Question 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]

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.

 

[dduff617]

Three months ago, I was on a casual ride with my family - out to get bagels on a Saturday morning. Going down a mild hill. Apparently (based on what I was told later) I blacked out, my memory restarts later that day waking up in the ER. I had multiple broken ribs, injured neck, scrapes on my hands and elbows, and some major bruises all over. I was told that I had just inexplicably started drifting to one side and crashed into my wife, who was also injured in the accident.

At the time of the accident, I was rested. Not especially hungry. Not drunk. Not on drugs. Not exerting myself in any major way.

I was hospitalized for four days following the accident, during which time my heart was monitored and studied extensively. Since the accident, I have worn a holter-type cardio monitor for a month, done a stress tests, echo cardiogram, etc. and they've found nothing that "explains" what happened. I've never had any other similar incident of fainting or passing out. I do have some mild hypertension, and have experienced some mild atrial fibrillation.

This was on a hybrid-style bike with conventional flat bars.

So YES! some of us have had similar experiences.

 

[Gooseman]

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...

Clinks - did you ever follow up with a doctor about this issue? My father unfortunately passed out on his tri-bike just a few days ago and we’re trying to figure out the cause. His initial brain scans and heart scans show him in good health. I would say his fitness is very good. He is 58 and generally healthy. Thanks for your time.

 

[dduff617]

Following up to my earlier post...

A few weeks ago, my wife struck up a conversation somewhat by chance with another older gentleman while we were on a camping trip. He was an avid cyclist and did occasional recreation/commuting rides that from the sound of it were in the 30-50 mile range and was very fit and in generally excellent health. He described an incident where he had (apparently) been having an uneventful ride along a bike path and later "woke up" laying in a ditch off the trail. Someone who had seen him lying there came along and tried to help. He was too dazed to even have any sense of what had happened or how bad his injuries were, and not being mentally aware nor able to think coherently, he denied requests to provide help. Some time later, he eventually made it home. When he regained full mental capacity, he had had a fairly major accident with many bad bruises and lost skin. He said this fit the pattern of an apparent passing out incident, as he remember nothing of the accident. Coincidentally his incident had happened at right around the same time as my own.

My point is not to belabor relaying a 3rd-hand account. In this case, admittedly details are unknown and its certainly not possible for me to claim with any certainty what happened. However, I mention this just to raise the possibility that these kinds of accidents might actually be more common than we realize - perhaps because of the way that they get reported (or don't). I mean there's no car accident to report, often no police involved, and often the people directly involved don't even know for sure what happened to them, nor do they have any specific medical incident or diagnosis they can point to.

 

[rahul]

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

Hi I have had similar episodes since two years and in june of this year i had a bad crash at 30mph. Fractured shoulder ,cracked rib , lacerations etc. I have gone thru a battery of tests both neurologic and heart related. I have a loop recorder implant which records my heart constantly but nothing has come up as yet. My heart is healthy and my brain is healthy . The docs just cant say what it is. Funny i can go for a spin class for 90 minutes and never pass out . It seems to happen on my early morning rides only and my Electro Physiologist doc suggested it might be weather related. However no certain diagnosis. I have stopped my morning rides . Lets keep in touch and see if anything comes up.

 

[Nick1954]

I blacked out while riding 8 weeks ago, Like many of the other contributors to this conversation, there is still no explanation, despite numerous heart and brain tests and scans, consultations with my primary care physician, a cardiologist and two electro-physiologists.

At the time of this incident, I has been riding about 3 1/2 hours, a duration that I've done countless times. Parts of the ride had had been uphill/anaerobic, but the blackout happed in a flat stretch, where I was actually pacing myself in preparation for a steep climb about 5 minutes later.

I had no recollection on blacking out, but came to on he pavement with what turned out to be a broken collarbone, 3 broken ribs. and bruises and scrapes on my left side from shoulder to knee. Similar to what another contributor wrote, I likely fell to my left, sparing myself what could ave been life-altering injuries.

