You get up one day, or get up from a chair, or just stand there and you faint.

Fainting (or by its medical name, syncope), is one of the most frightening problems for patients, but it’s also a common problem. 1-3% of visits to the ER are due to fainting each year.

In this article, we will cover the various reasons behind fainting. As with our other solutions pages, this data is not meant to replace a doctor’s advice, and only serves as a reference.

Definition

Syncope (or fainting) is defined as a sudden, brief loss of consciousness caused by a decreased blood flow to the brain.

Syncope

Causes

The causes for syncope can be divided into 5 groups, as can be seen in this diagram:

1. Vasovagal:

In spite of the numbers above, this is the type most commonly seen in the hospital.
This type occurs when the body over-reacts to certain triggers. Examples of these triggers include:

a. The sight of blood, or having your blood drawn
b. Standing for a long time
c. Exposure to heat
d. Pain
e. Emotional stress
f. Fatigue
g. During normal body functions such as coughing, urinating, swallowing or straining in the toilet.

This is caused because the vagus nerve, a part in our nervous system which helps regulate our blood pressure and heart rate, malfunctions. This causes our heart rate to slow in response to the above triggers, and the veins in our legs to widen, causing blood to pool in your legs. Both of these come on the account of blood coming to the brain, causing the brain to get less blood, and then we faint.
Usually this type is harmless and doesn’t require any treatment, unless it happens frequently, in which case there are drugs which can help.

Here are some live examples:

2. Orthostatic:

In this type, your blood pressure drops when you get up from sitting or lying down.
When we stand up, blood pools to our legs due to gravity. Usually, special cells in the body sense this and cause our heart to pump faster and harder in order to get more blood up to the brain. When these cells don’t function properly, orthostatic hypotension occurs, causing you to faint.
There are a few things which can cause this:
a.  Dehydration
b. Some forms of drugs
c. Diabetes – Diabetes can damage nerve cells, like the ones responsible for sensing the low blood pressure here.
d. Other neurologic problems

Thirsty? You might faint. Photo by hrtmnstfr.

3. Cardiovascular:

You may also faint if you have problems with your heart. Such problems can include problems with your heart rate (which in medicine are called arrhythmias), and can also include mechanical problems with the heart, which cause it to not pump enough blood to your brain.

4. Neurologic:

There are some neurologic conditions which can make you faint:
a. Seizures – Technically, this isn’t syncope. Your brain does get enough blood, but it doesn’t function properly. (In the future we will cover epilepsia here, so stay tuned).
b. Stroke
c. Migraines

5. Miscellaneous:

There are other things which can cause you to faint, including:
a. Low sugar in your blood
b. Not getting enough oxygen (such as when you dive, or in a fire)
c. Anemia

Even with all this knowledge, in about 35% of cases, the reason behind the faint can’t be found.

Now it’s your turn. Have you ever fainted? Was the reason found? Let us know in the comments.

Related posts:

1. Parkinson’s Disease – 1 Out of 100 People Over Age 60
2. Multiple Myeloma – Bone Marrow Cells Taking Over
3. Graves Disease – Why Some People Are Hyperactive For A Reason

First of all – What is anemia?

Anemia, according to Wikipedia’s definition, is “a decrease in normal number of red blood cells or less than the normal quantity of hemoglobin in the blood”.

What does this mean, in plain English?

First, red blood cells: Our body needs oxygen to function. This oxygen has to reach each and every organ in our body. The oxygen is placed inside our red blood cells, which travel throughout the body in our blood vessels and deliver the oxygen to all organs. The oxygen in the blood cells is carried in a special molecule called hemoglobin

Hemoglobin. Oxygen is delivered in it to all body parts. Photo by Zephyris.

As the definition above says, anemia can happen if one of these two things occurs:

1. When you don’t have enough red blood cells – This can happen if you have less than the normal amount of blood (for example, when you bleed from somewhere in your body).
2. When you have the normal amount of red blood cells, but not enough hemoglobin

How does anemia feel?

