If you experience giddiness and fainting, the first step we take is to measure your blood pressure lying down and standing up to see if orthostatic hypotension is the cause of your symptoms. We will also take a detailed medical history from you as this often sheds light on the cause. We may also order bloodwork to exclude other non-cardiac causes of fainting.
An ECG will be done to exclude any ECG changes that can lead to cardiac arrhythmias and fainting. A more detailed analysis of your heart rhythm can be done by putting you on 24-hour Holter monitoring.
We will also perform an echocardiogram 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 and you may need to undergo a tilt-table testing at our centre. At the end of 40 minutes, if you have not developed any signs of fainting, sublingual glyceryl trinitrate will be given to stress the system further and we will repeat the test for another 15 minutes.