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Positive Tilt Tray...what will it mean?!
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Positive Tilt Tray...what will it mean?!

Hi,

I have fainted several times per year since I was a very little girl. More seizure like than faint,  told not epilepsy, but "just phrone to fainting".  I learnt to have high salt diet and reads the signs of when one was coming on, often laying down with feet up seemed to help...but not all the time.  

Was told I'd grow out of it, which seemd to be the case when started to happen less (ie only once a year)....but during my late 20s I started to get them around every 4-6mths.  Nearly all in the middle of the night, with stomach pain and getting out of bed.  Once while still lying in bed...which was what made me go back to the doctor for futher tests.  

Now am 30 and have just had a positive tilt tray test, fainted after a few minutes. Am waiting to see doctor to get referral to neurologist for analysis.  However from what the nurse showed me, when I fainted on the tilt tray the Blood Pressure and Heart Rate lines dropped suddenely and flat lined for a little bit (didnt see what readings were).  Because it will be a while until I see the neurologist have been searching online to see what it could all mean.  

Vaovagal and NCS definitely seems to show all my symptoms - fainting due to pain, hot/cold, shock, standing etc.  I am still quite healthy and happy in other ways!  

If anyone out there can help I have a couple of questions:

* can you still have a baby?
* i often suffer fatigue - some mornings I can jump straight out of bed to face the day, but other days (even with full night sleep) I often feel like i've been hit by a bus and it's a struggle to get up.....could this be related?
* anyone know why you get the stomach pain?  I often get it before or after a faint.  Over the last year I have also had stomach problems inbetween faints...could this be related too?!

Thanks for your help.  :)
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492869_tn?1285022533
I'm sorry your diagnosis has delayed by so many years.  A positive Tilt Table Test in the way you describe is indicative of a Dysautonomia, specifically Neurocardiogenic Syncope (also called Neurally Mediated Syncope).

It seems that you are responding appropriately by laying down, and raising your legs when you feel an episode coming on.  This will help to restore blood flow to your brain more quickly.  Even if it doesn't prevent the episode, it is likely to shorten it.  Additionally, there are medications available to treat some of the symptoms.

It's much less common for the episodes to occur while in a supine position, (such as while sleeping), but not entirely impossible.  Just the same, I would recommend a full workup by a Cardiologist, as well as a Neurologist to be certain there isn't anything else causing your symptoms.

The fatigue you describe is a very normal symptom in various forms of Dysautonomia.  If the patients heart rate or blood pressure is too low to support much physical activity, the individual will undoubtedly feel fatigued.  Do you have a home blood pressure monitor?  It may be helpful to make a log of these readings for your doctor.  In POTS, (another common form of Dysautonomia), the heart rate climbs excessively upon standing, and causes fatigue as well.

Digestive problems are also common in many forms of Dysautonomia, which could account for some of the stomach pain you're experiencing.  Not only that, but nausea can be a symptom of low blood pressure, thus a warning to a pending fainting episode.  You may want to visit a Gastrointestinal Specialist to check for Gastroparesis (Delayed Gastric Emptying), and other digestive problems.  IBS (Irritable Bowel Syndrome) is also common in Dysautonomia.

Autonomic Dysfunction & Dysautonomia Index:
http://www.medhelp.org/health_pages/Neurological-Disorders/Autonomic-Dysfunction--Dysautonomia-Index-Page/show/857?cid=196
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875426_tn?1325532016
I don't know what causes your abdominal pain, but since it seems like a precursor to a faint, has anybody ever checked to make sure your abdominal aorta was in fine condition, with no wall weaknesses?  I might be way off base here and way out in left field, but if it were me, I'd be curious to know and wanting to make sure I did not have an abdominal aortic aneurysm or other abnormality there.
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612876_tn?1355518095
How severe is this stomach pain that accompanies your syncope, on a scale of 1-10?  There are people who experience vasovagal syncope in response to severe pain.  On the other hand, if it's not a severe, crippling kind of pain and it doesn't seem that the pain itself is bringing on the syncope, but rather the pain is just part of the constellation of symptoms you feel as you are about to faint, that's different.  As your body is about to faint, blood is failing to circulate properly to the heart and thus up to the brain.  Recall the warning we all received as children not to swim immediately after eating, because blood flow would be diverted to the stomach for digestion, and the blood demands of the muscles to perform the actions of swimming could cause muscle cramps.  Similarly, I wonder if your stomach pain as you are fainting could be caused by reduced blood flow to your stomach as your body tries to divert as much blood as possible away for the essential functions of your heart and brain?  

As halbashes said, gastrointestinal complaints are common in dysautonomia, from acid reflux to gastroparesis to irritable bowel syndrome.  It's not at all uncommon to have GI symptoms on a regular basis, even if your syncope is only sporadic.  Likewise with fatigue between episodes.  I highly recommend you read Dr. Grubb's overview on syncope here to gain a better understanding of fainting:

http://www.medhelp.org/health_pages/Neurological-Disorders/Further-Reading-on-Dysautonomia/show/696?cid=196

Yes, women with NCS still can have healthy pregnancies and give birth to healthy babies.  Planning should be done in advance to consider if any medications need to be changed or discontinued before the woman gets pregnant to protect the health of the fetus.  There may be special precautions taken during the birth if the mother's blood pressure is too low, but a knowledgeable doctor can guide you through all of this.  
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I always used to get stomach cramps and abdominal bloating/pain just before fainting. Sometimes I would get diarrhoea and vomiting in place of fainting.

I have since cut out all wheat from my diet - and amazingly - no more stomach pains, bloating or diarrhoea!

This may not work for everyone - but definately worth a try. If you want to give it a go, cut out all wheat products (check those labels carefully!) for two - four weeks. If you don't notice a difference by then, then wheat probably isn't a problem for you.

I noticed the difference within a week! Now if I eat even 1 biscuit I start getting stomach pains again within half an hour. It isn't coeliacs with me - just wheat allergy.
Cutting out the wheat also reduced the number of faints I have.
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969031_tn?1247609194
One medicine which works great with blood flow if u have POTS is midodrine. This medicine is so great, i have stopped fainting and i dont get dizzy. I also have alot more energy then i used too. Ask ur doc about this med. Hope u feel better.
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