When the patient presents with giddiness and fainting, the first step is to measure the blood pressure lying down and standing up. If there is the presence of orthostatic hypotension, then it can account for the symptoms. A careful history will be obtained by our doctors as the cause of fainting is usually apparent from the story told by the patient. A blood workup may be done to exclude other non-cardiac causes of fainting.
A ECG will be done to exclude any ECG changes that can lead to cardiac arrhythmias and fainting. A more detailed analysis of the heart rhythm can be done by putting the patient on a 24 hour Holter monitoring.
An echocardiogram will also be done to exclude any structural heart diseases that can lead to giddiness and fainting such as hypertrophic cardiomyopathy, valve stenosis and depressed heart function etc.
An ultrasound of the carotid arteries will be done as well to exclude any obstruction of blood flow to the brain.
Sometimes, the nervous system may be implicated as a cause of the fainting. The patient may be asked to undergo a tilt-table testing at our centre. This will usually involve patient lying on the tilt table in an upright position for 40 minutes. The patient’s ECG and blood pressure will be monitored continuously to see any changes which may lead to fainting. At the end of 40 minutes if the patient still has not developed any signs of fainting, sublingual glyceryl trinitrate will be given to stress the system more and the patient is again held in an upright position for another 15 minutes. The test usually ends at the full interval if the patient has no reaction or when the patient develops the faint.