Similar to what the Sept 4, 2019 contributor wrote, someone who saw me lying there offered help, but I, too, was too dazed to have any sense of what had happened, and also not being mentally aware nor able to think coherently, similarly turned down the offer of help. (I actually walked 1 1/2 miles to a nearby hospital ER; my wife met me there to pick up the bike).

Also similar to what the December 28, 2019 contribution wrote, both electro-physiologists recommended an injectable cardiac loop recorder, which I'm inclined to accept in the absence of other remedies. Interestingly, both the cardiologist and the electro-physiologists are fine with me walking, hiking and swimming (as these are typically not anaerobic activities) but all strongly counseled me to stay off my bike until this is sorted out, which I am doing (albeit with sadness).

 

[Rubykalik]

Hi All,

I had similar case just recently (2 days ago). I was riding up Mountain Bike to hills and on the way back I felt unconsciously from the bike. Likely I had GoPro on my helmet and it recorded the moment I fell. There was no witnesses when I fell but the GoPro 8 recorded all the breathing. When I heard the profile of the breathing from the record it was scary for me. I will see the cardiology doctor today and will show the video to the cardiology specialist. I hope the video recorder will be helpful to find the causes.
I will post any answers here to share what doctors said.

thank you

 

[N44WW]

I took a long ride (for me) on a bike trail last Sunday night, which was warm (high 80s) and clear. Didn't have any water (dumb, in retrospect). After about 25 miles, I felt a brief bit of lightheadedness, but kept riding. Next thing I remember is standing and looking at my bloody left shoulder. So then I just rode home the final five miles.

I do not remember hitting sand or wet pavement. I had no sensation of falling. I had no "protective" injuries, meaning that when I fell on my left side, I did not injure my hands or forearms. Presumably, my hands were still high on the handle bars when I hit the ground.

I got in to see the doctor the next afternoon. I went just to make sure I was OK. I wasn't. Seven broken ribs in back, with several ribs also torn from my breastbone/sternum and a separated shoulder (clavicle pushed higher than normal at the shoulder). Might need surgery. Need MRI to confirm.

Considering everything I've read, I suspect that I fainted due to dehydration/exertion/exhaustion. As with others, there seemed to be no clear evidence of any (other) medical reason for the loss of consciousness.

I'd love to hear what Rubykalik's GoPro recorded. Especially the scary breathing, which I didn't really understand.

 

[WVTG]

Has anyone received any answers to why they collapsed? I had a strikingly similar incident about a month ago. I’m going through tests at the moment but, doctors appts are slow with Covid-19 pandemic in the air. Would really like to have some ideas to take to the doctors. I know every situation is different but, my accident is identical to the many that have been posted here.

 

[WVTG]

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

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!

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.

Three months ago, I was on a casual ride with my family - out to get bagels on a Saturday morning. Going down a mild hill. Apparently (based on what I was told later) I blacked out, my memory restarts later that day waking up in the ER. I had multiple broken ribs, injured neck, scrapes on my hands and elbows, and some major bruises all over. I was told that I had just inexplicably started drifting to one side and crashed into my wife, who was also injured in the accident.

At the time of the accident, I was rested. Not especially hungry. Not drunk. Not on drugs. Not exerting myself in any major way.

I was hospitalized for four days following the accident, during which time my heart was monitored and studied extensively. Since the accident, I have worn a holter-type cardio monitor for a month, done a stress tests, echo cardiogram, etc. and they've found nothing that "explains" what happened. I've never had any other similar incident of fainting or passing out. I do have some mild hypertension, and have experienced some mild atrial fibrillation.

This was on a hybrid-style bike with conventional flat bars.

So YES! some of us have had similar experiences.

Hi I have had similar episodes since two years and in june of this year i had a bad crash at 30mph. Fractured shoulder ,cracked rib , lacerations etc. I have gone thru a battery of tests both neurologic and heart related. I have a loop recorder implant which records my heart constantly but nothing has come up as yet. My heart is healthy and my brain is healthy . The docs just cant say what it is. Funny i can go for a spin class for 90 minutes and never pass out . It seems to happen on my early morning rides only and my Electro Physiologist doc suggested it might be weather related. However no certain diagnosis. I have stopped my morning rides . Lets keep in touch and see if anything comes up.

