Syncope........

[CardioTrans, BSN, RN]

Hi all....... I am in need of some thoughts/critical thinking.

I went to my primary MD on Thurs due to 2 epsiodes of syncope each lasting

Any suggestions on what further questions I need to ask. I have asked about tx, was told that possibly beta blockers, but wanted to do the salt and fluid first, and cards did not set me up a follow up appt. Prim MD will call after Mon.

I still feel lightheaded at times, get SOB walking from the house to the driveway. I have no energy. Have been under a good deal of stress lately and thought that may have induced some of the symptoms. Im only in my mid 30's and otherwise healthy. I did have to go to ER about 4 yrs ago with chest pain and tingling of the L hand to which ER played it off to chondocondritis. My mother had an MI when she was 32.

Again, what other questions/information should I focus on to get them to give me a straight answer? Thanks in advance for any insight.

[jmgrn65, RN]

has your hgb come back? I had a low hgb, I was sob just walking from the store to car. i had iron deficiency anemia. Just a thought.

Beta blockers will lower your pressure even more. Have you always had a low bp? if so then that probably isn't causing syncope. Good Luck and stay well

[CardioTrans, BSN, RN]

No, I havent gotten anything back regarding my labs. They didnt come back until sometime Friday. I thinking that they will call me Monday with the results. My BP has run low all my life. Im just at a loss.

[LanaBanana]

As a teenager I had problems with syncope episodes all the time. Nobody could figure out what the problem was, even after 2 trips to Mayo's. Finally a cardiologist ordered a Tilt Table Test. My test was positive and was diagnosed with Neurally Mediated Hypotension, also called NeuroCardiogenic Syncope, and a more severe form of the common VasoDepressor Syncope. Lab tests for this are always normal, EKG's, Holter monitor's, everything is always normal, but a TTT can diagnose it. Basically, the body reacts abnormally and BP drops to a level that causes syncope. Everytime I passed out EMS was called to take me to the hospital and by the time they got there and took my BP it was generally back to normal due to me laying down.

This might not be the problem, but it's worth checking in to. It took 7 years for someone to finally know what my problem was, hoping it doesn't take you that long!

[CardioTrans, BSN, RN]

Thanks for the info Kayte. I will add that to my list!

[eprn]

Yeah, you may need an extensive workup, such as the ol' tilt table or an EP study. If they just can't figure it out (even after the event monitors, holters, studies, etc.), they may implant a loop recorder. It's a small implantable device that can monitor your heart rhythm for a year or so. I've seen them used in cases of syncope that really don't have a cause they can readily identify. Of course, the loop recorder is only going to rule out an arrhythmia. There are plenty of other reasons behind syncope.

Hope this helps...

[Angie O'Plasty]

Any new information?

[CardioTrans, BSN, RN]

Update...... I had the Cardiolyte stress test and the Echo on Monday. I hit my target heart rate, but not the time. I got dizzy and almost passed out again. The cardiologist said that he "saw changes on the axis" and for me not to do alot of driving until he read everything. Of course he didnt elaborate. So they call yesterday said that "nothing major showed up on the echo or stress test", but want me to come to their office on Friday.

Didnt tell me not to drive again, or go to work. I have missed my last 5 shifts of work. Luckily, my nurse manager is great. She told me that she wanted me to stay home and make sure everything was ok with me, that my job would be there.

So any ideas as to why they want to talk to me, even though "nothing major showed up"?

[eprn]

Syncope is tricky, and there are many, many causes for it. Like I said, it can be an extensive workup. As far as your axis deviation, it's generally meaningless by itself. Let him continue his workup and hopefully they will come up with an answer for you.

Good luck.

[CardioTrans, BSN, RN]

Update again................ went for my follow up today. Cards told me that everything looked fine. No problems with valves, muscle or blood flow. Last Friday he told me he wanted me to increase my fluid and salt intake. I have done that, but had 2 really bad spells yesterday. He started me on Florinef to help keep my pressure up. Today it was 90/58. I have drank enough water in the last week to float Noah's Ark and eaten enough salt that I think the ocean is out of it. He told me that basically what I have is Neurocardiogenic Syncope. The only other time in my life that I have passed out was once when I was pregnant with my oldest son. He told me that with all the stress I had been under with working full time, in grad school and a 16 yr old that is driving me nuts that it was my body's way of saying "Hey, I need a break". That I would prone to fainting spells with my low BP, for no particular reason.

Sooooooooo, least I know my heart is in good health. So hopefully this med will help. He wants to see me again in 3 wks to make sure.

[LanaBanana]

Welcome to the syncope club! Glad you didn't have to do the tilt test! Glad you got some meds to start. I took Florinef once upon a time. The most recent thing I was on for it is Zebeta. Looks like I've got to head back to the cardiologist now due to a fainting spell last night.

[Havin' A Party!, ASN, RN]

Cardio -- Are you an athlete? Do aerobics? Absolutely essential to stay hydrated.

Other ideas: Check your pulse at the time you experience the symptoms. Determine if you're in rhythm.

How's your K level? Do you follow a varied diet? Include sources of mag?

Also, doc may suggest colonoscopy.

Good luck!