Nueral Mediated Syncope

[JFreeer]

Hi All, 

hope everyone is staying well. 
I had a tilt table test last week and was diagnosed with Nueral Mediated Syncope from an EP. He said we would discuss more in an office visit but that may not be until end of August or September. They haven’t even called me back yet. 
I’ve been stable on 6 grams of Sodium a day and 30-40 compression hose. He said to continue those and there is other options We can discuss. 
I guess my question is what makes this different than other dysautonomia diagnoses? I did stand on tilt table for 36 minutes and finally had a very low bp episode which felt horrible. Is it the length of time I stood that makes it a differential diagnosis? 
thank you to all in this community! 

[Sushi]

3 hours ago, JFreeer said:

I guess my question is what makes this different than other dysautonomia diagnoses? I did stand on tilt table for 36 minutes and finally had a very low bp episode which felt horrible. Is it the length of time I stood that makes it a differential diagnosis? 

That you didn't get a POTS diagnosis. I have more or less the same diagnosis though I have time to sit down quickly before I faint. Were you to have POTS, your HR would have gone up 30 or more points. On my TTT I had a short (about 15 minutes) tilt, then some other autonomic tests done lying, and then a long tilt. After 30 some minutes, my BP went to 88/80 and I did feel awful, awful and asked to end the tilt. I think that my official diagnosis is Neurally Mediated Hypotension.

[PotsieCrocheter]

Yes, for POTS in adults the heart rate must go up 30 bpm within 10 minutes of standing in the absence of orthostatic hypotension. 

You also have to have some orthostatic symptoms like light-headedness, brain fog, shakiness, pounding heart beat, etc that worsen when upright and get better when laying down.

[Pistol]

@JFreeer - I have HPOTS and neurally mediated syncope ( also called NCS - neuro-cardiogenic syncope ). My first TTT showed NCS b/c after 20 minutes my HR spiked and then plummeted, along with my BP, and I passed out. The second TTT was supposedly normal but was misinterpreted by the EP and actually showed POTS due to the elevated HR within minutes. 

It is very good that the compression and salt helps you so much. NCS is also a form of dysautonomia, so it is something that will be with you forever but often the treatments can control it. I find that the biggest prevention for episodes of fainting ( or almost fainting ) is the avoidance of prolonged standing. After the first diagnosis I was started on Metoprolol but it did not help at all, possibly due to the fact that I have POTS as well. But starting a Beta blocker may be something your EP is considering, and if so it is a perfectly acceptable treatment option.