Causes of fainting and fainting. Pre-syncope: causes and first aid

There are moments when you suddenly feel weak, your eyes go dark, and your consciousness floats somewhere. What causes presyncope and what are its causes? There are many factors that cause this discomfort. Only by dealing with them, you can prevent fainting in the future.

Pre-fainting state.

What causes fainting

Clouding of consciousness does not always end in fainting. But if you had an attack when you felt weak, turned pale, your head went around and your knees gave way, then this is most likely caused by a deterioration in blood circulation and a weakening of oxygen supply to the brain.

All of the above happens for the following reasons:

stress and mental shock as a result of fright, strong excitement, surging fear;
severe physical pain upon impact, trauma, blood loss;
sun or heat stroke;
weakening of the body after an infectious disease, starvation, during heavy physical exertion, poisoning;
the final phase of pregnancy;
many chronic or acute diseases (cardiovascular system, high blood pressure, atherosclerosis).

Feeling unwell in any of these cases indicates health problems. Only a doctor can determine the exact cause and prescribe the appropriate treatment.

Pre-fainting: what to do in this case

You do not have to wait for all the symptoms of this condition to appear. It is necessary to take action as soon as possible and consult with a specialist. And it is very important to provide first aid as soon as possible with this ailment, otherwise it can go into a faint, which is fraught with more serious consequences.

If a person begins to lose consciousness, the following actions should be taken:

lay it on a horizontal surface, raise your legs slightly above your head to improve blood flow to the brain;
loosen the neckerchief or scarf, unbutton the top button on the shirt;
soak a cotton swab in ammonia and let it inhale the vapors;
if weakness is accompanied by chills, cover the person with a blanket;
when muscle weakness begins to pass, and consciousness clears up, he can slowly sit down and, making sure that everything has passed, get up.

Probably everyone knows what syncope, or fainting, is. Such a condition often occurs as a result of severe emotional and nervous shock, overwork or physical exhaustion. However, not everyone knows what constitutes a pre-syncope state that precedes loss of consciousness.

Syncope can be easily prevented by paying a little more attention to the person's condition and deviations in his well-being. To help a person, it is necessary to accurately determine the causes of pre-syncope, and be able to recognize its first symptoms.

The development of presyncope

Pre-fainting can occur for a variety of reasons. In addition to them, there are several other factors that predispose to the onset of an attack.

Causes of POS may include:

Factors that predispose to the occurrence of pre-syncope include:

prolonged fasting;
malnutrition;
malnutrition;
prolonged adherence to bed rest;
the strongest emotional shock;
physical fatigue;
pain syndrome, shock.

Pre-fainting often occurs in women during pregnancy. But you should not panic, because this is a fairly common phenomenon, which does not always indicate pathological disorders in the body of the expectant mother. In most cases, the causes of such ailments during pregnancy are associated with physiological changes in the female body.

Changes in the hormonal background, preparation of internal organs for bearing a fetus, changes in metabolic function - all these factors have a powerful effect on the condition of the future mother. As a rule, pre-fainting is observed in mothers at 1-3 months of pregnancy, after which it disappears.

If the expectant mother began to show similar attacks in the third trimester, this should be reported to the doctor immediately. Such anomalies can occur during pregnancy due to the development of preeclampsia - late toxicosis.

Since such a pathology poses a serious threat to the life of the fetus and the health of the mother, it is strictly forbidden to take measures to eliminate it on your own!

Pre-fainting can also occur during menstruation, but such a malaise is quite rare. In this situation, we can talk about hormonal changes in the body, as well as the features of the functioning of the reproductive system of a woman.

Pain during contraction of the uterine muscles, also accompanied by nausea and dizziness, can also cause malaise. With heavy bleeding, there is a large blood loss, leading to anemia. In this case, presyncope should be a good reason to see a doctor.

Before menstruation, the attacks of dizziness characteristic of POS are also not ruled out. This happens when a woman has a hard time with a condition such as premenstrual syndrome. At this time, the patient may experience jumps in blood pressure, that is, it can be much higher or lower than normal. The malaise disappears with the onset of menstruation, or after they end.

Clinical picture and first aid

The symptoms of presyncope are easy to recognize. They appear as:

dizziness;
disorientation;
sudden weakness;
a sharp lack of air;
increased sweating.

