Sudden Fainting

My wife (58 year old, f) is prone to erratic blood pressure and also has Sarcoid which comes and goes.  She has been seeing several doctors.  She is normally a very active person.  Four years ago she began complaining of sudden episodes of dizziness and a racing heartbeat.  We went to the ER and after finding nothing immediatly wrong besides a high blood pressure she was given a portable heart monitor which she wore for a month.  Although she experienced the dizzy feeling twice no irregularities were found on the readings and blood pressure medicine was prescribed.  A year or so ago she fainted suddenly while reading a newspaper.  She awakened wihin seconds and we went to the ER and beyond a slightly elevated BP nothing was found.  Her BP medication was adjusted and everything was fine for a few months.  She continued to have occasional episodes of dizziness and an MRI was done and nothing was found.  Early this summer she experienced sudden dizziness and a sense of a racing heart beat and fainted while preparing to get on a riding mower.  Again after examination her BP was a little low, but nothing else was noted.  Her BP medication was again adjusted by a physician.  This morning she experienced dizziness and the racing pulse sensation while urinating and tried to make it back to the bedroom but fainted and collapsed enroute.  She revived in a few seconds, said she was fine and refused to allow another trip to the ER.  I took her BP before she got up and it was 124 over 74, pulse 86.  She is resting now and seems fine but I am concerned, and at a loss.  She has just told me she has had several similar episodes this year I was not aware of while I was working.  We live in a rural area on a small farm with no immediate neighbors.  My job involves frequent long distance travel for extended periods and while I have placed the farm machinery off limits and contracted for seasonal lawn mowing to ease her burden, I would be happier if a cause of the fainting episodes was found so it could be prevented.  At this time the medications she is currently taking for differing conditions are (names of medications from the bottles) HCTZ, Fluoxetine, KLOR-CON M2 0, half an asprin every week and estrogen.

[Kevin Pho, MD]

What is being described is syncope, which is defined as an abrupt and transient loss of consciousness associated with absence of postural tone, followed by a rapid and usually complete recovery.

A portable heart monitor (Holter monitor/event monitor) and MRI were not revealing.  Here are some other tests that you may want to discuss with your personal physician.  

An echocardiogram can be considered to look for structural heart defects.  Exercise stress testing is used to look for possible heart ischemia that may contribute to syncope.  There is also a test known as a tilt-table test that is used to try and reproduce the symptoms - this can be discussed with your neurologist and ENT specialist.  

You may want to note that there are a significant proportion of patients where the cause is not found (i.e. idiopathic syncope).  You may want to consider a referral to an academic medical center for more further evaluation.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.