogenic syncope need only avoid predisposing factors (such as extreme heat or dehydration). Some will require medical therapy to prevent further fainting spells. A variety of different medications are used, and no one therapy works for everyone. Some patients may require therapy with low doses of two or three agents in combination. This is often tolerated better than a very high dose of a single agent.

In summary, neurocardiogenic syncope is a complex and common disturbance of the autonomic nervous system that can lead to sudden drops in blood pressure leading to fainting (syncope)."

Blair P. Grubb M.D. (http://www.ndrf.org/ParoxymalAutonomicSyncope.htm)

This makes my morning commute very interesting. Though I am on medication (a beta-blocker), which generally prevents me from losing consciouness at random, extended bouts of standing (for example, on the Metro during rush hour) are still an iffy prospect for me. I have trained myself to (usually) keep from freaking out about the prospect of fainting (panicking about it only makes it worse, i.e. flipping my shit makes me more likely to pass out), but sometimes that old anxiety creeps up and catches me unaware. If you think about it too much, the notion that you have very little control over such a simple and intrinsic thing as your own consciousness and ability to remain upright can be quite terrifying... especially for a control freak like me. So in addition to the meds, I have devised other coping mechanisms to combat my body's tendency to crap out when I stand for too long. Mostly I just never stand still. Any time I have to stand, I fidget, remaining constantly in motion, focusing on keeping the blood flowing, especially in my legs where it is wont to settle (and therefore never make it back to my brain). So if you see a tall chick with dykey hair on the Metro shifting her weight awkwardly back and forth, please know that she's not crazy or trying to bust a move -- she's just trying to avoid being that asshole who passed out on the Metro and made everyone late to work.