Self-induced syncope: the fainting lark

W. Wieling, J.J. van Lieshout.
Department of Medicine. Academic Medical Centre. University of Amsterdam. Amsterdam (The Netherlands).

The fainting lark is a self-applied manoeuvre that induces fainting [1]. Self-induced fainting has been used by children, high school students and military recruits as entertainment for their friends [2][3][4]. The fainting lark has also been applied as a research tool to document the sequence of events during abrupt onset syncope in young subjects [4].

The classical procedure consists of squatting in a full knee bend and overbreathing by taking about 20 deep breaths. The subject then stands up suddenly and performs a forced expiration against a closed glottis.

Fig 1. Continuous monitoring of changes in finger blood pressure, end-tidal CO2 and cerebral blood flow velocity induced by the fainting lark in a 55 year old male. After a very short period of lightheadedness (grey area), the subject blacked out and fainted.

The figure documents the precipitous and deep fall in arterial pressure and cerebral blood flow in one of the authors (WW) [1]. The subject briefly (2-3 s) lost consciousness preceded by an extreme short period of light-headedness and black out. Note the overshoot in blood pressure after lying down.

Editor's comments

The fainting lark combines the effects of systemic arterial hypotension induced by acute vasodilatation of the lower limbs (the combination of standing up and the post-ischemic effect of squatting) and decreased cardiac output (effects of arising and raised intrathoracic pressure) and cerebral vasoconstriction induced by hypocapnia (due to hyperventilation) [2]. The high cerebral venous pressure induced by straining can be expected to play an important adjunctive role in the effectiveness of the fainting lark to induce fainting [5]. The fainting lark can trigger syncope in almost anyone. Myoclonic jerks directly after falling down are observed in the majority of the subjects engaged [2][6].

Other manoeuvres that are applied to induce syncope are the mess trick [2] recently described as suffocation roulette [7]. During the latter trick subjects are instructed to take a deep breath and a companion grasps the subject unexpectedly from behind around the chest and squeezes it as hard as he can. The subject automatically closes his glottis, the intrathoracic pressure is raised and the subject faints. This is liable be done as entertainment, usually with the effects of alcohol added to the mechanical effects. Self-induced fainting is reported to be safe, but injuries may occur by falling. Moreover, severe complications and even death have been described [8][9][10].

References

1. Parts of this case were published earlier: Wieling W, van Lieshout JJ. The fainting lark. Clin Auton Res 2002; 12: 207. We thank Springer Verlag (Darmstadt, Germany) for permitting this reproduction.

2. HOWARD P, LEATHART GL, DORNHORST AC, and SHARPEY-SCHAFER EP. The mess trick and the fainting lark. Br Med J. 1951 Aug 18;2(4728):382-4. DOI:10.1136/bmj.2.4728.382 |

3. Johnson RH, Lambie DG, Spalding JMK. Syncope without heart disease. In: Johnson RH, Lambie DG, Spalding JMK. Neurocardiology. The interrelationships between dysfunction in the nervous and cardiovascular system. WB Saunders. London 1984 pp 159-183

4. LAMB LE, GREEN HC, COMBS JJ, CHEESEMAN SA, and HAMMOND J. Incidence of loss of consciousness in 1,980 Air Force personnel. Aerosp Med. 1960 Dec;31:973-88.

5. Gastaut H. Syncopes: generalized anoxic cerebral seizures. In: Magnus O, Haas AM eds. Handbook of clinical neurology. Vol 15. Chapter 42. Amsterdam: North Holland 1974: 815-836

6. Lempert T, Bauer M, and Schmidt D. Syncope: a videometric analysis of 56 episodes of transient cerebral hypoxia. Ann Neurol. 1994 Aug;36(2):233-7. DOI:10.1002/ana.410360217 |
7. Shlamovitz GZ, Assia A, Ben-Sira L, and Rachmel A. "Suffocation roulette": a case of recurrent syncope in an adolescent boy. Ann Emerg Med. 2003 Feb;41(2):223-6. DOI:10.1067/mem.2003.49 |
8. Murphy JV, Wilkinson IA, and Pollack NH. Death following breath holding in an adolescent. Am J Dis Child. 1981 Feb;135(2):180-1. DOI:10.1001/archpedi.1981.02130260068021 |
9. RUMBALL A. Pulmonary oedema with neurological symptoms after the fainting lark and mess trick. Br Med J. 1963 Jul 13;2(5349):80-3. DOI:10.1136/bmj.2.5349.80 |
10. Chow KM. Deadly game among children and adolescents. Ann Emerg Med. 2003 Aug;42(2):310. DOI:10.1067/mem.2003.313 |