Almost blacking out

[L Andrews]

I am a 38 yr old female with a history of autoimmune disease (Sjogren's Syndrome, Fibromyalgia, Mixed Connective Tissue Disease, Hashimoto's). My physical conditioning is fair. I have mild PAC's.  Because of thyroid antibodies I have some difficulty regulating my thyroid but it is generally fairly stable.  

I have 3 problems that occur.

1.  During hot weather and occasionally during cooler weather I have a problem of almost blacking out when I enter a store after parking my car. Sometimes this happens at home when just walking around the house. I have never actually fainted but for 10 to 60 seconds the room goes black, I can barely hear, and I feel like all the blood in my body is pounding in my head. No history of this except father has carotid artery disease and diabetes.

2.  Occasionally (not at all for a month or two & then several times a week for a month) I get a feeling of pressure in my chest and mild breathlessness. What prompted me to finally go to the cardio was a 30 minute episode of this accompanied by a strong feeling of squeezing & lightheadedness - had never had the squeezing before. This passed after resting.

3. For the past 4-6 weeks I have had daily episodes of dizziness and one episode of vertigo. I have little tolerance to heat and feel lightheaded on exertion.

I had treadmill and thallium tests. The treadmill produced a false positive & the thallium results were good. Holter monitor didn't show anything either. Dr attributes the problems to autoimmune disease and slightly above normal levels of LDL which are only during episodes of low thyroid.

Questions
What could be causing the black outs if it is not heart related & what kind of dr should I see for it? Or could it still be heart related and I need further testing?

Can PAC's cause the squeezing sensation or what else might cause it? Normally I just feel the flip flopping from PAC's.

Any comments on the dizziness? With father's history of CAD should I have this investigated? His symptoms are dizziness. What kind of dr does this? When I take my blood pressure at home during these times it is low (85/50) though blood pressure us usually 100/70.

Thanks for this great service.

[Cleveland Clinic, MD]

Dear L,

The medical term for fainting is syncope (or near syncope if one dosen't actually pass out).  This is a common but complex condition that has many causes.  The most common cause is the common faint (neurocardiogenic or vasovagal syncope).  This is the typical faint caused by strong emotional factors (i.e. the sight of blood) and is usually brief in duration.  The person almost never harms themselves and the precipitating factor can usually be identified.  More serious forms of syncope are due to cardiac and neurologic causes.  

Syncope due to bradyarrhythmias (slow heart rate) or tachyarrhythmias (fast heart rates) are often hard to document.  Holter monitors will only reveal the source if they are being worn during an event.  "Event monitors" are devices that can be worn for months at a time and when an event occurs a button is pressed that saves the heart rhythm for the last 5 minutes.  This can then be sent to the doctor over the telephone for a diagnosis.  Other less common cardiac causes are carotid sinus irritability which is due to an abnormal structure in the neck that results in syncope when pressed upon.

Neurologic forms of syncope include autonomic nervous system diseases and seizure disorders.  These are diagnosed with tilt table testing and seizures with an EEG.  Tilt table testing is a simple test that is pretty much what it sounds like.  The patient is placed on a table and ECG and blood pressure monitoring are attached.  The table is then tilted upright so the person is in a vertical position and the heart rate and blood pressure are monitored.  People with certain types of syncope are more likely to have symptoms during this test.  The entire test lasts about a half hour.

Medications can sometimes be used for treatment of the "common faint".  A beta-blocker is the most typical medication used. Other treatments that may be recommended include liberalizing  salt intake, compression stockings and elevating the head of the bed with blocks 6 inches.  Finally, slowing rising and "bouncing" on one's toes when a faint feeling comes helps return blood circulation to the head.

As you can see the diagnosis is somewhat complex. Therefore, I would recommend that you see a specialist in the area of syncope.  Two doctors that specialize in this area here are Dr. Fred Jaeger and Dr. Fetnat Fouad.  You can make an appointment with either of them by calling the number below.  Good luck.

