Vasovagal

I have had near syncope occurring off and on for 2 months and it is not getting any better. I did pass out completely in January while visiting someone in the hospital. I was having head pressure and lightheadedness 2 weeks prior. They ran a EKG, CT scan, and Xrays and found nothing a half hour after I fainted. The cardiologist had me do a echo with doppler and tilt test over 3 weeks ago, and my pulse on tilt table, while induced with a drug, went from 180 down to 84 in less than 5 seconds. The symptoms I felt before it dropped was head pressure and lightheadedness. Therefore, the cardiologist diagnosis was vasovagal. All other test results were clear. He prescribed 25 mg Toprol XL. My blood pressure is usually low, so he did not start with the 50mg. After a week on the drug, I was doing somewhat better, but still having 3-4 episodes a day. Med was increased to 50mg after 1 week. The 50mg made more occurences(7-8 per day). Driving over 5 miles and walking in a store for over 5 minutes is difficult. The only other medicine I take is Lorazepam 0.5mg X 2/day for anxiety. I have a history of Crohns and Celiac. Am I going to have to deal with this forever?  Does lorazepam affect the chemicals in the brain to cause this?
How do I get back to "normal"?

[CCF-M.D.-MJM]

Hi Ohioan,

As I am sure you realize now, this is a very difficult problem to treat and regimens are individualized for each case.  Even with careful follow up, the success is variable.  Some people recover completely, others recover with occassional relapses, and still others do not find much that helps.

1. Am I going to have to deal with this forever?

Only time can answer that question.  If the metoprolol does not help, other medications that may help include selective serotonin reuptake inhibitors, fludrocortisone, midodrine, theophylline, disopyramide, scopolamine, and hyoscyamine. A side from medication, a high salt diet and staying well hydrated may help.

2. Does lorazepam affect the chemicals in the brain to cause this?

Lorazepam is not causing these events and does not cause perminant neurochemical changes.  It is possible the reason you take the lorzepam, anxiety, is playing a role.  That is why some selective serotonin reuptake inhibitors (paxil, zoloft, prozac) help.

If you live near Cleveland, Dr. Jager or Dr. Fouad may be able to help.


I hope you get back to normal soon, but it is difficult to predict the course.  Good luck and I hope this helps.

[jennann]

I nearly passed out twice a few months ago, also ended up on Toprol and switched to Nadolol because of horrible nightmares.  But with my near fainting, I felt there WAS a cardiac component - like a buzzing in my chest and I felt no pulse when I tried.  Did you have any heart symptoms that you were aware of?  
Best,
Jennifer

[I'mallheart]

hey i have had a terrible night.been up since 1 am ints 530 now.took my atenolol before bed heart been not racy but like fluter or tapping sensations tonite..wierd..hasnt been this bad for aloing time.. i feel fainty alot also..pulse seem fine..blood preasure was borderline high for a hr earlier in the night..just i guess one of those night..
hope u get feeling good
dave

[dreamboat]

Do you think you are just having pvc's?

[I'mallheart]

thats what i think...do you have them? what do you describe the sensation to be... its driving me crazy..
hope all is well with all today

[dreamboat]

Yes I do. Aren't you the one who wrote the coment on pvc's in February?Did you get that from someone else or did you write it?

[I'mallheart]

got it from someone else in another health forum..
thanks
dave

still not doing great but alive so thats good!!

[dreamboat]

Hope you are feeling better. When I have them I feel the extra beat then the pause then the thud. I have them all the time sometimes only worse. Sometimes they jolt my upper stomach. I feel it in my eyes sometimes. My heart, at times, or my throat, it jumps around.I have been told that I worry too much. I can't help but pay attention to it. If you are feeling fainty you should probably go to the hospitoal or at least call your Dr.The other morning before I got up I felt it start skipping around it went into some kind of tachycardia. I told my teenage daughter I can't breath and my heart is beating fast. When it finally wore off she basically laughed at me.Everyone thinks I panic too easy.But I try to figure everything out. Why did this happen what did I do different. DoI need to drag someone with me to Walmart in case I have one?I use to be somewhat agoraphobic because of weird heart things and panic and the what ifs. I don't want to start that again.

