Can Someone Tell Me, Is This Really Vasovagal Syncope?

[gtg287y]

BACKSTORY:

My Problem: I get sudden, and often unexplained onsets of a variety of symptoms (usually symptoms appear in predictable clusters... I am often dehydrated, confused, fatigued and light headed all at once, while I get chest pain, nausea, difficulty breathing, grey outs and vertigo together). These symptoms can last several hours, and often repeat for several weeks or even months. Sometimes certain foods or environment conditions (hot dry heat, for example) will give me an isolated case of symptoms, but generally I get them in clusters, around the warmer times of the year (if they start in spring, I'm usually okay by fall, but if they wait until summer I can be suffering until winter). When I'm experiencing symptoms, I get exhausted very easily, and have found that "pushing myself" makes me likely to outright faint. Sometimes "pushing myself" can be as simple as walking, standing up, or even crawling. When I faint, I usually immediately regain consciousness, but if I try to get up at all (even sitting), I'll faint again. I'm usually very, VERY dizzy afterwards, and need to rest. I USUALLY faint while walking, but it's not unusual to faint while sitting, crouching, or crawling. I have never fainted while lying down, but often have symptoms get much worse (to the point where I'm pretty sure getting up will make me faint even if I wouldn't have when I initially lay down).

I've had a variety of tests over the years (EKG, Holter Moniters, EEGs), but nothing really turned up. There was some brief excitement when I went to the doctors immediately after fainting at work a year ago (and hadn't yet recovered), and fainted again while they were checking my pulse. My pulse was around 110 when they started, then I fainted, and they checked it immediately and it was around 140. They carried me to an EKG, but by then my heart rate was normal, and the test came out fine. I got sent to another heart doctor, with the possibility of a "EP Exam" (didn't sound fun), and this doctor said it wouldnt' be necessary, and that I probably had "common fainting", or vasovagal syncope.

I felt frustrated, because it seemed like the heart doctor hadn't been listening to me. The way he described it (and internet research seems similar) is that you pass out because the blood in your legs is pooling, and your blood pressure drops. All well and good...but how does the blood pool in my legs if I'm sitting cross legged? Or lying down? Or crawling? He told me to drink sports drinks, and do training by standing up against a wall and flexing my legs. He also said that if these things didn't help, to come back in, and we'd see. Sports drink have helped (though if they've helped more than water, I haven't seen it...staying hydrated in general helps). I'm not so sure about the leg flexing...especially since I (regretably) dont' keep up with it much because I'm confused as to how it will help...

QUESTION:

Does this actually SOUND like vasovagal syncope? Is my understanding of it mostly being about blood pooling incorrect? Is my understanding that symptoms are usually only while standing up incorrect? Do clusters of prodromal symptoms that persist no matter what position I'm in make sense in the context of vasovagal syncope?

If it doesn't sound like vasovagal syncope...does it sound like ANYTHING?

Should I go back into the doctor and see if there is any thing else they can do, if it doesn't sound like vasovagal syncope? Should I just continue to try to minimize it's effect on my life, and accept it? I've pretty much lost hope in doctors, after years of no relief...

[shanying418]

Did you try measuring your blood pressure while standing, sitting and lying down? It sounds like you are fainting a lot, maybe find another cardiac doctor will help?

[gtg287y]

Did you try measuring your blood pressure while standing, sitting and lying down? It sounds like you are fainting a lot, maybe find another cardiac doctor will help?

I did, and in general, my blood pressure was pretty constant regardless of position. My heart rate tended to go up more when standing, but usually not much over 100 bpm. I haven't ever tried monitering my blood pressure while actually having symptoms, though (mostly because standing up long enough to have my blood pressure taken is usually not a good idea).

[dianne.fraser]

Hi Jenny

I have all of the symptoms you mentioned, but I only collapse post-exercise.

I collapsed while on a holter monitor and it showed no abnormalities at all and, like you, there were no abnormalities during other cardiac investigations (apart from ventricular ectopics and a bit too much fluid around my heart). It was only when my blood pressure was measured while I collapsed that it became clear that my blood pressure was dropping suddenly while my heart rate stayed absolutely constant.

