If someone feels chest flutters right before a near fainting episode, does this strongly point towards a cardiac cause of the pre syncope, or could it still likely be vasovagal (in a 30 year old mildly obese smoker).
Later, chronic chest pain and malaise develops and it's noted that lightheadedness and syncope comes on during sporadic tachycardic episodes, but the first episode was the most noticeable chest flutter by far. So far an EKG, regular Echo, Cardiac enzymes D-Dimer, CBC Chemistry and TSH/T4 and chest Xray have proven non revealing. The 30 day event monitor never caught anything because there were no symptoms while it was on. Maybe we will try it again, but in the meantime, What are a couple more useful tests to rule out cardiac causes? I would assume a Carotid ultrasound, but what about some sort of stress test? Stress Echo, or nuclear stress test? What is the most useful. Could this in fact still be vasovagal or probably not?
I have also thought about testing the waters to see if this is inflammatory in nature by asking for a steroid shot, do you think that is reasonable to ask for?
In these cases there has been some evidence that implantable loop recorders diagnose the problem better than all of the test ordered above plus EP studies. If it bothers you to this extent then you should undergo the risks involved in implanting one of these devices (look up Medtronic Reveal). It is unlikely that a carotid ultrasound would show much in a 30 yo, and ischemia presenting with chest flutter and syncope is extremely unlikely without a heart attack or dangerous arrhythmia. If anything, in your case, I would order a CT of the chest to ***** the aorta and presence of congenital abnormalities.
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