In addition, a person is tormented by severe dry mouth and an attack of nausea. In this case, it is extremely important to provide timely assistance to the patient, since these signs are the line between pre-syncope and syncope.

Such symptoms last from 5 to 30 seconds, but if a person is not helped during this period, the development of fainting is quite possible.

Vegetovascular dystonia is one of the most common causes of syncope. Symptoms of POS in this pathology are:

panic attacks;
accelerated heart rate;
dyspnea;
a dark veil before the eyes;
noise and ringing in the ears;
dysfunction of the musculoskeletal system.

Such unpleasant symptoms are observed in people with an advanced form of VVD, and since this is a very dangerous disease that can have quite serious consequences, it must be treated immediately.

During the period of bearing a child, the expectant mother may experience the following signs of pre-fainting:

bouts of nausea;
numbness of the limbs;
exhaustion;
vertigo;
dark spots before the eyes.

If such anomalies are cyclical, you should not worry. But under the condition of their frequent recurrence, especially if POS almost always ends in fainting, a woman should urgently contact her gynecologist. This is extremely important for both the mother herself and for her unborn baby.

To prevent syncope, the person next to the patient must know what to do with POS. First aid should be provided according to the following algorithm of actions:

Do not give the patient any medication without the advice of a doctor. If the problem is low or high blood pressure, then only a medical specialist can change it to a normal level. Independently taken actions can adversely affect human health.

Diagnostics and prevention

If such attacks occur infrequently, they can be attributed to fatigue, the negative impact of the environment, as well as many other adverse factors. However, under the condition of frequent attacks, it is impossible to turn a blind eye to malaise - this can have dangerous consequences.

To understand the reason for the deterioration of health, you need to contact a cardiologist. After collecting anamnesis and physical examination, the doctor may prescribe instrumental diagnostic studies. In particular, the patient may be prescribed:

However, this is only an approximate survey program. Only a cardiologist can develop an exact scheme, based on the patient's complaints and his general well-being.

The treatment for this deviation depends on what caused it. In addition, the symptoms of a pathological condition also play an important role. But in general, the therapeutic program consists of:

stabilization of the psychological state of the patient;
vitamin therapy;
diet correction;
providing a good rest;
developing a daily routine for the patient.

If anemia occurs, then the patient is prescribed iron preparations - Magne B6, Gino-tardiferon, Magnikum, etc. Also, in this case, buckwheat, liver and other foods enriched with iron should be included in the diet.

To prevent the occurrence of this pathological condition, it is necessary:

eat well;
get enough sleep;
do not overdo it with physical activity;
avoid stress;
adjust the hormonal background;
improve the body's metabolism.

Here, in principle, are all the recommendations regarding the prevention of this deviation. If they do not help, you should not wait for the patient's condition to stabilize on its own - the person should be immediately examined and adequate treatment prescribed.

Often, such a pathological condition is not taken seriously, since in most cases it goes away on its own. Many people think that, apart from syncope, POS is not fraught with anything for the patient. However, fainting may well cause more dangerous consequences, in particular, injuries during a fall, oxygen starvation of the brain. Therefore, it is worth paying closer attention to any deviations in well-being.

Fainting is caused by a temporary loss of blood supply to the brain and may be a sign of a more serious illness...

Temporary loss of consciousness - fainting

Fainting is a temporary loss of consciousness.

Fainting is caused by a temporary loss of blood supply to the brain and may be a sign of a more serious illness.

People of any age can faint, but older people may have more serious causes.

The most common causes of fainting are vasovagal (a sharp decrease in heart rate and blood pressure) and heart disease.

In most cases, the cause of fainting is unknown.

Fainting can have many different causes:

Vasovagal syncope also known as "general weakness". This is the most common cause of fainting due to an abnormal vascular reflex.

The heart pumps more vigorously, the blood vessels relax, but the heart rate does not compensate fast enough to keep blood flowing to the brain.

Causes of vasovagal syncope:

1) environmental factors (more often when it's hot);

2) emotional factors (stress);

3) physical factors (loads);

4) illness (fatigue, dehydration, etc.).

situational syncope only happens in certain situations.