Based on this, I was diagnosed with cardioneurogenic syncopy two years ago (cardioneurogenic syncopy is one condition among many on the spectrum of dysautonomia). I'm not sure that I got an accurate diagnosis, but I'm satisfied that my cardiologist managed to put me on the right disease spectrum. The diagnosis has led to much better management of my illness, and I'm more functional than I was.

I suggest that you try having your blood pressure taken during and after a collapse.

With best wishes

Dianne

[shanying418]

Um... I really think you might want to seek out another specialist. If you have a family doctor or general physician, maybe ask for his/her ideas? My GP sent me to a new cardio doc. when vasovagal syncope doesn't seem to explain everything...

[comfortzone]

I have no answers but you seem quite intelligent and with persistance I bet you'll find some answers. Perhaps a new medical center altogether - even in another state if necessary. I got told my bouts of low b/p and feeling nearly ready to faint were due to venous pooling. Then a holter showed an avg. heart rate of 100. And short runs of atrial tach (a type of SVT) with a few PVC's for good measure. I got put on metoprolol to slow the heart down and stop the palpatations. It didn't help much. My blood pressure is being treated for being too high - but the cardiologist was to frightenend to treat it with additional higher dose meds for fear the low episodes would have me actually faint. My low's are almost exclusively related to me standing for longish periods of time. Then I noticed postural Hypertension......where my b/p would rise upon sitting and then standing over 30 points.

So like you I'm still looking for answers. For now I got switched to 2.5mg of Bystolic - now anytime I take my pulse it's in the seventies. I sweat a lot - not sure what that's about. My blood pressure is a bit closer to normal finally - but everything changes just when I think I have it figured out.

Be persistant - Keep a 3 ring binder with all your test results and consult notes in orderly tabs - it will help you and your next round of clinicians immensely. And be careful if you are driving - fainting and driving do not mix - I've had that feeling once or twice while driving and it's ridiculously scary - I just pulled off the road and drank fluids at a restaurant till I felt better. Best wishes to you!

[gtg287y]

I guess I can put more effort towards getting a BP reading during a fainting spell....any tips for actually doing it though? The home machine I have takes far too long for me to be standing up during it.... Or would just taking my blood pressure while laying down be just as effective? In general, when I have symptoms, and FEEL close to a faint, the readings are completely normal (if anything, I've noticed my heart rate is closer to 70, when it might normally be around 100). It's frustrating that other than an occasional high heart rate, I seem just fine, other than feeling miserable most of the time, and fainting... I keep hope that my readings during an actual faint will reveal something...but they're so impossible to predict! When they had me in a Holter, I went out of my WAY to push myself, and expose myself to suspected triggers, and the most I got was a hint of symptoms. So frustrating...

I've kept track of actual fainting spells, and the symptoms around them, as well as near fainting episodes, etc, but I hadn't thought to keep track of what the doctors were saying/doing. Might be a good idea, thanks for the advice, nowwhat!

Thankfully, I don't have to worry about driving just yet (a combination of college, then fainting kept me from ever officially getting my license), but one of my goals is to control my fainting enough that a license is possible.

*sigh* Shan, I agree...my family doctor has been wonderful (he was the one who caught the initial high heart rate)...but I'm really not all that sure about his recommended EP Study (which involves a cardiac ablation? *shudder*). I didn't like the heart doctor, that's for sure, and experiences like that (for several years with several different specialists) have left me just sort of burnt out on doctors... But hearing other people say I should probably continue the search does push me in the right direction...

[shanying418]

my family doctor has been wonderful (he was the one who caught the initial high heart rate)...but I'm really not all that sure about his recommended EP Study (which involves a cardiac ablation? *shudder*). I didn't like the heart doctor, that's for sure, and experiences like that (for several years with several different specialists) have left me just sort of burnt out on doctors... But hearing other people say I should probably continue the search does push me in the right direction...

Maybe you should just make it clear to your GP and ask if he can refer you to someone else. I had problem with my first cardio doctor and is in the process of getting to see the third doc while also sticking to the second cardio doctor. I guess this is a general experience for all of us. Even my GP told me to "keep pushing and telling, then the specialist will hear it." She told me that's what so does herself. So, don't give up. You'll get closer to getting a right diagnose and get better.

[Brye]

An EP study doesn't necessarily mean a cardiac ablation. It can be used just as a diagnostic tool. I had an EP study and it really wasn't that awful. They couldn't reproduce my V-Tach or find any abnormailities and there was no ablation.

