Fainting or Black Outs

[Pat__0__0]

  Hi,
  I am needing help for my father who is 78 years old and very active.  He had a fainting or black out spell Friday while eating lunch.  My mother said he just slowly passes out and he thought he was telling her he needed help but no words were coming out.  He is only out a couple of minutes but we are worried.  Could these spells be TIA'S and he not know it?  He just saw his heart doctor and a complete stress test with pictures of his heart was done and everything was ok.  He has had his esophagus checked out by a specialist and everything was ok.  He needs to drink water while he is eating as he feels he needs to drink water if not he will pass out.  He said he doesn't remember anything and no pain other than pressure in his head when it happens.  Where do I start to find out what could cause this or what doctor to see.  He has a history of heart attach and stroke.  Please help me if you can.  This only happens while he is eating.  No choking or problems swallowing.  Just passes out without notice.  Thank you for any help you may be able to give me.
  Pat

[Cleveland Clinic, MD]

Dear  Pat,
The medical term for what you are describing is syncope (or near syncope if one dosen't actually pass out).  This is a common but complex condition that has many causes.  The most common cause is the common faint (neurocardiogenic or vasovagal syncope).  This is the typical faint caused by strong emotional factors (i.e. the sight of blood) and is usually brief in duration.  The person almost never harms themselves and the precipitating factor can usually be identified.  More serious forms of syncope are due to cardiac and neurologic causes.  
Syncope due to bradyarrhythmias (slow heart rate) or tachyarrhythmias (fast heart rates) are often hard to document.  Holter monitors will only reveal the source if they are being worn during an event.  "Event monitors" are devices that can be worn for months at a time and when an event occurs a button is pressed that saves the heart rhythm for the last 5 minutes.  This can then be sent to the doctor over the telephone for a diagnosis.  Other less common cardiac causes are carotid sinus irritability which is due to an abnormal structure in the neck that results in syncope when pressed upon.
Neurologic forms of syncope include autonomic nervous system diseases and seizure disorders.  These are diagnosed with tilt table testing and seizures with an EEG.
As you can see the diagnosis is somewhat complex. Therefore, I would recommend that your father see a specialist in the area of syncope.  Two doctors that specialize in this area here are Dr. Fred Jaeger and Dr. Fetnat Fouad.  You can make an appointment with either of them by calling the number below.  Good luck.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.