Causes of situational syncope:

1) cough (some people faint with a strong cough);

2) when swallowing (in some people, loss of consciousness is associated with a disease in the throat or esophagus);

3) when urinating (when a susceptible person passes out with an overflowing bladder);

4) hypersensitivity of the carotid sinus (in some people when turning the neck, shaving or wearing a tight collar);

5) Postprandial syncope can occur in older people when their blood pressure drops about an hour after eating.

orthostatic syncope occurs when a person feels fine in a lying position, but when he gets up, he may suddenly faint. Brain blood flow decreases when a person is standing due to a temporary drop in blood pressure.

This syncope sometimes occurs in people who have recently started (or received a replacement for) certain cardiovascular medications.

Orthostatic syncope can be due to the following reasons:

1) low circulating blood volume caused by blood loss (external or internal blood loss), dehydration, or heat exhaustion;

2) impaired circulatory reflexes caused by drugs, diseases of the nervous system, or congenital problems. Cardiac syncope occurs when a person loses consciousness due to cardiovascular disease.

Cardiac causes of syncope are usually life-threatening and include the following:

1) anomaly of the heart rhythm - arrhythmia. Electrical problems in the heart impair its pumping ability. This leads to a decrease in blood flow. The heart rate may be too fast or too slow. This condition usually causes fainting without any warning.

2) cardiac obstacles. Blood flow may be obstructed in the blood vessels in the chest. Cardiac obstruction can cause loss of consciousness during exercise. Various diseases can lead to obstruction (heart attacks, diseased heart valves with pulmonary embolism, cardiomyopathy, pulmonary hypertension, cardiac and aortic tamponade).

3) heart failure: the pumping ability of the heart is impaired. This reduces the force with which blood circulates in the body, which can reduce blood flow to the brain.

neurological syncope may be associated with neurological conditions.

Its reasons are:

1) a stroke (bleeding in the brain) can cause fainting associated with a headache;

2) transient ischemic attack (or mini-stroke) can cause loss of consciousness. In this case, fainting is usually preceded by double vision, loss of balance, slurred speech, or dizziness;

3) in rare cases, a migraine can cause fainting. Psychogenic fainting. Hyperventilation due to anxiety can lead to fainting. The diagnosis of psychogenic syncope should only be considered after all other causes have been ruled out.

Syncope symptoms

Loss of consciousness is an obvious sign of fainting.

Vasovagal syncope. Before fainting, a person may feel light-headed; blurred vision will be noted. A person can see "spots before the eyes."

The patient has pallor, dilated pupils, and sweating.

During a loss of consciousness, a person may have a low heart rate (less than 60 beats per minute).

The person must quickly regain consciousness. Many people do not have any warning signs before fainting.

Situational fainting. Consciousness returns very quickly when the situation passes.

Orthostatic fainting. Before a fainting episode, a person may notice blood loss (black stools, heavy menstruation) or fluid loss (vomiting, diarrhea, fever). The person may also be delirious. Observers may also note pallor, sweating, or signs of dehydration (dry lips and tongue).

Cardiac fainting. The person may report palpitations, chest pain, or shortness of breath. Observers may note weakness, irregular pulse, pallor, or sweating in the patient. Fainting often occurs without warning or after exertion.

Neurological fainting. The person may have a headache, loss of balance, slurred speech, double vision, or dizziness (feeling like the room is spinning). Observers note a strong pulse during the unconscious period and normal skin color.

When to seek medical help?

Since fainting can be caused by a severe condition, all episodes of loss of consciousness should be taken seriously.

Any person, even after the first episode of loss of consciousness, should see a doctor as soon as possible.

Depending on what the physical examination reveals, the doctor may require tests to be done.

These tests may include: blood tests; ECG, daily monitoring, echocardiography, functional stress test. Table tilt test. This test tests how your body reacts to changes in position. Tests to detect problems of the nervous system (CT of the head, MRI of the brain or EEG).

If the person next to you has fainted, help him.

Lay it on the ground to minimize the chance of injury.
Stimulate the person actively and call 911 immediately if the person does not respond.
Check the pulse and start CPR if necessary.
If the person recovers, let him lie down until the ambulance arrives.
Even if the cause of fainting is not dangerous, have the person lie down for 15-20 minutes before getting up.
Ask him about any symptoms such as headache, back pain, chest pain, shortness of breath, abdominal pain, weakness, or loss of function because these may indicate life-threatening causes of fainting.

Syncope treatment

Treatment for fainting depends on the diagnosis.

Vasovagal syncope. Drink plenty of water, increase your salt intake (under medical supervision), and don't stand for long periods of time.

