Blacking out

[clinks]

Hi --
Two times in the last few weeks while cycling (with tri-bars) I passed out. In the hospital and after many investigations and tests, they cannot find anything, other then being in excellent physical shape. Just wondering whether cycling posture can have anything to do with it: elbows close together (forcing shoulders forward) and heads up, pushing it into the neck. Would it be possible that posture blocks blood flowing to the brains? The passing-out happens within 3-5 seconds, enough to stop to avoid an accident, but in both cases I fell and was unconscious for a few minutes.
Did anyone have a similar experience or heard about it? it is pretty scary to not be able to trust one own's body.
Thx., Cees

[FrankDay]

Hi --
Two times in the last few weeks while cycling (with tri-bars) I passed out. In the hospital and after many investigations and tests, they cannot find anything, other then being in excellent physical shape. Just wondering whether cycling posture can have anything to do with it: elbows close together (forcing shoulders forward) and heads up, pushing it into the neck. Would it be possible that posture blocks blood flowing to the brains? The passing-out happens within 3-5 seconds, enough to stop to avoid an accident, but in both cases I fell and was unconscious for a few minutes.
Did anyone have a similar experience or heard about it? it is pretty scary to not be able to trust one own's body.
Thx., Cees

you need to spend some time with a holter monitor.

[usedtobefast]

that does not sound normal at all.

[Tapeworm]

First, I'd try to seek a another medical opinion. Blacking out is neither normal or good for your health. Unless you have some funky position there is nothing about the tri position that should induce this.

Second don't start riding again till you have this sorted. Blacking out on the bike is a very good way to ensure death or serious injury.

[twothirds]

I second the Holter monitor test. See if you can also have a stress test done on a bike in a similar position.

[Martin318is]

Safe environment with some form of medical supervision would be my suggestion

Time trial position on a stationary trainer would be the way to go.

[clinks]

Thanks for all the replies, but follow-on research is pointing towards "carotid sinus syndrome", probably a combination of time trial posture, in combination with a quick turn of the head checking on upcoming traffic from behind. With a sensitive carotid sinus this can cause cardio inhibition: your brains telling your heart to take a break for a few seconds or longer -- causing immediate collapse...

[Martin318is]

Never heard of that - sounds really scary!
I would definitely do some indoor supervised testing in that case to check your position and whether anything can be done to stop that pressre happening.

[Black-Balled]

I have had 2 similar episodes...though neither involved TT bars;)...and I wonder if they may be similar?

My Dr told me it was his opinion that my fitness/low body fat/ low blood pressure created the perfect conditions to allow blood flow to the brain to slow at times. The feeling is similar to the one one might feel when standing up too quickly.

Simple remedy for me: I just need to put my head to my knees when I feel it coming on. Not that you can do that while riding!

[on3m@n@rmy]

Thanks for all the replies, but follow-on research is pointing towards "carotid sinus syndrome", probably a combination of time trial posture, in combination with a quick turn of the head checking on upcoming traffic from behind. With a sensitive carotid sinus this can cause cardio inhibition: your brains telling your heart to take a break for a few seconds or longer -- causing immediate collapse...

Dang! Strangest thing I think I've heard.

[Raul Ramaya]

I have had 2 similar episodes...though neither involved TT bars;)...and I wonder if they may be similar?

My Dr told me it was his opinion that my fitness/low body fat/ low blood pressure created the perfect conditions to allow blood flow to the brain to slow at times. The feeling is similar to the one one might feel when standing up too quickly.

Simple remedy for me: I just need to put my head to my knees when I feel it coming on. Not that you can do that while riding!

But did you actually black out like the OP? What you describe I've read before (can't remember where) is normal. I get those as well - but not to the point of actually blacking out.

[jnyagaitau]

[quote="clinks"]Hi --
This happened to me today..I'm yet to see a doctor I'll tell you of the results as soon as I see one..

[BLUE]

Hi --
This happened to me today..I'm yet to see a doctor I'll tell you of the results as soon as I see one..