When you have anemia, not enough oxygen is delivered to your organs. This can cause fatigue, difficulty breathing when you do physical activity, and if you have a heart condition, it can even bring about angina pectoris.

People with anemia look pale. Their heart rates can be faster (the heart is trying to move more oxygen to the body, so it will move the blood faster). The blood pressure of people with anemia can change as well – it tends to fall when they stand up (“dizzy spells”).

According to the type of anemia (we’ll get to that later), other things can happen as well. This picture sums it up:

What are the causes?

There are many types of anemia. Its causes can be divided into two main groups:

Here’s a rundown of what’s in each group. Please note: Each of the diseases below will be featured in future posts and linked back here, so it’s worth bookmarking this page and returning to it from time to time.

Group 1 – Problems in the production of blood cells

There are a few diseases in this group:

1. Iron deficiency anemia: This is a common cause of anemia. Iron is needed by the body to make hemoglobin. If you don’t have enough of it, the body can’t produce enough hemoglobin. Reasons for this include bleeding from somewhere in your body (such as when you have a period), not eating enough foods that contain iron or problems in absorbing the iron, and times at which more iron is needed (such as during pregnancy).
2. Thalassemia: This is a genetic disease in which there is a problem with the production of hemoglobin.
3. Anemia of chronic inflammation: Sometimes, people with chronic diseases may have anemia due to their illness. Examples of such illnesses include chronic infections, HIV, cancers and others.
4. Folate or vitamin B12 deficiency: Folate (folic acid) and B12 are needed for the production of red blood cells (as well as other cells in the body). If you have a deficiency in any of these, you’ll have anemia. Folate is present in leafy green vegetables and fruit, and B12 is present in foods of animal origin (such as meat. This is why vegetarians can have a deficiency).
5. Other reasons: Other things can also cause problems in the production of red blood cells. These include liver diseases, alcoholism, problems with the thyroid gland, certain medications and others.

Group 2 – Increased destruction or loss of blood cells

1. Blood loss – When you are injured and lose blood, such as after a car accident or a gunshot wound, you lose blood. This causes anemia and your body will not be able to transfer oxygen to your organs efficiently. That is why blood transfusions are often given after an injury.
2. Hemolysis – This is a Greek word (hemo = blood, lysis = to break open) which means the destruction of red blood cells. There are a few diseases which cause this:

   a. G6PD Deficiency – A genetic problem which causes the red blood cells to be more susceptible to damage, which causes their destruction.

   b. Sickle cell anemia – Another genetic disease. It causes the hemoglobin to have a strange shape, which causes the red blood cells to get destroyed.

   c. Hereditary spherocytosis – Yet another genetic disease. In this disease there’s a change of shape in the cover of the red blood cells, which causes them to be more susceptible to destruction.

   d. Paroxysmal nocturnal hemoglobinuria – A disease in which there’s a problem with the cells from which red blood cells are created.

   e. Autoimmune hemolytic anemia – In this disease, antibodies (the molecules in our body responsible for fighting infections) attack the red blood cells and destroy them, for unknown reasons.

   f. Microangiopathic hemolytic anemia – This is a complicated name for a groups of diseases. The common thing they all have is that the red blood cells are destroyed inside our blood vessels. Diseases here include thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), and disseminated intravascular coagulation (DIC).

   g. Hypersplenism – Our red blood cells don’t live forever. They live for about 120 days, and then get destroyed, mainly in the spleen. When our spleen gets bigger it tends to trap more red blood cells and so they get destroyed even when they are not old. Reasons for that includes tumors, infections and others.

How can the doctor tell if you have anemia?

First of all, if you have the right symptoms mentioned above, such as feeling tired and being pale.

Second, they will run a blood test, in which the hemoglobin will be low. (The normal values are 12-14 in women and 14-16 in men). Other lab tests help the doctor understand which anemia you have.