I blacked out while riding 8 weeks ago, Like many of the other contributors to this conversation, there is still no explanation, despite numerous heart and brain tests and scans, consultations with my primary care physician, a cardiologist and two electro-physiologists.

At the time of this incident, I has been riding about 3 1/2 hours, a duration that I've done countless times. Parts of the ride had had been uphill/anaerobic, but the blackout happed in a flat stretch, where I was actually pacing myself in preparation for a steep climb about 5 minutes later.

I had no recollection on blacking out, but came to on he pavement with what turned out to be a broken collarbone, 3 broken ribs. and bruises and scrapes on my left side from shoulder to knee. Similar to what another contributor wrote, I likely fell to my left, sparing myself what could ave been life-altering injuries.

Similar to what the Sept 4, 2019 contributor wrote, someone who saw me lying there offered help, but I, too, was too dazed to have any sense of what had happened, and also not being mentally aware nor able to think coherently, similarly turned down the offer of help. (I actually walked 1 1/2 miles to a nearby hospital ER; my wife met me there to pick up the bike).

Also similar to what the December 28, 2019 contribution wrote, both electro-physiologists recommended an injectable cardiac loop recorder, which I'm inclined to accept in the absence of other remedies. Interestingly, both the cardiologist and the electro-physiologists are fine with me walking, hiking and swimming (as these are typically not anaerobic activities) but all strongly counseled me to stay off my bike until this is sorted out, which I am doing (albeit with sadness).

Hi All,

I had similar case just recently (2 days ago). I was riding up Mountain Bike to hills and on the way back I felt unconsciously from the bike. Likely I had GoPro on my helmet and it recorded the moment I fell. There was no witnesses when I fell but the GoPro 8 recorded all the breathing. When I heard the profile of the breathing from the record it was scary for me. I will see the cardiology doctor today and will show the video to the cardiology specialist. I hope the video recorder will be helpful to find the causes.
I will post any answers here to share what doctors said.

thank you

I took a long ride (for me) on a bike trail last Sunday night, which was warm (high 80s) and clear. Didn't have any water (dumb, in retrospect). After about 25 miles, I felt a brief bit of lightheadedness, but kept riding. Next thing I remember is standing and looking at my bloody left shoulder. So then I just rode home the final five miles.

I do not remember hitting sand or wet pavement. I had no sensation of falling. I had no "protective" injuries, meaning that when I fell on my left side, I did not injure my hands or forearms. Presumably, my hands were still high on the handle bars when I hit the ground.

I got in to see the doctor the next afternoon. I went just to make sure I was OK. I wasn't. Seven broken ribs in back, with several ribs also torn from my breastbone/sternum and a separated shoulder (clavicle pushed higher than normal at the shoulder). Might need surgery. Need MRI to confirm.

Considering everything I've read, I suspect that I fainted due to dehydration/exertion/exhaustion. As with others, there seemed to be no clear evidence of any (other) medical reason for the loss of consciousness.

I'd love to hear what Rubykalik's GoPro recorded. Especially the scary breathing, which I didn't really understand.

Trying to consolidate this thread. Seems like a lot of us have suffered the same scare. It would be nice to hear if anyone has received any definitive answers? I will give this, & its not definitive, as I haven't had enough care to get sufficient results, yet. My mother had some episodes of passing out when she was near my age 40's. She was placed on Zoloft because she had an issue wth her Vagus Nerve not controlling oxygen to the brain properly. Please post with any info you have confirmed, or which we can pass on to our healthcare providers. Maybe we can zero this down to a cause.

 

[Pinarellogrl]

I just suffered a blacked out while riding, same thing, many tests and they can't find anything. I have a fractured clavicle and some road rash. Oddly enough my blood pressure and oxygen levels were fine. There is a possibility of my BP go up and then drop suddenly causing the black out.