[Matthew Nelson]

OK... I don't have any history of anything neurogical(did i spell it right?) but my mom had a brain tumor removed and had seazures after it. She later died from one. But my case is i am 14 years old. I've had asthma since the 2nd grade. I sometimes get this feeling of dizzyness all of a sudden just during the day. It can happen all of a sudden. I am a long-distance runner but this has been going on for a while before hand. My mind will go blankish, i guess, i can't think as fast. These things go on for about 10-30 seconds. I am afraid this might relate to something my mom had. IF you can give me ANY help or direction to who I should see, please reply to this. Thank You

[Question to Nicole]

Matthew,
The doctors at Cleveland Clinic will not usually answer your questions when you post under someone else's. They only take 1 or 2 questions a day and it is hard to get your question posted before they have reached their daily quota. I am not a doctor but I would advise you to speak to the physician who treats you for your asthmatic condition. Many things can cause the symptoms you are describing such as, any medications you may be taking for asthma, OTC medications, nutritional or vitamin deficiencies,
low hemoglobin level, low or high blood sugar, slow or fast heart rates, problems with your ears and so on. It is also important to find out what you are usually doing when these episodes happen. Since their are so many different things that could cause problems, your best bet is to talk with an older parent, relative, school nurse or whomever is responsible for your care and have them get you in to see your doctor. I am sure you must be afraid, especially since you lost your mother so tragically, but try not to worry and know that their are many people on this site who share in your fear and grief. If you are without a doctor, someone who specializes in Family Practice, Internal Medicine or Pediatrics is a good place to start. I wish you luck.

[lisa]

hi
i am so glad to hear of someone else who is experiencing "black outs" and hearing loss (with the feeling that someone is pumping a pounding techno beat into the side of your head!).  my episodes (which come in strage patterns... once a month or 3 per week, none for a year or two, 20 in 5 months, etc.) begin with the feeling that my imaginary airplane suddenly dropped 1,000 feet in altitude (it's a crazy rollercoater-dive rush)- at this point i've learned to hang on to something because a blackout is bound to follow...the room just kinda cones out, zooming out to black.  this "blindness" lasts for about 10-60 seconds.  the freaky part starts when my vision pops back in gear... my heart at that point is virtually kicking its way out of my chest at close to 230 beats per minute and strong as an ox.  two sundays ago this rate kept up for over an hour.  i never "balckout" again once my heart is in full force, but i begin to lose hearing about 10 minutes into the ride (that's when the internal audio-pounding is loudest..if that makes sense) and then get a deep irritating pain in the center of my back which refuses to go away and aches like a *****.  oddly enough... the episode will stop so abruptly - it feels like my heart flops over like a dead fish and resumes a normal beat.  my blood pressure is pretty low naturally 90/60. these symptoms have been going on for years now (I'm 28 years old,5'7", 135 pounds and a resting hearbeat of 60 or so), but i just thought it was caused by being stressed from exams, or drinking too much coffee, smoking, or from generally partying like a rock-star.  (i forgot that these symptoms were present before i ever touched a cigarette or stayed awake beyond 2am).  i did go to a doctor 2 weeks ago, got my first EKG, ehco, and blood work and they say i've got an abnormally symptomatic WPW.  they threaten me with a looming cardiac arrest.  i'm sheduled for ablation next week, jacked up on beta-blockers, and they've indicated that my pathway is close to my AV node (according to my delta waves) and that i should decide if a pacemaker would be out of the question... consequently, i'm living like a nun and have found myself writing in my first forum.  wow.  

any comments?  are these standard WPW symptoms?  just interested in different perspectives here.  i've never been to the hospital for more that general female checkups and obligatory dr. visits in school.  needless to say, this is all greek to me!

longwinded,
lisa

[Andrew]

I had the same problem when i was about 13/14 yrs old.  At first they (the Docs) thought it was a middle ear imbalance.  I was sent for all the middle ear test and they came back perfect. At the time I was told that it can be caused by the onset of puberty. I was then sent to a cardiologist for and Echocardiography, as a result was diagnosed with a dialated Cardio Myopathy, and because of this disease and my height (6ft 3) I had a very low blood pressure, and every time my heart was called into action (for standing, rolling over in bed etc) i would feel light headed or pass out.  this would only happen for a time until my heart was up to speed or i had come to after fainting.

I hope this helps

[Andrew]

I had the same problem when i was about 13/14 yrs old.  At first they (the Docs) thought it was a middle ear imbalance.  I was sent for all the middle ear test and they came back perfect. At the time I was told that it can be caused by the onset of puberty. I was then sent to a cardiologist for and Echocardiography, as a result was diagnosed with a dialated Cardio Myopathy, and because of this disease and my height (6ft 3) I had a very low blood pressure, and every time my heart was called into action (for standing, rolling over in bed etc) i would feel light headed or pass out.  this would only happen for a time until my heart was up to speed or i had come to after fainting.

I hope this helps