[mika_k]

Hi I have this also and have for a long time.  I have tried many medications and different treatments.  The thing I found that helps me the most is midodrine.  Drink tonz of water, more than you ever would normally.  I have worse symptoms when under emotional stress, and standing for long periods of time.  When you start to feel the head pressure, sit or lay down before you pass out and after a while you learn to have better control.  Good luck, if you do find things that help you, let me know, I would be interested in trying them.

[I'mallheart]

hey..doing somewhat better now..took a 20 min power nap..still feeling like buzzing sensation in left breat/chest area..take pulse and its good.oh well we are blessed i guess to feel everything in are body..hope you have a great day..feel free to email ***@**** anytime you need.. oh now my neck hurts from the way i took a power nap..there we go..worry worry worry..
dave

[I'mallheart]

Message:
Well, it appears only my supplemental message made onto your network, so I will take the time hear to try and repost it.

original message:

okaaaaay. This effort is placed on your support group website courtesy of my spouse, who is seated next to me with threats of bodily harm if I do not take time from my schedule to provide a professional response and take appropriate interest and concern. To this extent, I summarily aplogize that my occupational schedule generally prohibits the latitude necessary to search out your groups and assist with providing information where it might be sought or needed.

Under the circumstances and to avoid physical reprisal by my well-intended wife, I hereby consent to the necessary time expenditure without further delay. And with particular reply to the young lady who so keenly observed that no men visit or participate in your support network, allow me to make a footprint in the sand and be the first to join you.

Well ladies, down to business. Firstly, let's see if we can collect your concerns and provide a general and hopefully beneficial response. We need to start with a little and very brief general anatomy course, so let's take our seats.

I want to start by talking about a very special part of the human anatomy that does not seem to appear in the collective messages I've reviewed; The VAGUS nerve. The vagus nerve, also referred to as the 10th cranial nerve, is appropriately termed a "mixed" nerve. It provides a sort of two-way communication of nerve impulses back and forth between the brain and the pharnyx,larynx, esophagus, stomach and associated abdominal viscera(basically, your throat, windpipe, your tummy and guts), the heart, lungs and several more complex but irrelevant body organs or functions. The vagus nerve is the longest and most complex of the cranial nerves in the body.

The key point here is to make note that this nerve involves the "heart," the "lungs" and basically the whole digestive system of your tummy and intestines. Now let's pair that with some real specific and limited physiology about the heart and its rhythm.

We also need to bring clarity to some of the medical jargon being taked about by many of you in your messages. The term PVC, or Premature Ventricular Contraction, is just one of many arrythmias and not necessarily isolated to what many term as "palpatations." When we speak of palpatations, what we really mean is the presence of "ectopic" beats(hearbeats where there should not normally be)and the precise induction of these beats is felt by us as dancing of our heart or a flutter sensation in our chest, the prominence or intensity of which is determined by the precise moment of the extra beats in proximity to the most recent beat and the upcoming beat or contraction of the heart ventricles or atria. Think of it in relation to your memory of your worst date, where the guy you're with has no rhythm whatsoever but wants to impress you with all the right moves and clumsily tries to introduce his own dance-step into your otherwise smoothly flowing and natural pace with the music. Depending upon his rather untimely entry, he can cause awkwardness that either simply causes you to quickly pause and regain your rhythm or literally trip you repeatedly until you're forced to leave the dancefloor. Well, the same holds true for the heart in our example. The extra beat, or palpatation might come at a point that's subtle, or it might be at a point where the heart stumbles repeatedly until normal sinus rhythm is regained. Now let's get to "why" palpatations occur.

The heart has a natural pacemaker called the sinoatrial node among several less distinct and similar pacers, which is stimulated by guess which nerve? You guessed it; The VAGUS nerve.

The vagus nerve helps regulate the heart in comparison to other functions taking place with other areas and is doing its job right now in each and every one of us. In fact, the variability of your heart rate during inspiration and expiration of your lungs is an effect of the vagus nerve. We've all noticed that when we take a breath in, our heart tends to beat just a little faster and when we breath out, a little slower. It's an entirely normal bodily function and is connected to the need by the body's system to respond to the environment.