This happened to me on the evening of 31 October 2017 just before 9 pm. I'd cycled to an event about 2 miles from home, I wasn't hungry (I'd eaten beforehand), hadn't had any alcohol, not even a coffee, no advance warning (I know what it feels like if you're going to faint - it happened to me years ago), no-one else was involved. All I know is I came round in the trauma department in the local hospital, having been unconscious for about an hour, with cuts, grazes to face, nose and hands, 2 black eyes and a headache. I was kept under observation overnight and discharged the following afternoon, looking rather like a zombie. Results of tests (ECGs, bloods etc) all perfectly normal. General fitness - very good. So what happened? My GP has now referred me to the cardiology department. Still waiting for an appointment. In the meantime, I'm advised not to cycle or drive. I'm devastated but realise it could have been so much worse.

[Merckx index]

This happened to me on the evening of 31 October 2017 just before 9 pm. I'd cycled to an event about 2 miles from home, I wasn't hungry (I'd eaten beforehand), hadn't had any alcohol, not even a coffee, no advance warning (I know what it feels like if you're going to faint - it happened to me years ago), no-one else was involved. All I know is I came round in the trauma department in the local hospital, having been unconscious for about an hour, with cuts, grazes to face, nose and hands, 2 black eyes and a headache. I was kept under observation overnight and discharged the following afternoon, looking rather like a zombie. Results of tests (ECGs, bloods etc) all perfectly normal. General fitness - very good. So what happened? My GP has now referred me to the cardiology department. Still waiting for an appointment. In the meantime, I'm advised not to cycle or drive. I'm devastated but realise it could have been so much worse.

Is it possible you were hit by a driver who didn’t stop? People frequently lose all memory of the immediate event in those circumstances, and since you were out cold for some time, you took a serious blow to the head. I assume you got to the hospital thanks to someone who did stop? If traffic was sparse, that driver might have come upon you some time after you were hit, so wouldn’t have actually seen the incident. Unless s/he actually saw you fall, though, s/he wouldn’t be able to rule out your being hit.

Since you don’t mention any damage to your bike, perhaps you’re using that fact to rule out being hit by a car. But if you had been barely grazed—say the car just bumped your handlebar--then went down and lost consciousness upon hitting the pavement, your bike might not show much sign of impact. That might also be why the driver didn’t stop, not being aware that s/he struck you, particularly if you didn’t go down instantly.

If I were in your situation, with no medical explanation forthcoming so far, I would make every effort to rule out this possibility. For example, examine the bike very closely for any signs of contact with a car, such as tiny flecks of paint, any bending of the handlebar or other portion, etc. (Yes, I realize it's a little late to be doing this, but if you haven't ridden since, any evidence is still there). I would also consider the pattern of your injuries, whether they’re entirely consistent with a fall onto pavement, or if some of them are perhaps more likely to have resulted from being hit by a car. From your description of them, it sounds as though you fell face first onto the road, holding your hands in front of you in an attempt to break your fall. If you blacked out without any external cause, you wouldn't be able to place your hands that way (unless you had started to fall before completely blacking out), and i would expect you would probably fall to one side or the other. If it's not too late to ask whoever stopped for you, I'd also want to know where the bike was found in relation to my body. There are all kinds of potential clues available.

And of course you can have a nasty fall without any help from a car. I once was riding my bike at night and went over a trench running across the road. It had been dug to get at a pipe, and hadn’t been completely filled back in. It was one of those obstacles that would have been no problem if I'd seen it in advance and been able to prepare for it, but since it happened suddenly, I lost my balance and went down very hard. As it happened, I didn’t hit my head, but I can imagine that had I done so, and had lost consciousness, it’s possible that when I came to I would not remember falling, and therefore have no idea why I blacked out. And FWIW, one of my hands was especially banged up, because I tried to use it to break my fall.

[BLUE]

Thanks very much for your response, Merckx index.

There was a witness to the accident. She saw me ' wobble and fall' and immediately realised an ambulance was required, I suppose. Also, a nurse, drinking in a nearby pub, came out to help. I've so far been unable to trace her even though the landlord has been helping. I agree it would help to have details concerning the immediate aftermath of the fall. The bike was completely undamaged, not even a small scratch. So clearly, no-one else was involved in the accident. The grazes on my right shin were probably the result of losing contact with the pedals which then spun round and hit my leg. The back of my right right hand was covered in small cuts as if it'd been dragged along something like a wall. I could have veered off the road, turned and hit the wall that runs round the church yard there. Anyway, I have an appointment with Cardiology at the John Radcliffe Hospital, Oxford on Wednesday, 10th January. That will probably mean having at least an ECG.