Related posts:

1. Iron Deficiency Anemia – A Common Type of Anemia
2. Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency – When Certain Conditions Can Destroy Blood Cells
3. Multiple Myeloma – Bone Marrow Cells Taking Over

Head spinning is a common complaint in medicine. The main problem with head spinning is actually its definition: People often confuse it with dizziness. When someone comes to the doctor complaining “I feel dizzy”, it usually means one of two things: Either they feel their head is spinning, or they feel they are about to faint.

In this article we’ll cover the first option – head spinning, or in medicine “vertigo”. When you have vertigo you feel as if you are spinning or the world is spinning around you, when there is no actual movement.

Vertigo. You feel as if the world is spinning. Photo by Melle_Oh.

Why is vertigo caused?

3 systems are responsible for our body’s balance:

1. The eyes – For example, if you don’t see where you’re going, you will fall.
2. The somatosensory system – That’s a complicated name, but what it means is that our skin, joints and muscles are constantly sending information to our brain telling it where we are in space.
3. The ears – Our ears have two main parts: The one responsible for hearing, and the one responsible for balance.

Vertigo is usually caused by a problem in the part of our ear responsible for balance (that part is called the vestibular system).

Our ear from the inside (the inner ear). This part is responsible for our balance, and for vertigo.

What are the causes?

A bunch of diseases can cause vertigo, but it can also occur to normal people:

1. Seasickness – We mentioned above that 3 systems in our body tell it where we are in space. Sometimes these systems send different messages to the brain, getting it “confused” – such as when we’re at sea. When we’re at sea, our inner ear will feel the movement from the waves. At the same time, our eyes will tell the brain we’re not moving (since we’re just sitting in our cabin). This confusion leads to seasickness (also called motion sickness).This mismatch between our systems also explains why we have carsickness, fear of heights, and the vertigo some people feel when watching chase scenes in a movie.
2. Unusual neck or head positions – Such as when we paint a ceiling – our necks would be extremely extended, a position to which we are not used.
3. Following a spin – Ever tried to spin on a spinning chair? Most likely after that spin you felt as if the world was spinning around you.

As mentioned above, there are also diseases which cause vertigo:

1. Problems in our inner ear -
   a. Meniere’s Disease – This is a condition in which there is a problem with the fluid inside our inner ear. This causes vertigo, ear ringing and hearing loss.
   b. Benign paroxysmal positional vertigo (BPPV) – In this condition brief vertigo spells that come and go are caused by changes in the position of the head.
   c. Labyrinthitis – This is caused when there is inflammation inside our inner ear. It’s mostly caused by a virus.
2. Migraine headaches – About 25% of people with migraines have some sort of “dizziness”, which can sometimes manifest as vertigo.
3. Stroke – Stroke happens when the blood supply to the brain is disturbed. When the blood supply to the area of the inner ear and our brainstem is disturbed, vertigo can occur. This is a life-threatening situation.

There are other diseases which can cause vertigo, but these are the most common ones.

In the future we will cover each disease mentioned here, so you can return to this page or bookmark it to learn about each of them.

Ever experienced vertigo yourself? Let us know in the comments.

Related posts:

1. Meniere’s Disease – From Head Spinning To Hearing Loss
2. Labyrinthitis – An Ear Infection Causing Loss of Balance
3. Superior Canal Dehiscence Syndrome – Hearing Sounds Inside Your Own Body (As Seen on Grey’s Anatomy)

First, let’s start with the answer: NO. Chest pain isn’t always a sign of a heart attack, or even of a heart problem. We’ll try to sort out the various causes of chest pain here to help you understand it better.

BUT: As with our other solutions pages, the data presented here was not meant to replace a doctor’s advice. In any case of chest pain, you should visit a doctor, and only use this page as a reference.

Also note that in time we will add the diseases shown below to the site, so make sure to bookmark this page for future reference.

Where is it coming from?

As can be seen in this picture, we can divide the causes for chest pain to those coming from the heart, the lungs, or the gastrointestinal tract (or simply gastro. This includes everything from the esophagus to the end of the intestines). Another category is others.

