Book Review: The Fainting Phenomenon: Understanding Why People Faint and What to Do About It, Second Edition

Dr. Blair Grubb is among the well-known authors in the syncope literature, having co-edited one of the most important books in the last decade that specifically addressed syncope and a multitude of original research papers regarding neurocardiogenic syncope. Why then publish yet another book on fainting? Although not expressly stated, his latest book addresses this complex subject from an explanatory standpoint that is simple enough for the lay public to grasp, yet scientific enough to expand the knowledge of physicians and other healthcare professionals, and possibly encourage further research. If writing a book that can be read by both doctors and patients was indeed his objective, he has succeeded. Everyone, even specialists in this area, will find in it something to learn about syncope or firm up knowledge of this phenomenon. Gracian first said good things, when short, are twice as good. At 131 pages and with abundant illustrations, the book is short and a very quick read for those versed in the subject. Lay persons may need time to analyze the figures more carefully and familiarize themselves with basic medical terms and concepts, but judging by the reaction of some of my patients who have read the book, it is quite understandable. For those unfamiliar with scientific and medical jargon, there is a glossary that makes the reading easier. The book starts with a brief introduction to the fainting phenomenon, after which the author sets out to explain the anatomical and physiological functions of the nervous and cardiovascular systems. He describes how these systems combine to maintain the homeostatic perfusion of the brain at both baseline and during orthostatic stress, allowing the maintenance of consciousness and muscle control. Although these two chapters are certainly superfluous for most physicians and healthcare givers, they are essential for the lay population reading the book, and later chapters refer to them many times. Even for physicians and other healthcare professionals, the first third of the book is a worthwhile quick review. Even my most educated patients report that these chapters are very informative and essential for understanding related readings. Chapters 5 through 8 undertake the assessment of specific entities of near syncope and syncope, starting with orthostatic intolerance and hypotension, progressing to neurocardiogenic syncope, the postural orthostatic tachycardia syndrome (POTS) and sundry mechanisms of fainting, from arrhythmias, to seizures, to psychogenic faints. Each of these entities is explained pathophysiologically to the best of our current understanding of how changes in posture or abnormalities in the autonomic nervous system lead to syncope and its associated phenomena. Patients might not realize that the fainting phenomenon may be comprised of various overlapping entities, and each patient might not neatly fit into one specific category, which is made clear by this section of the book. However, these chapters are not meant to be exhaustive but rather just enough to explain how syncope can occur. Chapter 9 addresses the unique circumstances of the entities reviewed previously as they relate to children, adolescents and the elderly. Diagnostic maneuvers, with brief explanations of tilt testing, electrophysiologic testing, autonomic testing, and other diagnostic interventions are covered in chapter 10. Treatment options are presented in chapter 11, including medical and lifestyle treatment approaches. Medical treatment strategies are reviewed, from increasing salt and water intake, to beta blockers, disopyramide, fludrocortisones and the older medications for neurocardiogenic syncope, to midodrine and serotonin reuptake inhibitors, among others. As well, non-medical treatment strategies are addressed, and the basis for their use is explained; for example, tilt training, biofeedback and support stockings (with one of the easiest explanations I have read about the hydrostatic reasons for how they work) are addressed. Once again, this is an introduction to the subject, not a guide to treatment with specifics, doses and approaches tailored to a unique situation. For that, you will need to read further, probably starting with Grubb and Olshansky's text on syncope. A meaningful wrap-up statement that is so characteristic of Grubb's commitment to patient care and the glossary finalize the book. The language is simple but direct. Medical jargon and scientific terms are explained succinctly and clearly. The essential concepts are emphasized and reviewed more than once in various chapters, as there is considerable overlap in the pathophysiology of the different conditions. Each chapter contains references to important papers and sources, which form the basis for the explanations and opinions expressed in the book. Who should read this book? The answer is: everyone who has to deal with this complex issue, including the patient, relatives, friends (and maybe even coworkers), as well as nurses and technicians interacting and performing testing on these patients, and the physicians who refer patients to subspecialists for treatment. The subspecialists may also learn a thing or two. If, for example, you are unfamiliar with erythropoietin or pyridostigmine for the treatment of the different neurocardiogenic syncope entities, read on. This book will introduce you to the reasons for them. In short, The Fainting Phenomenon is a book that bridges the chasm that so often separates patients from their doctors. Paraphrasing Grubb loosely, we need to be partners in the treatment of this disorder if we are to support the patients afflicted by these conditions. An excellent start is educating all those involved, at the very least with the basics of this phenomenon. This book achieves this brilliantly. As per Grubb's objective, one of my POTS patients commented that she found the book to be most helpful in terms of understanding the autonomic nervous system, medical terminology, related disorders, and treatment options, as well as explaining her condition to others; thus, we have been able to be partners in her treatment. Online, the book sells for $24.95. In summary, The Fainting Phenomenon is short, inexpensive, and accessible. It is thus thrice good. For more information on ordering a copy of this book, please visit: www.blackwellcardiology.com