Could unexplained syncope be caused by TIA?

Hello,

My 88 year old father with a history (12 years ago) of triple CABG is now experiencing random spells of syncope. He has had a holter monitor, doppler echocardiogram, and stress test within the past month and all came up fine. He's on a variety of cardiac medication (and has for a while now since his CABG) and the only new medical incident is severe BPH w/ hematuria (he's had a cystoscope). He's also had two congestive heart failure attacks.

Is a TIA a possible cause of his fainting and which tests would you recommend he go through (MRI, CT,?). He has not had slurred speech, vision issues, etc. according to my mom who has witnessed these attacks. He's refused the ambulance and won't go to the ER. She said he is unconscious and soaking wet when these attacks occur.

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Syncope can be the result of varying organ systems. For example, cardiac causes include arrhythmias, decreased cardiac output, outflow obstruction, enlarged heart, etc. I know you posted that a holter and echo have been performed. Was the holter a long-term holter (e.g., 14 days)? Neurological causes of syncope are less common but do occur with carotid artery disease (which a carotid ultrasound can evaluate) and posterior circulation stroke/insufficiency. Other causes of syncope can include low blood sugar, low blood counts, and situational (such as during defecation or urination).

Your father has BPH. Was a medicine recently started for this? Many of the medications to treat BPH can cause syncopal episodes.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[maybebaby29]

The holter was a 24 hour one. For the BPH, these syncope episodes occurred before the antiandrogen (finasteride) was started.

With all of those heart assessments and all of them coming up normal, we just don't know what to do or where to go to next.

I know you don't have his tests/history but is it possible that the congestive heart failure is just getting worse and in essence his heart is just failing? More or less, it's a 3x CABG heart, 12+ years of medication, 88 years old = just life progressing (ie. slowly ending)?