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Postive tilt table & treadmill stress test, but negative cath at ag...
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Postive tilt table & treadmill stress test, but negative cath at age 22 .. what now?


I've had issues with my kidney's for about ten years now - infections, reflux, stones, and scar tissue.

For the past few years I've been telling my nephrologists I feel so tired, that I don't want to go out with friends or do normal things, I just want to sleep. They never addressed it.

I started passing out at 17, but always blamed it on my kidneys somehow. Most recently I passed out at a hospital while following a nurse for school. The doctor that responded suggested I get a holter monitor, after having a maternal uncle die from sudden cardiac death, they decided it was a good idea to check out my symptoms (High HR, tired and heavy/SOB feeling upon exertion, syncope, black outs)

Holter monitor showed avg HR of 96 at rest, high of 161 (Most I did was go up 10 steps) some pvc and svt
Tilt table test was positive, HR elevated with change of position, then passed out about 10 minutes in, maybe 2 minutes after initial dose of isuprel was given.
Stress test was positive - I was going for the first 9 or 10 minutes normally without SOB, but then started feeling funny - foggy head, little dizzy, clumsy, heavy chest - my BP/HR was raising normally - but with my symptoms it had suddenly dropped to 70/50. Stress test was stopped and they immediately had me lay down.

They now just did a cardiac cath, they said everything looks normal.
So he has me on 25mg of metoprolol and says lets see how it goes.

I've been taking metoprolol for about a month, and my HR does feel much better. I'm usually around 85 vs the 105 I was often at before .. but I still just feel tired, like I don't want to do anything, and like I could collapse when going up stairs or high inclines. Just doesn't feel right when I'm 22 and pretty healthy (have stopped exercising recently due to symptoms)

Any help, or personal experiences would be helpful
I like my cardiologist, but should I see another just for a second opinion? Should I be seeing an eletrophysiologist?
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Sorry to hear you have such issues with passing out. However, you have had some excellent tests for determining the cause of these. Your negative cath excludes artery disease (coronary disease), which is reassuring. The Holter showed SVT for which you got the metoprolol, which will hopefully prevent further SVT episodes. If it doesn't then further evaluation by an electrophysiologist (EP) may be necessary to determine the type of SVT and whether other medication, or perhaps ablation therapy is warranted.

Your positive tilt table is concerning for vasovagal syncope, where an overactive vagus nerve causes the heart to slow and the blood vessels to dilate, which drops your heart rate and blood pressure. Some people have both responses at once, whereas most have one or the other. Things that can stimulate this are pressure on the neck, sudden change in temperature, dehydration, pain, and many other things. Treatment of this typically involves indentifying the cause and potentially avoiding it, as well as sometimes medications, depending on the type of response you have (slowed heart rate vs decreased blood pressure vs both). Your cardiologist should be able to help you with this. However, if you aren't getting the help you think you need, or you want a second opinion, you can seek one from a cardiologist who focuses on syncope (passing out) which can be either an electrophysiologist or a general cardiologist.
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