Treatment options

Syncope (fainting) can have many different causes. The majority are not life-threatening and can usually be easily controlled. However, a very small minority can be dangerous. As a result, some causes of fainting are more treatable and can be improved with simple self help measures. Others are complex and may require medication or pacemaker options.


Managing your syncope:

Counter Manoeuvers

  1. As soon as you experience 'pre-syncope' symptoms (hot, clammy, sweaty, nauseous), learn to immediately squat or lie down which could help avoid a complete blackout.
  2. Do not try to fight your symptoms by standing up. You are not stronger than your blood pressure and it will win!
  3. If you are not able to lie down, cross your ankles and tense your calf-muscles as this will help to get the blood pumping around your body and increase your blood pressure, combine this movement with buttock clenching to make effects more pronounced which will alleviate the symptoms. This is a really useful exercise if you are caught at the supermarket checkout!!
  4. If you are able, sit down immediately or, if possible, lie down flat and put your legs in the air - for example against a wall or propped up on pillows, if you can it is preferable to do a cycling movement with your legs.

Daily routine

  • When getting up in the morning, sit on the side of the bed for a few minutes before attempting to stand up. If you feel dizzy, sit down for a few more minutes then start again. If you are able, ask someone to bring you a cup of tea and a biscuit before rising.
  • Eat regular meals, particularly breakfast. Low blood sugar is no friend of people who faint!
  • As a rule blood pressure is higher during the afternoon so try to schedule your activities for that part of the day.
  • Try to avoid tasks that include prolonged periods of standing, especially if having to stand still – not a good idea!
  • Sleep with the top end of your bed raised a few inches. This will help prevent fluid loss during the night and so help keep your blood pressure up.

Summer Days

As soon as the weather becomes warmer, you may find you need to increase your fluid intake and take a drink more often. It is very easy to become dehydrated in the hot weather and this is one of the most common triggers. A little extra salt may also be necessary. Avoid getting overheated – ensure you have your fans for those lovely balmy days that everyone seems to enjoy, except you! Wear loose clothing.


Tried and Tested Tips

  • Support tights worn during the day can help prevent blood from pooling in your legs, but remove them before going to bed.
  • Regular exercise can improve the muscle tone in your legs which will help return blood to your heart, good for the legs also!
  • Avoid activities that cause you to strain, such as lifting heavy objects as this can cause the heart rate to slow down and so lower the blood pressure. Men may benefit from sitting whilst they urinate.

  • Small frequent meals are preferable to large meals which can cause the blood vessels to enlarge and reduce blood pressure. For the same reason it is advisable for some sufferers to avoid alcohol, or at least an excess of it.
  • If working in a hot atmosphere, open plan offices or a small area, it is advisable to have a fan on hand for those days when you are not one hundred percent.



In recent years a drug has come onto the market, Midodrine, which can safely raise blood pressure in sufferers of syncope. It works by constricting the blood vessels, which reduces blood pooling in the legs and increases blood pressure.

Much patience is required in the treatment of syncope and POTS as medications that help some may have no effect for others and in some cases make matters worse. Midodrine is one of the more successful drugs and and has few side-effects. Itching, tingling and feeling cold are some of the adverse reactions, but these can easily be controlled by changing the dosage.

Common side effects of beta-blockers include fatigue, cold hands, dizziness and weakness. Less common side effects include shortness of breath, trouble sleeping, loss of sex drive and slow heartbeat.

Some people find that they make them very dizzy and nauseous so have to stop taking them.

For some sufferers of syncope and POTS, Midodrine can significantly improve the quality of life.


Beta-blockers work by blocking the effects of the hormone adrenaline. As a result, the heart beats more slowly and with less force, thereby reducing blood pressure. Beta-blockers also help blood vessels relax and open up to improve blood flow.

Some beta-blockers mainly affect your heart, while others affect both your heart and your blood vessels. This is why they can be prescribed for people with high or low blood pressure since different types do different things. Some people are put on them for stress even though they have low blood pressure, but others are put on them to lower high blood pressure.

Beta-blockers might be prescribed for:

  • High blood pressure
  • Arrhythmia
  • Heart failure
  • Chest pain (angina)
  • Heart attacks
  • Glaucoma
  • Migraines
  • Generalized anxiety disorder / Stress
  • Hyperthyroidism
  • Certain types of tremors

The following are the more commonly prescribed beta-blockers:

  • Atenolol
  • Metopropol
  • Propranolol
  • Sotalol

However, whatever medication you may be given, no doctor would consider it unreasonable if you asked him/her to explain how it could help your particular symptoms. Taking medication and not understanding why you have been given it can be counter-productive in its effectiveness.


If your doctor has suggested that you have a pacemaker fitted it is because you have an abnormality in the electrical conduction system of your heart. Read more >>


Lifestyle advice for patients prone to syncopal episodes

Syncope and Diet

Blood pressure and pulse rate can be influenced by what we consume. These changes can be quite dramatic in a patient with Vasovagal Syncope or Postural Tachycardia Syndrome (POTS). This can work to the advantage or disadvantage of the patient.

Life can feel very complicated when you have Vasovagal Syncope or POTS. You may have to attend lots of medical appointments, make adjustments at work or be unable to work, support family members who are also affected, keep your environment and clothing cool, monitor your posture, exercise regularly - and all this when you feel tired and unwell. Why should you also have to watch what you eat and drink?

Actually, this is all about a healthy diet. With the exception of high salt intake, it’s what everyone should aspire to, whether you have autonomic problems or not. It also helps to give you some control over your symptoms. It’s healthy, it makes you feel better and it can be rewarding. Read more