brother has chest pain and seizure episode

[harmanel]

hello. Yesterday my brother, who is an 18 year old male who is in good shape, eats and exercises on the average and has no real major health concerns except for slight asthma, had a episode where he stated that he first had chest pain and (it had happened before but went away within a couple minutes) then as he was walking across the hall, just fell into a semi unconcious state and was twitching like he had a seizure. He came to and asked what was going on just to go into another episode of this seizure. He had a total of 3 episodes before he was taken to the hospital and the blood test and ekg came back normal. I am just so confused as to what this could be. He is a perfectly healthy kid and this happened out of nowhere. He explained the episode as "it was difficult to breathe and it felt like all the veins in my body were constricting" I don't know what else to write and we are all very confused. he is home now and is feeling a lot better. no chest pain but a slight feeling in the heart area, like a tingling feeling. i cannot really explain it that well. has anyone experienced or know what is going on? ANY KIND OF ADVICE OR INPUT IS APPRECIATED, THANK YOU SO MUCH

[CCFHeart MD23]

Hi harmanel,

Your brother is very lucky to have you looking out for him. I am glad to hear that his EKG and blood work were both normal as it puts him in a lower risk category. However the question as to what caused his transient loss of consciousness remains.

In some patients, pain can trigger a drop in blood pressure that leads to collapse. Such episodes are called a 'vasovagal'. Breaking it up, 'vaso' refers to vasodilation or relaxation of the blood vessels leading to a blood pressure drop, while 'vagal' refers to the vagus nerve and parasympathetic nervous system which cause a slow heart rate, also leading to a blood pressure drop. Reasons for a vasovagal include feeling run down, dehydrated, over-exertion, stress, pain, and anxiety. If a complete medical assessment is normal then most patients can simply be reassured without further investigation. Your brother may very well fall into this category and the best approach is to wait and see.

If patients have repeated episodes of collapse this can signify a more significant problem. Further history of collapse dating back to childhood and a family history of collapse are important to provide to doctors. Additional investigations may include a heart rate ('Holter') monitor, an EEG (to rule out seizures originating in the brain), an echocardiogram (=an ultrasound of the heart to check the pump and valve function inside the heart), and a 'tilt-table test' where changes in heart rate and blood pressure are checked lying and standing. If patients have an abnormal ***-table test and a suggestive history, the diagnosis of 'neurocardiogenic syncope' may be made.

I'm not sure what to make of the 'tingling in the heart area'. The potential causes for this are wide and varied so I would recommend that he follow this up with his family doctor. Tingling + skin changes + fever can be consistent with a viral infection such as shingles. Chest discomfort + shortness of breath should be investigated with a chest x-ray to rule out a partially collapsed lung. Coronary disease or blockages in the vessels supplying the heart with blood would be uncommon in a young adult without a family history or other risk factors for heart disease (ie smoking, diabetes, high blood pressure). Musculoskeletal strain would be the most common cause of chest discomfort in an 18 year old male. particularly if there has been a recent change in exercise program / physical activity.

If his symptoms persist I recommend that he visit his family doctor or local emergency department for further assessment.

Take care and good luck.

[CCFHeart MD23]

Hi harmanel,
I thought I would just check in to see how things are going. Thank you for the update. I'm glad to hear that the echo was normal and that stress/anxiety is not an associated concern.

The finding of an unusually high heart rate can be a problem depending upon how high the heart rate is. If the heart rate is persistently elevated above 100 beats per minute (even when resting) then this could signify an "inappropriate sinus tachycardia". Such a finding requires follow-up with a cardiologist that specialises in heart rates and rhythms, called an 'electrophysiologist'. Over time an inappropriately high heart rate can lead to weakening of the heart muscle, so repeat echocardiography (ultrasound of the heart) is recommended. Additional tests may be required to rule out an underlying problem in the electrical circuitry of the heart.

Remember also to have thyroid function and electrolytes (potassium, magnesium, calcium) checked.

Take care.

[harmanel]

Thank you for your time and your response. To update you.We have done an echo as well and everything came back normal. The only thing now is that he has an unusually high heart rate a majority of the day. He still also feels slight pain around the heart area, not sure if it is the heart because the tests did come back fine. No more fainting or anything of that sort. So he is doing much better but still no idea what caused the episode. He is a totally calm person and assured me this was not stress related at all and he had plenty to drink that day. He did exercise slightly more than he usually does but was still very light exercise. So overall everything seems fine just a little confused still about what exactly caused it because the tests are normal. Thank you again for your time and your response was really appreciated.