Orthostatic fainting. Change your lifestyle: sit down, flex your calf muscles for a few minutes before getting out of bed. Avoid dehydration.

Elderly people with low blood pressure large meals should be avoided after meals, or plans should be made to lie down for a few hours after meals. In most cases, you should stop taking drugs that cause fainting (or replace them).

Cardiac fainting. To treat cardiac syncope, the underlying disease must be treated.

Valvular heart disease often requires surgery, while arrhythmia can be treated with drugs.

Medications and lifestyle changes.

These procedures are designed to optimize the performance of the heart, control of high blood pressure is necessary; in some cases, antiarrhythmic drugs may be prescribed.

Surgery: bypass surgery or angioplasty are used to treat coronary heart disease; in some cases the valves can be replaced. A pacemaker may be implanted to normalize the heart rate (slows the heart for fast arrhythmias or speeds up the heart for slow arrhythmias). Implanted defibrillators are used to manage life-threatening rapid arrhythmias.

Syncope Prevention

Preventive measures depend on the cause and severity of the fainting problem.

Fainting can sometimes be prevented by taking simple precautions.

If you are weak because of the heat, cool the body.
If you faint while standing (after lying down), move slowly while standing. Slowly move into a sitting position and rest for a few minutes. When you are ready, stand up using slow and fluid movements.

In other cases, the causes of fainting may be elusive. That's why see your doctor to determine the cause of fainting.

After determining the cause, treatment of the underlying disease should begin.

Cardiac syncope: due to the high risk of death from cardiac syncope, people who experience it should be treated for the underlying disease.

Periodic fainting. Consult a doctor to determine the causes of frequent loss of consciousness.

Prognosis due to syncope

The prognosis for a person who has fainted depends largely on the cause, the age of the patient, and the treatments available.

Cardiac syncope has the greatest risk of sudden death, especially in the elderly.
Syncope that is not associated with cardiac or neurological disease is a more limited risk than in the general population.

Checking the pulse in the neck. The pulse is well felt only near the throat (trachea).

If a pulse is felt, note if it is regular and count the number of beats in 15 seconds.

To determine the heart rate (beats per minute), multiply this number by 4.

The normal heart rate for adults is between 60 and 100 beats per minute.

If you fainted only once, then you don't have to worry about it.

It is important to see a doctor because fainting can have serious causes.

Fainting can be a sign of a serious problem if:

1) It often happens within a short period of time.

2) it occurs during exercise or vigorous activity.

3) fainting occurs without warning or in a supine position. In mild syncope, the person often knows that it is about to happen, vomiting or nausea is noted.

4) a person loses a lot of blood. This may include internal bleeding.

5) there is shortness of breath.

6) there is pain in the chest.

7) the person feels that his heart is pounding (palpitations).

8) Fainting occurs along with numbness or tingling in one side of the face or body. published .

If you have any questions, ask them

The materials are for informational purposes only. Remember, self-medication is life-threatening, consult a doctor for advice on the use of any medications and treatments.

The collection of anamnesis is mainly aimed at making a differential diagnosis between cardiovascular and neurological causes of syncope (Table 1). This can be difficult for both the patient and the physician. With neurological causes, dizziness is often present, and against the background of impaired coordination, there are often no precursors of loss of consciousness. Possible nausea. Presyncope states associated with cardiovascular disease (CVD) are usually not accompanied by dizziness; patients sometimes describe their sensations as mild dizziness, although in fact this is the beginning of a loss of consciousness against the background of arterial hypotension. If the patient does not describe the rotation of objects around him and he has a feeling of imminent loss of consciousness, CVD is most likely.

Cardiovascular causes	neurological reasons s
No harbingers	There are harbingers (aura)
-	Urinary or fecal incontinence
-	Tongue bite
The patient is usually silent	Moans, involuntary sounds
Marked pallor	Often cyanosis (especially in the tonic phase)
immobility	Seizures (may be mild)
After the fainting episode: usually feeling tired, but no disorientation, most often patients quickly come to their senses	After the fainting episode: often disorientation, feeling unsure, possibly also residual paralysis

Sometimes a decrease in blood supply to the brain due to cardiovascular causes can provoke seizures. In patients who complain of sudden "failures", it is necessary to establish exactly whether they really lose consciousness. Some patients say they have lost consciousness, when in fact they simply have the feeling that they are losing touch with the outside world. This feeling of "depriving one's body in full consciousness" is often associated with anxiety and other psychological problems. Diagnostic errors can also occur when the patient says that he lost consciousness, although in fact he fell to the ground, remaining conscious. If the patient remembers the moment of hitting the ground, this possibility should be taken into account and further differential diagnosis should be carried out. There are patients who have "buckling legs" in the absence of any CVD. These are patients with so-called "fall attacks".

