Re: What next?

Posted By CCF CARDIO MD - CRC on November 30, 1998 at 09:43:41:

In Reply to: What next? posted by tommy on November 28, 1998 at 20:25:59:






Hello,
I have posted on this forum before.  I am a 26 yr. old male being evaluated for chest pain and dizziness.  About 2 months ago,  I had an episode of severe lightheadedness that lasted about 30 seconds followed by weeks of mild dizziness and recurrent chest pain.
I have had a stress echo, numerous EKGs,  and am in the second week of an event monitor.  So far,  nothing has turned up abnormal with the readings from the echo or the event monitor.  In addition, my blood pressure and heart rate are normal.  However,  recently I had another attack of severe lightheadedness followed by a week of mild dizziness.  In addition,  I get lightheaded/dizzy during weightlifting especially when bending over or straining hard but not to the point where I feel as though I am going to pass out.  The readings from the monitor during these times show nothing abnormal.  
My question is the following:  the chest pain has been ruled as non-cardiac as it responds to muscle-relaxants/anti-inflammatories and does not occur during exercise.  However,  the dizziness and near-syncope episodes are still unexplained.  What do you think I should do next to help diagnose this condition?  My internal medicine doctor does not seem to share my concern.  She has prescribed Paxil and Xanax for the anxiety which I am indeed having a lot of.  I had to push for the event monitor as well as the stress echo.  It seems as though I need to be pro-active in asking for treatment.  So far,  your forum has been very helpful in this regard.
Thank you,
Tommy






_____
Dear  Tommy,
The medical term for what you are describing 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.
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.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.