Exercise-induced Asthma or Neurocardiogenic Syncope?

[momme05]

I have also posted this question in the Heart Disease Forum.  But, given that I am not sure what it is, I thought to post it with this forum as well.  

My 19 year old son was diagnosed with NCS.  Now, my 16 year  old daughter is being sent for a Methacholine challenge test.  Not to question the doctor, but it seems to me that my daughter's symptoms are very similiar to my sons.  However, her's occur while exercising (playing soccer), as well as, just in the last three years, while having blood work done, dentist work, and severe pain from a cyst rupturing - she has passed out, When she is standing from sitting position, her vision goes dark and her hearing fades.  The most recent concerns are her symptoms during soccer practice.   Mostly while doing sprints, she has to stop becuase she becomes extremely breathless, heart pounding, very lightheaded, almost blacks out, her hearing fades in and out, she gets dry heaves and feels as though her throat is tightening on her.  Not to  mention that her hands become tingly.  Does all of this sound as though it is exercise induced asthma or are they true/possible signs of NCS?

[National Jewish Health]

The symptoms your daughter has experienced suggest that she may be having postural hypotension, commonly called low blood pressure, and/or an abnormal heart rhythm.  Another possibility is that she could have what has been described in the medical literature as the autonomic (nervous system) dysfunction syndrome.  Another possibility that manifests itself as autonomic dysfunction is a hormone producing tumor of the adrenal gland called pheochromocytoma.

What these symptoms do not suggest is asthma.

I would suggest that your daughter be given a treadmill exercise tolerance test with comprehensive monitoring, both respiratory and cardiac, under the supervision of a cardiologist or a pulmonologist, in a safe environment such as a cardiac laboratory.  This should also include measurement of rest and exercise arterial blood gases (ABGs) and pre- and post-exercise spirometry.  In anticipation of the testing, she should have a complete blood count (CBC) to rule-out anemia, an echocardiogram to assess pulmonary artery pressure and a resting electrocardiogram (EKG) to rule out any type of pre-exercise abnormal heart rhythm, abnormal electrical conduction or evidence of cardiomyopathy.

I also suggest that you not delay in arranging for this testing.

Until she has such an exercise test her physical activity, including soccer practice, should be severely limited.

Good luck.

Please give us a follow-up to let us know how you are doing.

[momme05]

Thank you very much for your reply.  I feel better knowing that someone else possibly agrees with me in the sense, it doesn't seem characteristic for Asthma.  I have been battling with my gut feeling to persue other causes with my doctor.  However, I will do more research on what you described and will discuss this with the doctor if her Methacholine challenge test (Tuesday, September 2) comes back negative.

Again, thank you very much.
When I have a final answer, I will post it on this forum.