Research leads to lifesaving care for patients who faint inexplicably
Could an unexplained fainting spell be a symptom of a more serious condition? That’s exactly what Dr. Venkatesh Thiruganasambandamoorthy was trying to determine when he developed what is now known in emergency departments around the world as the Canadian Syncope Risk Score.
The term syncope refers to fainting episodes, and the Syncope Risk Score is a set of guidelines which predict which patients are at risk of adverse effects after fainting.
Dr. Thiruganasambandamoorthy, one of The Ottawa Hospital’s Emergency Department physicians and scientists, says about 10 percent of people who faint actually suffer from a serious underlying medical condition. “Through an emergency department evaluation, we would be able to identify the underlying condition for about half of the patients, but another three or four percent have a hidden condition. Identifying that condition has been a problem worldwide,” he explains.
In an effort to address this challenge and ultimately save more lives, Dr. Thiruganasambandamoorthy created a prediction system that had been adopted globally to help identify those underlying illnesses. “We need to identify who is at serious risk of developing a condition within 30 days of visiting the Emergency Department. A majority of those underlying conditions are related to the heart, but it can also be clotting in the lungs or bleeding in the brain or belly,” says Dr. Thiruganasambandamoorthy, who was recognized as one of the top emergency medicine researchers in Canada in 2020.
He has also developed guidelines for how long to monitor the heart rhythm of patients who have fainted, which serves to improve both patient care and efficiency in the emergency department. “The patients I see deserve the best care based on the latest evidence. They inspire my research on common conditions like fainting and chest pain.”
It is this forward thinking which helped 51-year-old Jacinthe Bisson. Initially, doctors in the Emergency Department couldn’t explain why Jacinthe was having fainting spells. Dr. Thiruganasambandamoorthy’s clinical trial revealed she had a life-threatening heart condition.
“I’m interested in science and research, so if I could participate in the clinical trial, then maybe that research would help other people,” – Jacinthe Bisson
In one year, Jacinthe had three syncope, or fainting episodes. But by the time she arrived at the hospital, she felt fine, and the doctors could not identify what had caused her to faint. Dehydration, a drop in blood pressure, or an overactive nervous system (such as fainting when seeing blood) can bring on syncope. Jacinthe had none of these issues.
As part of a clinical trial, she went home wearing a monitor around the clock for 15 days to keep track of her heart’s rhythm.
“I wanted to find out what was going on with me. And I’m interested in science and research, so if I could participate in the clinical trial, then maybe that research would help other people,” says Jacinthe.
On the seventh day, she felt lightheaded, hot and weak. The monitor captured a potentially life-threatening arrhythmia. Her cardiologist hospitalized her immediately and performed further testing, resulting in Jacinthe having a permanent defibrillator inserted into her heart.
Today, Jacinthe is doing well and continues to be grateful for the exceptional care she received at The Ottawa Hospital.
“The patients I see deserve the best care based on the latest evidence. They inspire my research on common conditions like fainting and chest pain.” – Dr. Venkatesh Thiruganasambandamoorthy
This lifesaving research study, which resulted in what is now known as The Canadian Syncope Risk Score, was made possible thanks to community support. It is yet another example of clinical rules developed at our hospital which have been adopted around the world including the Wells Rule for Deep Vein Thrombosis, the Wells Rule for Pulmonary Embolism , the Ottawa Knee Rules, and the Ottawa Ankle Rule, which was also referenced in an episode of the television series ER.
These rules are one reason The Ottawa Hospital is recognized around the world as a leader in improving patient care.