FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

BLACKOUT SPELLS COULD SPELL TROUBLE FOR READER

Question: I've had a couple of blackout spells, but I didn't fall or get hurt, and I feel fine now. My doctor seems worried and has ordered a number of expensive tests. I don't have insurance to pay for the tests. Are they really necessary?

Answer: You didn't explain enough about your "blackout spells" to be certain, but it is logical to assume your doctor asked more about their history than is recorded in your letter. Your doctor has also had the opportunity to personally examine you. Therefore, I must conclude that these tests are important for your health care.

Often, sophisticated and therefore expensive tests are needed to identify the cause or causes of blackouts and help your doctor determine the most appropriate therapy. He or she can then tell you what to expect from the condition and its treatment. This is important because some causes of blackouts are curable, some are treatable, and others have ominous, life-threatening implications. Your lack of insurance doesn't really change the importance of the tests, only the way in which you pay for them.

A blackout can result from several different types of health problems. One of the least worrisome causes is a heat-related illness. It is possible to get "over-heated" and have mild dehydration from heavy perspiration. When this situation is then combined with standing for a long period of time, a blackout is not an uncommon result. This scenario is often associated with soldiers who are required to stand in formation after vigorous exercise; it can, however, happen to civilians just as easily. Prompt and complete recovery takes place after a brief rest and consumption of large quantities of liquids to correct the dehydration.

A blackout can also be due to the side effects of medication particularly some types of blood pressure pills and a rapid change in posture. If you are on one of these drugs and change from a sitting or squatting position to a standing position, you may experience a momentary lack of blood supply to the brain. The resulting blackout is brief and corrected by either sitting down or, in many cases, falling flat on your face.

To understand why the brain's supply is interrupted, it's necessary to explain what normally happens when a person stands up. In this situation, the heart must suddenly increase its pumping to maintain the proper blood supply both to the now-elevated brain and to the legs. This increased pumping usually occurs without any difficulty. However, some blood pressure medications slow the necessary reaction of the heart to this increased demand. The resulting brief drop in blood supply to the brain produces a blackout because the brain is a bit different than most other organs it requires a constant supply of blood. Even a brief interruption of it causes a loss of higher brain functions: in other words, a blackout.

Blackouts can be the result of an irregular heartbeat. Everyone has an occasional irregular or skipped heartbeat, and these are of no health consequence. But in some types of heart trouble, you have one irregular heartbeat after another. This keeps the heart from effectively pumping blood to all of the body, including the brain. And as you now know, a brief lack of blood to the brain causes a blackout. Usually the heart resumes its normal rhythm after a moment, so the spell ends. This abnormality is often the sign of heart disease. Your doctor has probably asked you to have an electrocardiogram (EEG) and a Holter monitor to find out if your blackouts are due to your heart.

A seizure is a common cause of blackouts. This abnormality of the brain causes loss of consciousness and may or may not be associated with jerking or movement of other body parts. Seizures can be due to epilepsy, certain medications, so-called "recreational drug use" particularly cocaine or from brain tumors. Unfortunately, sophisticated and expensive tests are often necessary to identify the specific cause. Epilepsy is very treatable but not curable, while other causes, such as a malignant brain tumor, have ominous consequences. So work with your doctor and hospital to figure out a way to get these tests done. They are needed.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.