Heart

There are several things originating in the heart that can cause chest pain:

1. Angina – This is the pain which is caused when the heart’s arteries are clogged. (When they are completely clogged, a heart attack occurs). The pain in angina is felt under the breast bone (around the center of the chest) like a deep pain. It usually lasts less than 30 minutes and can radiate to the neck, the jaw or the left arm. It can be accompanied by breathlessness, cold sweat and nausea or vomiting.The pain of angina usually gets worse with physical exertion and is relieved by rest or by taking a drug called nitroglycerine.
2. Heart attack – The pain here actually is the same as the one in angina. The only difference: It tends to last longer (more than 30 minutes), it’s more intense, and usually rest or nitroglycerine don’t help. Of course, the only way to really differentiate between those two is to do an ECG and blood tests.
3. Pericarditis – This is an inflammation of the coverings of the heart. The pain here is different – it’s sharp (and not dull as in angina or a heart attack). It radiates to the trapezius muscle. Breathing makes it worse. It’s relieved when you lean forward and gets worse when you lie down.
4. Myocarditis – This is an inflammation of the heart muscle. The pain is similar to that seen in pericarditis.
5. Aortic dissection – This is a rupture of the aorta (the main artery in our body). It’s a life threatening condition. The pain here starts suddenly and feels as if someone stabbed you with a knife. It tends to radiate to the back, between the shoulder blades.

Lungs

1. Pneumonia – Pneumonia can also cause chest pain. The pain here is aggravated by breathing and is sharp. With pneumonia usually come other things such as breathlessness, fever, cough and phlegm.
2. Pleuritis – This is an inflammation of the coverings of the lungs. The pain here is also sharp, and aggravated by breathing.
3. Pneumothorax – Pneumothorax is a collapse of the lungs, caused by the accumulation of air between the lungs and their coverings, making it hard for them to expand and for you to breath. The pain here is usually one-sided, sharp, starts suddenly and is aggravated by breathing.
4. Pulmonary embolism – A pulmonary embolism is the discharge of a clot from the body which reaches the blood vessels in your lungs, causing blood not to cross the lungs properly – meaning you won’t get enough oxygen into your blood. This is life threatening. The pain here starts suddenly, it’s sharp, and it’s aggravated by breathing.
5. Pulmonary hypertension – This happens when you have hypertension in the blood vessels in your lungs. Usually along with the pain comes breathlessness and pressure with physical exertion.

Gastro

1. Gastroesophageal reflux disease – The pain here is caused by acid going back from the stomach to the esophagus. You feel it under the chest bone (in the middle of the chest), and it feels like burning. Along with it can come an acid taste in the mouth. It’s aggravated by meals or lying down and is relieved by taking antacids.
2. Esophageal spasm – This is a condition in which the esophagus’ muscles contract periodically for unknown reasons. It can cause pain under the chest bone, which is aggravated by swallowing. Like angina, it can also be relieved by taking nitroglycerin.
3. Mallory-Weiss tears – This is a tear in the esophagus that can be caused by vomiting strongly. (It’s more common in alcoholics).
4. Boerhaave’s syndrome – This isn’t a tear, but rupture, of the esophagus. It can also be caused by vomiting, but also by other things which can damage the esophagus. The pain here is severe and is aggravated by swallowing.
5. Peptic ulcer disease – This is caused by ulcers (or wounds) in the intestine or stomach. The pain here is usually in the upper abdomen, and usually relieved by antacids.
6. Pain from the bile system – The bile system releases bile, which helps us digest food. Pain from that system is usually located in the upper right abdomen, can be accompanied by nausea or vomiting, and is usually aggravated by fatty foods.
7. Pancreatitis – This is an inflammation in the pancreas. The pain is usually severe. It’s located in the upper abdomen and can radiate to the back.

