My wife 5 years ago, immediately after Open Fundoplication Surgery for severe Gerd,,,and a tentative dx of Celiac disease,,there was the development of constant syncope episodes now for the past 5 years, many trips to the ER when she fell ill numerous times, especially in heat situations. These epidsodes left her with often migraines of a Classic, and Vestibular Migraine status with motion sickness, and upon Ambulance arrivals to the ER multiple times with these syncope events, ,EKG's, and blood work revealed a relatively normal some 20 minutes or so later, but the worst case involved a heart rate of the lower 30s', and a normally hypertensive BP around 160/90 dropped to more like 90/40,,bradycardia. Subsequent syncopes were common, sometimes a many as 2 or 3 times per day, but Holter monitors revealed no heart condition. She did have on occasion slurring of speech in the initial moments preceeding the syncope events, but upon arrival of the EMS crews, within minutes she gradually became mostly normal with the heart rate going into the 50's and 60s...still bradycardic. Other times she regains more consicious awareness and one tilt table test was positive which I assume meant the reason for calling this condition Neurocardiogenic or Vaso vagal sycope,,but she could never tolerate the Florinef and Midodrin therapy. So she had to D/C that combination and the syncopes persist with any exertion and exposure to heat, but year round these events have led to her total weakness and disablity with severe fatigue on any exertion or exposure to heat. It's the worst thing I've seen in terms of a somewhat variable diagnosis situation. Upon one hospitalization she was found to have a PFO,,(Patent foramen ovale) that often is significant, and the TEE study showed an atrial rit to left shunt that was described as significant. So what is causing these disabling horrid events on a daily basis. Cardiologist disagreed on whether to do a pacemaker or not,,and are divided as to whether a pacemaker would do any good. One very competent cardiologist said no pacemaker would help as this was a more neurological problems, and she would continue to faint, just with a better heart beat. Subequent MRI was questionable as they found no significant septal defect, yet the records show the TEE cardiologists termed the PFO as very significant, and closure might be indicated. Referral to a young rude neurologist with a bad attitude, only got her rejected as having any significant problem and the PFO young surgeon was informed on this questionable assessment that the PFO was a "tiny" defect and common, in 20% of people walking around. So the surgeon denied any treatment based on this PFO despite the shunt described as very "significant" sure gave reason to find this as the cause of my wife's serious problems with no treatment recommended. I am disgusted with the local hospital who now calls her's a Psychiatric issue. None of this fair, and we cannot travel to a major center to get to the bottom of this. I've heard Dr. Blair Grubb of Toledo, Ohio is the expert in these kinds of difficult diagnostics. Any suggetions?