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I go swimming in a pool. I wouldn't recommend going in a lake where you can't easily get to the shore. I am more likely to faint from the heat rather than when I'm in the water. I think a 'trigger' which starts the episode is different than a 'cause.' .We have lots of triggers but I don't think anyone can clearly say the 'cause' except to describe what happens when one has a big drop blood pressure for whatever reason. I think if you hit your head during an epsisode it could be extremely serious, and maybe fatal, but that's why all of us who have lived with this for a long time pay really close attention to our body's signals, drink lots of fluids without caffeine, and try to avoid things that might make an episode come on in the first place. Sometimes severe pain, like abdominal pain, causes it and you can't control that, but I have always been able to get to a safe place like the floor and put my legs higher than my head. Those of you who have had it happen in a grocery store, good luck - don't know what I would do then, but the floor is always good. You won't hurt yourself falling then.