Others

1. Pain from muscle or bone – Sometimes, a strained muscle or a hurting bone in the chest can cause pain. This pain is usually localized to a specific area, and it gets worse upon touching the area.
2. Anxiety – An anxiety attack can also cause chest pain. It will feel like “tightness” in the chest.
3. Herpes zoster – Herpes zoster is caused by the same virus that causes chickenpox. This virus “sleeps” in our body, and under certain circumstances can “wake up” and reach the skin, where it can cause a rash and pain (with the pain usually coming before the rash).
4. Disease in the spine – It can also radiate to the chest. It can be aggravated by movement, and usually lasts between seconds to hours.

As you can see, there are a lot of reasons for chest pain, and many of them look and feel the same. The above list can give you a clue, but, again, nothing replaces the judgment and experience of a doctor.

Related posts:

1. Understanding Heart Attacks – Part 2 – Angina Pectoris
2. Understanding Heart Attacks – Part 3 – Myocardial Infarction
3. Stroke – A Heart Attack In The Brain

Abdominal pain is a very common complaint in medicine. It’s estimated that about 75% of adolescent students and 50% of all adults experience abdominal pain.

But how do you know if your pain is serious and how do you get a clue to what’s causing it? We’ll try pointing you in the right direction here. Please note: This article was not meant to substitute a doctor, so please use it only as a helpful reference.

First things first – The location

There are 6 areas that can hurt in the abdomen, each relating to different conditions. We’ll list the possible conditions here, and whenever each of these conditions is added to A Disease A Day it will be linked here (so make sure to bookmark this page for future reference) -

1. Right upper quadrant – That’s where the liver and our bile system are located. Diseases that can cause pain here are hepatitis, cholecystitis, cholangitis, pancreatitis, Budd-Chiari syndrome, Pneumonia, or an abscess under the diaphragm.
2. Epigastric - This is the area of the abdomen under out chest. Diseases that can cause pain here are peptic ulcer disease, gastroesophageal reflux disease, Gastritis, Pancreatitis, heart attack, Pericarditis, or a ruptured aortic aneurysm.
3. Left upper quadrant – That’s where the spleen and part of the stomach are. Diseases that can cause pain here are an abscess or infarct of the spleen, gastritis, a gastric ulcer, and pancreatitis.
4. Left lower quadrant – Diseases here include diverticulitis, salpingitis, ectopic pregnancy, inguinal hernia, nephrolithiasis (kidney stones), irritable bowel syndrome, and inflammatory bowel disease (such as Crohn’s disease or ulcerative colitis).
5. Periumbilical – This is the area around our navel. Disease here could be the start of appendicitis, gastroenteritis, bowel obstruction or a ruptured aortic aneurysm.
6. Right lower quadrant – Diseases here include appendicitis, salpingitis, ectopic pregnancy, inguinal hernia, nephrolithiasis (kidney stones), inflammatory bowel disease or mesenteric adenitis.

Pain can also be all over the abdomen – in which case it can be caused by gastroenteritis, mesenteric ischemia, DKA, porphyria, malaria, familial mediterranean fever, bowel obstruction, peritonitis or irritable bowel syndrome.

Second – How can I tell if it’s serious?

Even though the final decision should be a doctor’s decision, there are some things you can do to tell if your problem is serious:

1. Refer to the appropriate article here on A Disease A Day – Each of the diseases above is marked with a color code for the Danger Level of the disease: Low, Medium and High.
2. Seek medical attention if you have any of the following -
   a. If you’ve had trauma to your abdomen, such as after an accident or injury.
   b. If you feel pressure or pain in your chest – Sometimes the pain of a heart attack can be felt as abdominal pain.
   c. If the pain is so severe that you find yourself unable to lie still
   d. If you have Bloody stools, or blood in the vomit
   e. If you have an Inability to pass stools, especially if you are have persistent nausea and vomiting
   f. If you have Fever
   g. If you have an Inability to keep food down that lasts for several days
   h. If you have Difficulty breathing
   i. If you have Painful urination, or urination that is very frequent
   j. If the pain lasts for several days and doesn’t go away

Related posts:

1. Chest Pain – Is It a Heart Attack?
2. Hernias – What Causes Them And How To Lower Your Chance of Getting One
3. Fibromyalgia – Chronic Pain and Fatigue