Question Title: "black-outs"

Forum: The Heart Forum
Topic: Heart Disease

When I rise from a seated position, within a few seconds, I loose all vision in both eyes, I have to crouch and hold on to something so I won't fall, I can feel pressure building up in my head, then slowly, I can feel the pressure draining from my head and my vision returns and I am normal again. I've been to my GP twice and a heart specialist once for this. The following test were normal: CAT scan, heart sonogram, urine, blood, sugar, nutrition, horomones, thyroid. The heart doc. said it was probably carotid artery hypersensitivity syndrome. He said pretty much that it wasn't any big deal. I havn't been able to find anything on this.

All this was done about two years ago and the symptoms presist. Now I sometimes find myself feeling very "drugged" while I am just sitting down. It goes away after a minute or so. Also my carotid arteries have begun throbbing painfully from time to time. This happens under no certain circumstances. Neither doctor even listened to my carotid arteries. I'm not trying to find something wrong with me and I've tried to accept that this is "no big deal".

The symptoms you describe are typical for a condition called "pre-syncope", where someone feels as though he/she is about to pass out. Pre-syncope and syncope (actual loss of consciousness) often occur due to similar mechanisms and can be due to a host of causes. In your particular case, i.e. a healthy young woman, these symptoms are usually not due to anything serious and are not life-threatening. However, you clearly describe a frequency of symptoms (up to 10 times per day) that doubtlessly has intruded upon the quality of your daily life. In this case, it would be quite helpful to pinpoint the cause of your symptoms, in order to consider various therapies that may lessen their frequency and severity.

Syncope and presyncope, as I mentioned, can be due to many underlying causes. In young people without evidence of structural heart disease (normal heart sonogram) a group of disorders known as the "neurally mediated syncopes" are typically responsible. This group includes carotid sinus syndrome (a condition where pressure or strain on the carotid arteries triggers the symptoms), vasovagal syncope, and a variety of other, less common disorders. Most likely, you suffer from vasovagal syncope, but you may also have a variety of orthostatic hypotension, postural tachycardia, or other related causes for your symptoms.

At this point, I would strongly recommend that you undergo a study called a "tilt table test". This test involves lying down on a table that tilts from the supine (horizontal) to the upright (60-80 degrees) position while monitoring your blood pressure and heart rate. A good study can help identify the precise cause of your symptoms in many cases (80 percent sensitivity). If the test is positive your doctor can prescribe a variety of helpful treatments (medications, dietary changes, and others) that are of considerable benefit in reducing the symptoms. You should be evaluated by an expert in neurally mediated syncope, preferably at a large medical center with broad experience with these common but tricky disorders. If you would like to be seen at the Cleveland Clinic, make an appointment with Dr. Fred Jaeger at F15, 1 800 CCF-CARE. Otherwise, seek out an electrophysiology expert, or an expert in autonomic dysfunction, at a medical center near you. Best of luck.

Information provided in the Heart Center is for general purposes. Specific diagnoses and therapies can only be provided by your physician.

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