It is very important to find out if there were witnesses to the loss of consciousness, and to ask them about the beginning, end and duration of the episode, as well as the color of the patient's skin, his behavior, the nature of breathing and the speed of recovery of consciousness. Sometimes bystanders record the patient's pulse. In the age of mobile phones, you can call a witness while the patient is still in the clinic.

When conducting a differential diagnosis between cardiovascular and neurological causes of loss of consciousness, it is important to find out the circumstances under which this happened. If the episode resulted from fright, intense excitement, prolonged standing, urination, defecation, it should be borne in mind that most of these situations lead to an increase in vagal tone and can cause vasovagal syncope (Box 1). Such seizures are often referred to as "situational". They are characteristic of young patients without comorbidities, although syncope due to urination or defecation is most common in the elderly. Such a situational vasovagal attack must be distinguished from a loss of consciousness in a patient with prolongation of the QT interval, where loud noise or other circumstances can contribute to dangerous arrhythmias.

Block 1.

Situation 1: influence of body position

A middle-aged woman with no history of cardiovascular disease noted the appearance of a rapid heartbeat after eating a heavy meal in a restaurant. She decided that she should visit the toilet, got up and went to the door, but after a few meters she lost consciousness.

Explanation

The arrhythmia causes a moderate decrease in cardiac output, however, when the patient is sitting, these hemodynamic changes may be less pronounced. As soon as the patient stood up, the effect of gravity led to an even greater decrease in cardiac output, and the patient lost consciousness.

In patients describing trauma during loss of consciousness, it should be assumed that there are no precursors and serious causes of syncope. The presence of precursors is evidence in favor of neurological causes, especially if the precursors are in the form of an aura, that is, unusual sensations that precede an attack of loss of consciousness. They should not be confused with the short pre-syncope period that occurs immediately before loss of consciousness. After loss of consciousness associated with CVD, the patient may feel weak, but usually does not feel a pronounced malaise. In contrast, patients who have a seizure tend to feel extremely ill for a long time, complaining of headaches, drowsiness, and what they call "blurring." Short residual paralysis (Todd's paralysis) is possible after syncope due to neurological diseases.

Sometimes patients talk about an episode of collapse and fainting, after which they wake up with a feeling of a strong heartbeat. This may be due to the fact that the cause that caused fainting also led to the occurrence of tachycardia. However, most often, a sudden decrease in cardiac output, caused by tachycardia and dilatation of peripheral vessels, contributes to a pronounced decrease in blood pressure (BP) and loss of consciousness. Then reflex vasoconstriction leads to an increase in blood pressure, despite the persisting tachycardia, and the patient comes to.

Edema and ascites

Although edema and ascites are physical signs, patients are able to talk about them.

Fast fatiguability

Fatigue is very common, but it is difficult to determine what it is associated with, since there are many causes. It can be very revealing when a patient, after successful treatment, realizes how much weakness bothered him before starting therapy. If this symptom occurs intermittently, it may be due to a serious illness, but it can be difficult to identify (Box 2).

Block 2.

Situation 2: Fatigue is a symptom that is difficult to interpret

Roger Hall, Iain Simpson

History taking and physical examination of patients with diseases of the cardiovascular system

emergency medicine Articles

Fainting: causes and first aid

2013-01-23

4. Sudden increase in intracranial pressure (tumor, hydrocephalus, cerebral hemorrhage).

5. Reducing the content of oxygen, sugar, electrolytes in the blood (hypoxia, anemia, hypoglycemia, renal and liver failure).

6. Decrease in the volume of circulating blood (bleeding, excessive urination, severe diarrhea).

8. Mental disorders (hyperventilation syndrome, hysterical neurosis).

9. Other forms of loss of consciousness are also distinguished, which occur as a result of epilepsy, traumatic brain injuries, infections, etc.