Now that we kind of have a little medical background under our belts, let's take one of the complaints by many of you regarding the proximity or timely appearance of palpatations and indigestion. Remember that we said the vagus nerve is linked to both the tummy, the throat and the heart. Let's assume that we've eaten meal and it's caused us to experience some gastrointestinal discomfort, or in other words, gas. The irregular presence and activity by your tummy and intestines stimulates, more appropriately irritates, the vagus nerve which sends a rather inappropriate signal back along the pathway to guess where? That's right! The heart. Move to the head of the class. The heart is busy pacing away regularly and is relatively unconcerned with all the food you poured into your tummy, when all of a sudden in comes a signal from the vagus nerve because it has been inappropriately stimulated and tells the heart to beat. Well, just like our bad date example, the signal to beat is rather untimely and awkward but the heart has to accept it and respond. The result is extra beats that make the heart feel like it is stumbling. The degree to which it stumbles oftentimes depends upon the extent to which the vagus nerve is irritated and the relative state of indigestion present as the causitive agent.

There is most often no pain assoicated with this occurrence because it is not the result of a lack of blood or oxygen that creates the palpatation, but rather just a simple additional electrical impulse or series of impulses. Pericardial pain, or pain adjacent to the heart, can sometimes accompany palpatations or exist exclusive of any arrythmia, but is not necessarily considered pathologic or harmful to us. Remember that we're dealing with inappropriate electrical impulses and muscle tissue other than the heart that is partially innervated by the vagus nerve and can respond inappropriately, causing a jabbing or shooting pain than many describe as a "catch" in their chest. We'll talk more about chest pain in a bit.

Let's discuss the sensation that some of you described as a warm flushing sensation of your face and perhaps other body areas that accompanies the palpatations. Recall our anatomy lesson. The vagus nerve stimulates many areas of the body in response to our environment or internal conditions caused by the outside environment, ie. a meal that produces indigestion. The vagus nerve provides all of us with a stable process called vagal tone. This tone or stability keeps us in a state of balance so to speak with our environment. In response to environmental cues or situations, that tone or stabiity changes to prepare for what may be required. You've probably all seen a guy that makes your heart "skip a beat." Ever wonder why that phrase ever came about? Think for a moment. If you've ever been emotionally overcome, your heart races or feels like it pounds in your chest, we begin sweating, our blood pressure rises, we feel nervous and at some point our face is overcome by a warm flushing sensation that we attribute to nervousness or embarassment. Well, guess what nerve plays a very big role in that entire process? Right Again!!! The VAGUS nerve.

The above scenario would be a case of increased vagal tone. Well, if there's an increase, there's likely to be a case of decreased vagal tone as well. Indeed there is. decreased vagal tone can make us weak, nauseated, tremble, and even faint. It happens in cases of being excessively startled or frightened. Other conditions, such as diabetes can cause decreased vagal tone, but for our purposes we'll stick to conditions that by what I've read from all of you are non-disease provoking conditions, with the exception of one individual with Mitral Valve Prolapse but we'll touch on that in a bit.

Anyway, the point is that our body doesn't always accurately recognize proper environmental cues and the vagus nerve doesn't always know when and how to act. In other words, it misbehaves once in a while as a result of inappropriate stimuation. All sorts of things make the vagus nerve act out, including stress, anxiety, depression, illness and even ideopathic causes(origin or cause is unknown). In fact, there is work going on right now using electrical vagus nerve stimulation to treat depression, anxiety and even seizures.

And here's a little extra for those who cough when experiencing a palpatation. Recall your anatomy lesson again. Remember we said the vagus nerve stimulate the pharnyx, larynx, bronchi and esophagus. Well, what do you know. Those are exactly the processes involved in the cough reflex. So when the vagus nerve inappropriately stimulates the heart and causes a palpitation it also stimulates in some cases the cough reflex. How about that!

