Vasovagal Syncope and avoiding a pacemaker Vasovagal Syncope and avoiding a pacemaker

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Thread: Vasovagal Syncope and avoiding a pacemaker

  1. #1
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    Default Vasovagal Syncope and avoiding a pacemaker

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    Ever trained anyone who faints when the room temp changes?
    My housemate (female 23yo 5'2" 48kg) has been struggling with vasovagal syncope for the best part of 8 years now. It would not be uncommon for her to faint once or more times a week. Temperature changes, high stress events, stimulants and rapid change in exertion all result in nap time.
    It goes without saying doctors have advised avoiding strenuous exercise at all cost. She runs, squats and deadlifts none the less, not dead yet. They have also proposed a pacemaker may be her only out.
    It seems logical to me that a stronger heart could only do good things.
    Thought it worth seeking a professional opinion, maybe someone on here could help her find a path to a more function life.

    Thanks for any help!

  2. #2
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    A pacemaker? For vasovagal syncope????

  3. #3
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    You can have a cardiodepressive version of vasovagal syncope, where the heart rate drops out....but itís pretty darn uncommon. Unless theyíve documented it on a tilt table test (or cardiac monitoring of SOME sort), she doesnít have that and doesnít need

  4. #4
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    I guess if she has had an event recorder demonstrate genuine bradycardias associated with the loss of consciousness and it is happening as frequently as you mention then there may be no other choice. However why this means no strenuous exercise is beyond me.

  5. #5
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    Quote Originally Posted by Mark Rippetoe View Post
    A pacemaker? For vasovagal syncope????
    Yeah. That's exactly my response. Something else is going on.

    Quote Originally Posted by Jdcuth View Post
    I guess if she has had an event recorder demonstrate genuine bradycardias associated with the loss of consciousness and it is happening as frequently as you mention then there may be no other choice. However why this means no strenuous exercise is beyond me.
    Yeah, we're talking in a vacuum here. "Vasovagal" is a wastebasket term. It basically means the syncope is neurocardiogenic....like most syncope. But sometimes it's because of a malignant arrhythmia. As Simon intimates, she needs a tilt-table test and probably a holter and an echo. IOW, she needs to see cardiology. If she came to me, I wouldn't train her until I had that workup in hand.

    I knew this girl once, a lab tech, with a similar presentation, which did not get worked up beyond the "oh it's just vasovagal syncope now go away" phase. Turns out she had a Brugada variant. Sudden cardiac death in the lab one day while working at the bench. Fortunately across the street from our ED. Resuscitated in less than 15 minutes with a fair neuro outcome, and got an ICD. Happy ending. Could have been...worse.

    Remember: syncope is a condition in which your brain temporarily stops working for some reason. Respect that, and get to the bottom of the "some reason" part. That's the role of a doctor who gives a shit and doesn't just slap a "vasovagal" diagnosis on a young person with recurrent syncope.

  6. #6
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    I really need to stop being imprecise in my replies.

    Syncope is loss of blood pressure to the head, for whatever reason, that lasts long enough for you not to be able to
    stay conscious (or at least upright). If. I remember aright, it will happen to about 10% of us during the course of our lifetimes.
    Most of the time, we never figure out what it was, and it goes away.

    There are red flags to watch out for, but one noteworthy thing about your friend is that she hasn’t died from any of these multiple
    episodes. That all but rules out most of the more terrifying causes. I’d be interested to know what they know about her syncope, before
    they start putting hardware into her.

    If nobody has documented a pause in her heart rate of more than 3 seconds, or SOME sort of bradycardia at the time she passes out, then
    they shouldn’t even bring up the word pacemaker.

  7. #7
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    Thankyou for your reply.
    Sorry i should have been more informative.

    She has been diagnosed with cardiodepressive vasovagal syncope. She was diagnosed via the tilt table test. She does see a cardiologist. No arrhythmia.
    During an episode her heartrate ramps up to +140ish before dropping to 40bpm and thus inducing the faint. At least that is what was recorded on the table. Her resting bpm is usually around 70.

  8. #8
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    In that scenario I suspect she does need a pacemaker. Iím no expert in cardiology but I canít think of another way to prevent the profound bradycardias she is getting and frequent fainting would be quite an unpleasant symptom to suffer I hope she gets somewhere

  9. #9
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    Ah, then that’s simple. Pacemaker. It will greatly improve her quality of life.

    I mean, there’s other stuff (making sure she’s hydrated, etc), but if she’s failed that, then this is a no-brainer.

    The vast majority of the time, the pacemaker will just sit there and watch the world go by. It will only leap into action
    If she goes low.

  10. #10
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    Quote Originally Posted by simon0596 View Post
    I really need to stop being imprecise in my replies.

    Syncope is loss of blood pressure to the head, for whatever reason, that lasts long enough for you not to be able to
    stay conscious (or at least upright). If. I remember aright, it will happen to about 10% of us during the course of our lifetimes.
    Most of the time, we never figure out what it was, and it goes away.

    There are red flags to watch out for, but one noteworthy thing about your friend is that she hasn’t died from any of these multiple
    episodes. That all but rules out most of the more terrifying causes. I’d be interested to know what they know about her syncope, before
    they start putting hardware into her.

    If nobody has documented a pause in her heart rate of more than 3 seconds, or SOME sort of bradycardia at the time she passes out, then
    they shouldn’t even bring up the word pacemaker.
    Yes, this should definitely be worked up and characterized before putting in a device, but I would just add that dying from the syncope itself is not the only concern. Regardless of the cause, sudden loss of consciousness can be a big problem if you are driving, swimming, holding a baby, rock climbing, etc. Not to mention it's a bummer to have an ambulance called on you unnecessarily every time you drop in the grocery store or mall. Fainting 2/week puts a huge crimp in your lifestyle. So even if it's "benign," it needs treatment. Whether a pacer is needed is another story. Pacers are pretty darn expensive, so I would assume that at the very least the insurance company is insisting on proper eval and perhaps trial of other treatment first, even if the doctor is a pacer-happy cowboy who drives a Bentley with a "MEDTRONIC" vanity plate. But maybe I shouldn't assume these things...

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