Neurocardiogenic Syncope or valve regurgitation?

46 yr.old female, 5'7" 130lb. Past med.history - DVT/PE postpartum in '92. Sister w/ MVP, Aunt w/CHF, grfather w/CHF, father MS. Past 6+ years episodes of dull headache, lightheadedness, blurred/double vision, weakness, left shoulder/arm numbness, palpitations, chestpain. Sometimes coughing, usually fatigue/weakness on mild exertion. Physical activity very limited. Told during episodes that I mumble, talk slowly and appear confused. Neg. neuro. work up except abnormal EEG showing spikes both temporal lobes. Blood/ endocrine normal. Echo - mild mitral reg/leaflet redundancy. EKG ST and T wave changes. Stress test- achieved 130bpm when symptoms appear,AV nodal at 50 w/retrograd P-waves,weak pulse BP 90/60, resp. at 30. Atropine 1mg and IV fluids given/ EMS called as I return to sinus rhythm/160/90bp/60hr. Cardiac Cath performed showing mild aortic regur. Diminished uptake of radioisotope in anterior wall. Dr. states this is severe exercise induced vasodepressor syndrome and placed on Bblocker which is discont. due to side effects. Tilt table test positive after 27 min. and nitro. given at 10minutes then 20 minutes. Baseline HR 54, BP114/74. Passive tilt HR 67-77 and Systole 98-104. After nitro systole 82-104 and HR 79-109. At 27 min on tilt symptoms develop, I pass out w/HR of 48 and systole of 60. Holter shows rare APCs/VPCs   Home monitoring - when symptoms develop BP drops 80/50 usually, and HR increase 100 -200. Fatigue follows lasting 20min.- several hours. Occasional sudden onset of rapid HR w/symptom, last 2 min or less and end suddenly. Input appreciated.

[Cleveland Clinic]

loraine,

thanks for the post.

Your symtoms (symptoms) are not realted to mild aortic regurgitation.  If your tilt table recreated your symptoms in addition to being positive I would attribute a lot to it. If not, I would have some concern over the temporal lobe spikes on your EEG and whether seizures could be playing a role.

good luck

[loraine13]

Thank you for the quick response.  It seems like the factor that brings on my symptoms is an increase in HR. This occurs whether I am sitting, standing, relaxing....and can last 20 minutes to several hours (w/BP 90/60 - 74/47 and HR hovering around 100).  It can be debilitating when it lasts a long period.  Is this consistent with syncope?  Thanks again.

[jan]

Hi Loraine,

I have NCS and IST and my cardio thinks that the tachycardia is sometimes a trigger for the NCS.  The IST and NCS is more or less controlled with beta blockers.  The bb's have made me feel a lot better, too (fatigue is improved, near syncope, and brain fog is gone).

I, also, have had abnormal EEG's.  It's really been something for the drs. to figure what symproms are from what.  Currently I have a Reveal ILR (insertable loop recorder) and have had it for 15 mos.  I am due to get it removed Friday.  Yay!

[loraine13]

Hi Jan,
When I was on the BB I did feel much better, but when they wore off at 4a.m. my HR would hit 150 and NCS would hit. Also, my BP runs low so even though the symptoms calmed down I felt like a slug.  Maybe I should try the BB again.  Thanks for letting me know about your HR increase possibly causing your NCS. It seems like my issue.  I am new to this ...what is IST?  Linda

[loraine13]

I found out what IST is and it looks like something to bring up on my appt. Tues.  My BP is lower than it was prior to all the other NCS symptoms and low BP is part of IST.  Thank you so much...you are right on how hard it is to get diagnosed when you have a multitude of symptoms.  Hope you are doing well with yours and thanks again! Linda

[jan]

Linda,

When I 1st started the bb's my cardio had me taking salt tabs to keep the bp up.  Maybe that is something you can ask your dr. about.   There was a time I took an evening dose of bb's.  (Also, I took a calcium channel blocker in the even'g in addition to the bb's for the IST when I was just taking the bb's in the morn).  Maybe these are somethings for you and your dr. to consider, too.  I stopped the salt tabs after a couple of years just because they were gross, LOL but they really helped.

[loraine13]

Thanks Jan. Good luck tomorrow w/ your ILR removal. Loraine

[zzzzzzz]

Hi Loraine,

     I read your post on ncs and vavular regurgitation.  I have some similar symptoms and would like to run  them by you and compare notes.  Before doing so, however, want to make sure it's OK with you and that, in fact, you even receive this post. I hope that your reply will be under your original post of 7/17/05, 'cause I'm not sure where else I would look.

              Thanks,

              Scott