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Heart Disease (Expert Forum)
Neurocadiogenic syncope and IST
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Neurocadiogenic syncope and IST
by Neener44, Sep 14, 2002 12:00AM
Is it possible to have both neurocardiogenic syncope and IST at the same time? Would the syncope be the result of medications? I have been taking sotalol 80 mg twice a day. My cadiologist/ep told me yesterday that I have N.S. (diagnosed from a recent holter monitor and symptoms of lightheadedness and pre-syncope) previously he said I had a rapid heart rate originating from the sinus node. I have had 2 ep studies with ablations and the rapid heart rate returned both times. I have difficult to control moderately high blood pressure, readings have varied from 140/90 to 184/108 taken at doctor's offices and at home during the last 3 months. Without meds my resting H.R. stays around 110 to 120 bpm jumping much higher with minimal activity.
Yesterday the doctor suggested I cut the dosage of sotalol to 40mg twice a day and begin taking Altace 2.5 mg to lower my blood pressure. I'll try it, but don't understand the rationale. How could my blood pressure and heart rate be both low resulting in neurocardiogenic syncope and high at the same time. I questioned him, but he did not seem to want to try and explain it to me. I get the feeling that he is frustrated with me since the ablations did not get rid of my problem and he has been seeing me now for about 2 years. He told me to try this new combination of meds and come back in 6 months. I am feeling very discouraged at this point as this is truly affecting my lifestyle. I like to hike and play sports, but these activities have been difficult if not impossible.
Thanks in advance for any advice.
Neener
Yesterday the doctor suggested I cut the dosage of sotalol to 40mg twice a day and begin taking Altace 2.5 mg to lower my blood pressure. I'll try it, but don't understand the rationale. How could my blood pressure and heart rate be both low resulting in neurocardiogenic syncope and high at the same time. I questioned him, but he did not seem to want to try and explain it to me. I get the feeling that he is frustrated with me since the ablations did not get rid of my problem and he has been seeing me now for about 2 years. He told me to try this new combination of meds and come back in 6 months. I am feeling very discouraged at this point as this is truly affecting my lifestyle. I like to hike and play sports, but these activities have been difficult if not impossible.
Thanks in advance for any advice.
Neener
Doctor's Answer
by CCF-M.D.-KE, Sep 15, 2002 12:00AM
Dear Neener 99,
From your discription is sounds as if you have neurocardiogenic syncope. Neurocardiogenic syncope occurs as a result of the triggering receptors which leads to a drop in heart rate and blood pressure. The rapid heart rate you experience from time to time may also be contributing to your syncope and lightheadedness.
Blood pressure is a parameter that changes from second to second and moment to moment. It sounds as if you do have high blood pressure, though at other times such as during syncope your blood pressure and pulse may be low. This is very typical. It also sounds as if you need more aggressive blood pressure control if you are continuing to have readings of 180/108.
You may consider going to a large medical center with doctors who specialize in this area. I do not know what type of rhythm disturbance you have had, but you describe 2 failed ablations. Though your medical regimen seems reasonable you may consider seeing a specialist who can put your history together and offer another opinion.
Thanks for your question,
CCF-MD-KE
From your discription is sounds as if you have neurocardiogenic syncope. Neurocardiogenic syncope occurs as a result of the triggering receptors which leads to a drop in heart rate and blood pressure. The rapid heart rate you experience from time to time may also be contributing to your syncope and lightheadedness.
Blood pressure is a parameter that changes from second to second and moment to moment. It sounds as if you do have high blood pressure, though at other times such as during syncope your blood pressure and pulse may be low. This is very typical. It also sounds as if you need more aggressive blood pressure control if you are continuing to have readings of 180/108.
You may consider going to a large medical center with doctors who specialize in this area. I do not know what type of rhythm disturbance you have had, but you describe 2 failed ablations. Though your medical regimen seems reasonable you may consider seeing a specialist who can put your history together and offer another opinion.
Thanks for your question,
CCF-MD-KE
My symptoms were mainly fatigue and brain fog, but when they put me on atenolol it was like I had my life back! I have a low tolerance to drugs, so I couldn't tolerate more than 12.5mg of atenolol which wasn't enough to control the tachycardia. My EP added verapamil 180mg and this seems to do the trick. We found that if I take the atenolol in the morning and the verapamil at bedtime I have fewer episodes of breakthru tachy. Later he started me on a 1g salt tablet. (I am now experiencing a good bit of fatigue again, but have other health problems, so I don't at this point know what the cause is).
I hope this helps you and that you can find something to work for you.
I haven't had a EP study, it's funny because all of my dr.s think I should have had one. I am glad I haven't and why should I? I am not willing to get my sinus node modified. A dr. from this forum (I think it was Dr. Cole) suggested looking into, but I am not interested, at least not yet. I don't know if I could get off of meds even with having it done, because of the NCS. It sounds like mine is better controlled than yours, also. I am not aware of any side effects with the atenolol being so low, nor with the verapamil.
I hope you can find something soon to help you!
Let me give you this link, it is a forum for autonomic dysfunction. Maybe you will find it helpful talking to others with these problems.
http://216.149.163.247/cgi-bin/forumdisplay.cgi?action=topics&forum=NDRF+General+Discussion&number=1&DaysPrune=20&LastLogin=
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