The main pathophysiological mechanisms underlying syncope are insufficient supply of oxygen or glucose to the brain, as well as convulsive activity. It is very important to exclude the possibility of an epileptoid seizure with loss of consciousness. In both cases, the person falls and loses consciousness, but these are two completely different conditions that require different treatment.

Signs of fainting

Factors provoking the onset of fainting are previous starvation, overwork, alcohol abuse, infection, recent serious illness, heat or sunstroke, intoxication, traumatic brain injury, being in a stuffy room, etc. Fainting can also develop as a result of excitement , fright, at the sight of blood, from severe pain from blows and injuries.

The first signs of an approaching fainting are often dizziness with ringing in the ears, a feeling of emptiness in the head, severe weakness, yawning. Then there is a darkening in the eyes, cold sweat, dizziness, nausea, numbness of the limbs, increased bowel activity. The skin becomes pale, the pulse is weak, thready, blood pressure decreases. The eyes first wander, then close, there is a short-term loss of consciousness (up to 10 s), the patient falls. Then the consciousness is gradually restored, the eyes open, breathing and cardiac activity normalize. For some time after fainting, headache, weakness, and malaise remain.

There are 3 phases of fainting:

. Presyncope (pre-syncope state) - there is a feeling of lightheadedness, darkening in the eyes, stuffy ears, sweating. It lasts from a few seconds to 1-2 minutes.

.Fainting (syncope phase) - there is a loss of consciousness for a short time, the person falls, the skin is pale, moist, the breathing is shallow, the pulse is weak, the blood pressure is reduced, the pupils are dilated. Lasts from a few seconds to 1 minute.

. Post-syncope (post-syncopal) phase - when recovering, a person experiences general weakness, weakness, dizziness, anxiety, while memory is preserved. The duration of the phase is several minutes.

Such fainting does not pose a threat to life and passes on its own.

Fainting due to diseases of the heart and large vessels. Most often, such fainting is due to heart rhythm disturbances (arrhythmias). They are characterized by a sudden loss of consciousness, a fall, a sharp pallor of the skin, which can later be replaced by its redness, the possible development of convulsions. Syncope with arrhythmias with a decrease in heart rate below 20 beats per minute up to the absence of heart contractions for 5-10 seconds (bradyarrhythmic), as a rule, is not the cause of sudden death. If syncope occurs with arrhythmias with a sudden increase in heart rate of more than 200 beats per minute (tachyarrhythmic), then this, quite often, leads to sudden death.

Fainting due to cerebrovascular disease or circulatory disorders in the system of vertebral arteries in cervical osteochondrosis. Occur suddenly, often in a vertical position of the body, last up to 1 minute, end quickly, without confusion. As a rule, they do not pose a risk to life.

The cause of fainting must be recognized as soon as possible. To do this, you need to clarify its duration, the speed of loss of consciousness and its recovery, the presence of precursors of fainting, memory loss. In addition, it is necessary to find out the possible provoking factors of fainting, past illnesses, the presence of fainting in the past, as well as well-being in the interictal period.

Examination for fainting

If the cause of fainting is unclear or there is the slightest doubt about the stability of the patient, it is necessary to call an ambulance team. The initial plan for examining a patient who has experienced syncope includes:

general blood analysis;
blood sugar test;
electrocardiogram;
x-ray examination of the chest.

First aid for fainting

Give the body of the victim a horizontal position, and the legs should be higher than the head (this will improve the blood supply to the brain), and turn the head on its side (to prevent the tongue from falling). You can put a person on the floor. It is necessary to observe a horizontal position until the feeling of muscle weakness passes.
Unfasten the victim's collar or loosen tight clothing, splash cold water on the face. Pat your cheeks.
Measure blood pressure and blood sugar levels with a glucometer (if available).
Allow the victim to inhale vapors of ammonia.
With chills, wrap the person with a blanket or a warm blanket.
After the return of consciousness and the disappearance of weakness, you need to get up gradually and carefully, first spending some time in a sitting position.

For the prevention of fainting it is necessary:

Give up bad habits (drinking alcohol, smoking).

On days of deterioration of health, use salty foods, tincture of hawthorn, lemongrass, strong coffee or tea, especially with low blood pressure.

After waking up, sit in bed, do a light massage of the hands, the cervical-occipital region on your own, make sure that there is no dizziness, excessive lightness in the head, and only then get up.

Get up gradually, on the exhale, being able to grasp the furniture when signs of fainting appear.