Brye

[lieze]

From the reading I just did sometimes the heart rate does slow down with the vasovagal syncope and it could be because you were more active-up getting exercise your body did less pooling because your leg muscles were constricting to help push the blood back to the heart.

[gtg287y]

From the reading I just did sometimes the heart rate does slow down with the vasovagal syncope and it could be because you were more active-up getting exercise your body did less pooling because your leg muscles were constricting to help push the blood back to the heart.

Slowing down, yes, but "slowing down" to a normal rate from something that's higher than average? And do you mean I didn't faint with the holter moniter because I was more active, or in general? *confused* If anything, the more active I am with symptoms, the more likely I am to faint. If I don't have symptoms, being active MIGHT stave them off in the future (that's my hope, anyways), but it's never a good idea to move around when I'm likely to faint.

[lieze]

Yes from the explanation I just read the vagal response will slow your heart rate down.

And when you walk your calf muscles help squeeze the blood back up to your heart-so the fact that you did not have an episode while you wore the monitor doesn't mean you aren't having them. They did show printouts from either heart rate or bp during the vasovagal episodes and the bars dropped down and got more sloppy.

They talked about a maneuver to prevent syncope (fainting) and presyncope of crossing your legs in front of you and squeezing. Kind of that same thing you do if you need to use the potty and you're waiting in line? Tensing up the leg and butt muscles can help push the blood back up to the heart and ease the symptoms of the episode. I would think you could do this in any position.

People have actually reported less faints since performing this maneuver.

Triggers for a vasovagal episode are stress, some body positioning, dehydration, and crowded places.

They also tried hand gripping and hand gripping did not have the same effect as working with the legs. It talked about working to strengthen leg muscles to help prevent episodes.

Also it suggested while driving if you start to feel stimulated that way to pull over under it subsides.

[gtg287y]

Yes from the explanation I just read the vagal response will slow your heart rate down.

And when you walk your calf muscles help squeeze the blood back up to your heart-so the fact that you did not have an episode while you wore the monitor doesn't mean you aren't having them. They did show printouts from either heart rate or bp during the vasovagal episodes and the bars dropped down and got more sloppy.

They talked about a maneuver to prevent syncope (fainting) and presyncope of crossing your legs in front of you and squeezing. Kind of that same thing you do if you need to use the potty and you're waiting in line? Tensing up the leg and butt muscles can help push the blood back up to the heart and ease the symptoms of the episode. I would think you could do this in any position.

People have actually reported less faints since performing this maneuver.

Triggers for a vasovagal episode are stress, some body positioning, dehydration, and crowded places.

They also tried hand gripping and hand gripping did not have the same effect as working with the legs. It talked about working to strengthen leg muscles to help prevent episodes.

Also it suggested while driving if you start to feel stimulated that way to pull over under it subsides.

I'm really confused...I'm trying to tell you that I don't think blood pooling is a problem at all for me. Walking doesn't stop me from fainting...squeezing my legs doesn't stop me from fainting...sitting doesn't stop...no position I'm in STOPS me from having symptoms... Trying to exert myself at all past my limit makes me faint, and when I have symptoms my limits go way down. Tensing myself all up might give me something to focus on, but if it pushes me past my limits, I go down. The only thing that seems to help is laying down, and it doesn't stop or reduce symptoms, it just stops me from fainting (because I'm already horizontal).

[lieze]

I think that monitoring your bp's might be the way to go.

If they are dropping you may be able to try a medication to help bring them up a bit.

I think the faints are probably happening because you aren't getting good blood flow to your brain and or your bp's are dipping or dropping out.

You might try the tensing up of muscles or even just elevating your legs to get more blood flow to the brain and see if it helps.

It seems like if you could get something to give your bp a boost it might help to increase it a bit.

Activity usually helps me increase my bp but I have to be careful too and not over do it. I usually do a little sit, do a little sit, etc and if I feel even the teensy lightheaded sit or lay down til I recover.

I have drank cold water before and walked off episodes but this is all dependent on how low those bp's are dipping. If it's too low no walking or activity wouldn't work.

It is possible if I'm just borderline to where I feel a little lightheaded the pumping of my leg muscles and calves does get the circulation flowing and blood back up to the brain and raises my bp enough to where I am no longer symptomatic.