So we begin to see that the cause for palpatations and the palpatation itself is not a life-threatening occurence at all. It concerns us for several reasons. First, it has to do with our heart and hey, that's the thing that keeps us alive basically. Big concern! Secondly, we've been bombarded by all the medical revelations and awareness about heart disease. But a case for heart disease does not make for every condition the heart demonstrates, especially palpatations. If you've ever had a cramp in your hand from typing too much, it probably never gave you pause to think you might not make it, so to speak. You reason in your mind that the cramp is caused by repetition fatigue and you need to take a break, massage your hand and rest momentarily. Well, palpatations can be considered sort of a cramp and nothing more. Under stress and other factors we talked about, the vagus nerve gets irritated or fatigued and acts out. Just because the heart is affected, doesn't mean that you've got heart disease or vascular problems that are looming. They're annoying, worrisome and even frightening, but knowing where they come from and why will help go a long way in knowing that they are non-injurous and if we respond appropriately, will subside and we can go about our lives with far less worry.

Let's touch on anxiety for a moment. Anxiety, and depression too, can definitely cause a state of dysfunction in many areas of our body. Many patients who have these disorders are exhausted from constantly presenting themselves to the medical community with real and valid symptoms of pain, fatigue, bowel problems, vision problems, tinnitus or ringing in the ears, difficulty swallowing, excessive saliva, dry mouth, sore or sensitive tongue, and many many more troublesome circumstances only to have repeated tests all return normal. How can that possibly be?!! It's there, we feel it, we experience it, we hate it. Why doesn't the test confirm that it's there? How frustrating is that????

Well, here's some news that should make you feel a bit less frustrated and even comfort you. Most all tests are based upon the algorithmic, or sequential processing, of certain symptoms and signs that are all conclusive of various disease and illness. When someone with anxiety, depression or other condition that has somatic features(felt physically)undergoes these tests, the components that underlie the actual diseases which have similar symptoms simply does not add up and no presence of the actual disease is evident. So it's a case of false identity, sort of like having a biopsy of a mole that turns out to be benign. Looks like cancer, but is not cancer. Well, that same thing can happen to us with regard to all sorts of disorders and diseases. They look similar in presenation, but one reveals true disease and the other a nonpathologic condition or illness. So the next time your doctor tells you he can't find anything wrong, be glad for that much at least. Many people get far worse news!

So with regard to depression and anxiety, these conditions impart disturbance upon body functions. I suppose you're already guessing that the vagus nerve is not exempt from those circumstances and you're exactly right. So when you have an episode of anxiety, rest easy when you have a palpatation or two, or three or even four. The vagus nerve is irritated and needs a break or to reset. No problem whatsoever and you needn't worry any longer that a palpatation is sure indication of worse things to come. Nothing else happens. Just an extra heartbeat or two where there should not normally be. What a relief!!!!!

And the caveat I promised to the one individual with Mitral Valve Prolapse, your heart condition, while not necessarily life-threatening at all, does predispose you to panic disorder which I'm sure you are probably already aware.

Okay, so now we know what these palpatations are and what causes them. What the heck do we do about 'em? Well, there are several techniques that can help. Firstly, let me say that if a run of palpatations makes you feel faint or weak, don't panic and try to make it somewhere less embarassing. Be safe and think smart. Squat to your knees or sit down until the feeling subsides. No sense in cracking open your skull by trying to make a mad dash for privacy. Anyone can feel faint and people in your company will always rally to your aid more often than not. So relax. The conditions will quickly pass and you'll be back to yourself in a jiffy.

Secondly, if you sense indigestion and gas, discomfort and bloating when the palpatations are present, try merely changing positions which often causes the distention to realign from its offending position proximal to the vagus nerve.

If you're pregnant, well indigestion or gestation. It doesn't matter. What's important to realize is that both conditions represent a temporary rearrangement and limited space downstairs. That means proximity or closeness to the nerve receptors of the VAGUS nerve and you're going to get palpations when conditions are right.

