Our Services / Syncope

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Syncope (fainting) is often a harmless event triggered by dehydration or the sight of a needle. But it might also be a sign of heart conditions that need treatment. David Harnick, MD, and Raymonda Rastegar, MD, offer in-depth testing such as tilt table testing, event monitors, or implantable loop recorders to help diagnose this condition. If you need an evaluation for fainting, call the office in the Murray Hill neighborhood of Manhattan, New York City, or book an appointment online today.

Syncope Q & A

What is syncope?

Syncope refers to fainting or losing consciousness, a condition that happens suddenly and lasts a short time before you recover. Fainting occurs when the blood flow to your brain suddenly drops, usually from low blood pressure.

There are three types of syncope, each with its own cause:

Cardiovascular syncope

Heart and blood vessel conditions that affect the blood flow to your brain and cause syncope include:

  • Coronary artery disease
  • Congestive heart failure
  • Slow heartbeat (bradycardia)
  • Fast heartbeat (tachycardia)
  • Irregular heartbeat (atrial fibrillation)
  • Structural heart problems
  • Cardiomyopathy
  • Low blood pressure (hypotension)


Heart conditions, low blood sugar, nutritional deficiencies, thyroid disease, and nervous system disorders are just a few of the things that cause low blood pressure.

Neurally mediated syncope

Neurally mediated syncope occurs when a trigger makes your blood vessels expand and your heart rate drop, a combination that reduces blood flow to your brain. Common triggers include pain, the sight of blood or needles, anxiety, and standing for a long time.

Orthostatic hypotension

If you have orthostatic hypotension, your blood pressure drops when you stand up. A few causes include medications, infections, and dehydration.

What symptoms accompany syncope?

In addition to blacking out, other syncope symptoms include:

  • Light-headedness
  • Dizziness
  • Falling for no reason
  • Drowsiness
  • Grogginess
  • Unsteadiness when standing 

Many people have symptoms before they faint, called premonitory symptoms. You may experience:

  • Dizziness
  • Nausea
  • Sweating
  • Cold, clammy skin
  • Blurry vision
  • Palpitations

You may also experience tingling in your lips or fingertips just before fainting.

How is syncope diagnosed?

Heartwise Cardiology performs comprehensive workups to determine the cause of your syncope, including a physical exam, bloodwork, and:

  • Electrocardiogram (EKG)
  • Stress test
  • Tilt table test
  • Echocardiogram (echo)
  • Electrophysiology study
  • Wearable monitors (Holter or event monitor)
  • Implantable loop recorder (ILR)

Your provider implants the ILR in the office. They can also integrate remote monitoring devices with their electronic medical record (EMR) system, allowing them to have immediate access to your heart information.

How is syncope treated?

If you have premonitory symptoms, your provider teaches you steps you can take at the first sign to prevent fainting.

When your fainting is caused by a cardiovascular condition, your treatment targets the specific problem. The first line of treatment generally includes lifestyle changes and medications.

However, you may also need a procedure such as angioplasty and stenting, cardiac ablation, a pacemaker, or an implantable cardioverter defibrillator.

If you experience syncope, call Heartwise Cardiology or book an appointment online today.

Conditions we treat

Valvular Heart Disease and Heart Murmurs

Aortic Aneurysm

Stroke/TIA’s and Carotid Disease

Peripheral Vascular Disease

Services We Offer

Implantable Loop Recorders (ILR)

Tilt table testing (TTT)