Heat Syncope

I remember the word syncope from my days in the hospital (working !). It was not the first thing I thought of today, nor the second really, when my friend went down hard during our kayaking lesson.

A little back story then.

Today I tried a new activity. I have a running friend who lives the hottest time of the year in Maine, but has been in Florida the last several months. She is due to leave June 30th so we planned this last minute "learn to kayak" adverture for this morning, having heard about it from another running pal.

We began relatively early, but not early by Florida standards. We usually start running no later than 7 a.m. this time of year, and our kayak "class" didn't get under way until after 8:30 a.m.

We began as a group, perhaps ten of us. We spread out in the grass and the instructor led us through some movements, standing up, with our paddle. The sun blazed upon us as we stood with our backs to it. All ten of us. All but one of us had on a hat. My friend had a hat, but it was a visor, that may have mattered.

Most of us were dutiful with our sunscreen and sun glasses as well.

I believe the standing in the sun part may have lasted an hour. The sweat dripped off the back of my neck and down my shirt. I felt uncomfortable.

(I had some significant over heating with my runs lately, it was not that bad.)

I worried about my friend because she will often have to take breaks during our runs when it is over 80 degrees. She was in the back and I was in the front.

We, the group, returned to our starting place near the instructors van and back into the shade. We then all had to put on life jackets. It was time to get in the water when my friend told me, very casually, "I feel nauseous." Maybe a bit later, "I am sort of dizzy."

The class was moving towards the waters edge (lake) but we stayed back. I asked if she wanted to sit, and she said, "Where would I sit?" I said, "I guess right here in the grass, so you are still in the shade." We had our paddles still. Maybe I had put mine down.

No one was near us anymore. My friend seemed to be leaning into her upright paddle with all of her weight. She doesn't remember this part. She was definitely pitching forward. I dropped my paddle, if I had it still, and lunged for her, but her legs went out and under mine as I yelled, "Help." We both fell in a rather tangled mess, and she hit her head.

People came then, but no one was medically inclined. I got her life jacket undone very first thing, sort of the "loosen the collar" of TV first aid. We got water on her, I checked her pulse. In fact it was strong, not thready as they say and not irregular. I knew that was at least not a bad sign.

We cooled her off etc. She went in the lake in a kayak after the class was over and rather got a private lesson. The Economy Tackle people were extremely accomodating to my friend and she does get to take the class again, no charge.

My biggest thought was why did she faint and I didn't and what do you call it when someone faints in the sun, but it isn't heat stroke?

First my investigation of the scene and the person>

My friend and I are about ten pounds different in size, we are both small people. She is about 20 years older then I am, but can at times out run me. She is physically active and eats nutritiously. She ate this morning at 6:30a and I ate at 8a. We both have low normal blood pressure. I do not think she is on medicine, I can't believe I forgot to ask!!

Our hats were different. Remember I felt bad, she actually fainted. She drank less water before and during than I and we think that the lack of hydration and the fact that about three hours had passed since her last meal.. may have pushed her over. She withheld water because... are you ready... there were no bathrooms nearby. A park with no bathrooms.


I was conscious of that too, however, I never "pee" when I run and I hydrate often. As I told my friend, you won't need to use the bathroom because you will be sweating! And we were.

So she is all good, had a nice lunch afterwards and stayed in the cool inside. Though she bumped her head, she has no sore spot.


What I learned since then is that a milder form of heat exhaustion is called heat syncope. At least some sources say it is a milder form of a more serious condition. I will stick with what I learned from the American Academy of Family Physicians. There are several types of heat related illnesses and some are life threatening and require medical stabilization, while others are mild and require hydration, a cool down, a lie down perhaps, and getting out of the heat. The best preventative measure is acclimatization. If you are going to be doing out door activity, get used to the heat gradually. It is clear that one needs to hydrate before, during and after activity in intense heat.

There absolutely is a way to over hydrate and a medical consequence to that as well. We are not discussing that today.

My friend did not hydrate prior to or during the activity.. that is likely the biggest contributing factor to her syncope. We did lie her down and cool her down, so good for us we responded as we should have.

So the heat related illness, in order of severity are:

Heat Edema - swelling in the limbs because one is not used to the hot temperatures (mildest)

Heat Cramps - not used to the heat yet, lack of sodium, perhaps medicine related (hydrate)

Heat Syncope - blood pressure drops and dizziness occurs, often from standing too long or from standing too quickly from sitting, (that is what orthostatic hypotension is) the heat can induce it. Heat syncope also comes from dehydration and lack of acclimatization. I should have gotten my friend on the ground as soon as she said she was dizzy. (recovery is quick)

Heat Exhaustion - may need IV rehydration, usually better in a few hours. No neuro deficits

Heat Stroke - very serious, may lead to death, does involve mental status changes (serious)

All right, try new things but be careful out there!

This was a nutshell synopsis, a syncope synopsis if you will... more technical stuff is yours to be had at :

http://www.aafp.org/afp/980901ap/barrow.html


[after note, June 21st. My friend said that she did NOT feel sick to her stomach and remembers saying instead, "I don't feel right." Now that she mentioned it, I believe she is quite right about that. Otherwise, it pretty much happened as I said. ]


OH my and here is a little extra thing I learned. Funny how we learn things. I wanted to make sure I was spelling nauseous right so I googled it of course, (though Bing is cool too). And I learned that my friend meant to say, I feel nauseated, as saying you feel nauseous means that you make other people sick... Huh....That is weird though isn't it, because if someone bothers us, don't we say "he/she is nauseating?"