As for the palpatations themselves, taking slow, deep breaths repeatedly will typically cause the palpatations to cease. Recall your anatomy lesson. The vagus nerve stimulates the lungs as well as the heart, so this purposeful stimulating of intention-breathing will often interrupt the irritation signal.

If you're experiencing tachycardia(racing heart), then if a fountain or bathroom is nearby, apply cold water from your hands to your face and while holding your hands against your face, press gently, repeat GENTLY, on your eyes. This will invoke what is termed the "dive reflex" and will cause your heart rate to decrease in most cases. Regardless, tachycardia, like palpitations is not harmful in of itself, just a bit unnerving.

The key in all cases is to do your best to remain calm and rational. Know from our little lesson what it actually taking place and that you'll be fine.

Finally, we'll save a lot of space here by simply stating that with regard to any of the conditions either described or that you're experiencing, do not substitute a support group for responsible notification of your symptoms to your personal primary care doctor. We live in an age where medicine is oftentimes scoffed at by many who fail to realize the benefits they expect. Yes, it's true that medicine is not a perfect science, but neither are human beings. It is difficult at best to create perfection from inperfection. But even so, we all must give recognition that many thousands of people are being cured of certain cancers that just a decade ago would have meant their demise. Simple penicillin saves hundreds of thousands in third world countries that would otherwise perish from infection.

So don't become discouraged that medicine doesn't find something wrong with you. Feel blessed that they don't have less encouraging news for you. I exist in an occupational environment where disease and illness is very concentrated. It is of great joy and optimism that I can walk from conditions such as those to the sanctuary of my private life and know that I'll return tomorrow.

You too, all of you, need to be thankful that your condition is benign and that you have the power of influence over its effects.


best regards and good health. Feel free to write if you care to and I'll do my best to answer, but no promises.

and this is for all the attorneys circling overhead who strive for a willing plaintiff, or even an unwilling one.

THIS COMMUNICATION REPRESENTS OPINION BASED UPON MEDICAL FACTS AND IS IN NO WAY INTENDED TO REPLACE OR SUPPLANT THE NEED FOR PERSONS TO DIRECT THEIR MEDICAL NEEDS AND INQUIRY TO THEIR PERSONAL FAMILY DOCTOR REGARDING THEIR HEALTH.

sorry, have to add that.

[dreamboat]

Where did you get that post from?

[I'mallheart]

not sure the name of the forum... i just saved the comment in my inbox
try to find it
dave

[Ohioan]

all heart tests came back ok

[jennann]

try afibbers.com.  It has a great message board going, lots of great advice and compassionate people.

[Honora78]

I have experienced my heart beating what feels like harder but not faster.  This has happened when I woke up from a dream or sometime while playing a game on the computer.  Is this normal with NCS-Neurocardiogenic Syncope?  Has anyone else experienced this with a fainting disorder.  Also has anyone else felt like their mind spaced out or became foggy?  Some people from the VVS group on yahoo have.  I was just wondering if this could be normal with this type of fainting disorder.

[Ellzeena]

I've had benign PVCs my entire life from very early childhood.  After years of struggling against real obsession regarding them (and high level cardiological exams at major hospitals plus event monitors, etc.), I finally deduced that these PVCs are directly associated with my gastrointestinal tract.  I discovered the causative link to the vagus nerve while doing research last year.  I'm not a physician but I can tell you this much:  If an individual has had a thorough examination (this might include, among other things, a stress echo which I have periodically) and no diagnosis of heart disease is found, the single biggest favor one can do for oneself is to STOP OBSESSING.  The more anxious you become, the worse the PVCs will be and the greater your GI discomfort will become.  I've discovered that a simple OTC like Gas-Ex can do WONDERS.  I prefer the chewable variety.  One or two will ease gastritis or irritated stomach and your PVCs will stop.  If you're having an especially bad day (as I was yesterday because something I ate really upset my GI tract), be careful of your food intake.  Stay away from gas producing foods and heavy meals; eat several small bland meals throughout the day.  Whatever is causing your GI problems will PASS (pun intended) eventually.  PVCs in a healthy heart are totally benign.  Do something relaxing, watch your diet for a few days, and stop worrying.