Syncope

[josie490]

I am in my early 20's and last week I had an episode of chest pain and very strong palpitations (lasted only 2 to 5 seconds) then I collapsed.  I was sitting down when this all started and I fell to the ground.  My co-workers told me I was unconscious for between 20-30 seconds and that when they took my pulse it was fast/racing.  When I woke up I was feeling back to normal and it was as if nothing had happened.  By the time I arrived in the ER I was in sinus rhythm with a HR of 125. A siezure has been ruled out.

6 months ago I had an ablation done for RVOT VT and AV nodal re-entry Tachycardia, both were thought to be successful.  My follow up holter done last month showed only 5 PVC's, but did show almost 6 hours of sinus tachycardia (peeking at 190 while walking and lasting for 30 minutes).  This was the first time I have had an episode of palpitations, chest pain or syncope since my ablation.  Is it true that it would likely NOT be VT considering my follow up holter showed almost no PVC's?   Is it necessary to find out the type of arrhythmia it was even though it has only occurred once in the past 6 months?

Thanks for your assistance!

[Michael J. McWilliams, M.D.]

Sinus tachycardia my have been the result of low blood pressure leading to the fainting --- it could have been a sign of the cause rather than the cause itself.  Arrhythmias can lead to loss of conciousness as long as your blood pressure remains low --- so yes, it could be an arrhythmia.

I would recommend that you discuss all these issues with your doctor.  Syncope can be a tricky issue.

[josie490]

Thank you for your opinion on this.  I have one last follow up question if you don't mind. Prior to my ablation, my episodes were much different than the one I experienced last week. Before I had the ablation done, I would basically become conscious as soon as I would fall to the floor, but this time I was out for about 20-30 seconds.  Also, before the ablation i usually felt some sort of overall tiredness after an episode, but this time it was as if nothing happened.  Is being unconsious for 20-30 seconds a typical length for fainting related to an arrythmia?  Could it have been simply due to Sinus tachycardia?

[Michael J. McWilliams, M.D.]

You cannot rule out ventricular tachycardia despite the holter.  If you have a structurally normal heart, normal EKG the odds of the heart rhythm being life threatening are very low.  I would still want to try and capture the heart rhythm on a monitor so I knew what I was dealing with. If you have only had one episode in 6 months, it will likely be very difficult to capture the event on monitor but iI would probably still try it.

The evaluation of syncope can be very difficult.  30-40% of cases often go undiagnosed.  

Does this answer your question?