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Neurocardiogenic Pre-Syncope
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Neurocardiogenic Pre-Syncope

Hello, all.  My name is Justin.  I am a 30 year old Soldier in the United States Army.  I suffer from infrequent Vaso-vagal pre-syncope.  I have found, during my copious amounts of research that this is often also referred to as Neurocardiogenic Pre-Syncope.  I have read many, many articles on this subject, but nothing that quite covers my situation.  

I will start at the beginning and effort to be brief.  I used to be quite overweight.  I am 67" tall and weighed in at 245 lbs.  I lost the weight many years ago and have since been quite active and am in very good shape.  However, after losing most of the weight, I began to have "incidents" that I could not explain and were quite alarming.  They invariably began, and still do, with a pressing urge to defecate.  I often describe the sensation as feeling like I have to pass a softball.  Imminently.  The sensation is painful as well as anxiety-producing.  It causes what I call "nervous movement."  I will pace, rock, groan, re-position myself, effort to find a position that eases the pressure.  All to no avail.  The anxiety is secondary.  It is not the focus.  It is derivative of the pressure.  In other words, it is not an anxiety attack.  These have become familiar and the anxiety controllable.

Secondly, the attacks began during the day, now they invariably wake me out of a dead sleep.  The pain/pressure comes first and is a harbinger of the pre-syncope to come.  The intensity of the pain/pressure is a good indicator of whether or not I can expect to suffer a "full on episode" or a more mild version.  

As the episode progresses, a trigger of unknown origin will send my heart rate plummeting and my anxiety level soaring.  I become diaphoretic, supremely bradycardic, suffer from sever tinnitis, and tingling of the extremities.  Tingling might be a misnomer.  My extremities fall asleep.  They then, once the episode is over, recover.  I would swear that my heart stops entirely during these episodes.  I have let a few close buddies in on my condition and have had them try to find a pulse during one of these episodes, to no avail.  Until I am shown otherwise, I believe my heart all but stops during these episodes.  

Often, as quickly as the symptoms will set in, they dissipate.  I say dissipate because, while they do recede quickly, I can feel my systems "coming back online," if you will.  I can first feel myself re-warming, the tinnitis subsides, my extremities begin the painful tingling reawakening, and finally the diaphoresis disappears.  I am left feeling quite normal after a period of no more than ten to fifteen minutes.  I suffer no lingering symptoms, save for the confusion and concern that this is evidence of an underlying condition.  

During these episodes, I know better than to stand, as I have collapsed in the past.  Only once.  I am a quick study.  I know to stay supine, or at least sitting when this takes place.  This is often hard to do because of the accompanying anxiety, but I manage to limit the danger by staying seated.  

They are very, very infrequent.  One ever six to eight months.  I am uncertain as to how accurate a time-frame this is as they are so infrequent that I can often not remember the last episode clearly enough to date it.  

Of note, I am bradycardic as a result of my physical fitness regimen.  My resting heart rate is usually between 40 and 55 bpm.  I suffer from poor perfusion to the extremities, either as a result of my bradycardia or some heretofore undiagnosed condition.  As a result, my limbs fall asleep easily and often.  I will frequently awake in the night with one or, occasionally, all limbs asleep.  I am not laying on them.  I move little in my sleep.  Physically, I feel fantastic most of the time and am in the upper echelon of physical performers among my peers in the Army.  I work hard to stay in shape and try to consume a decent diet.  Admittedly, I take in little in the way of salt and am a caffeine user.  Additionally, these episodes often accompany an INCREASE in physical output.  Such as when I make pushes to increase my plateau levels.  However, I have never suffered an episode during physical activity or immediately after.  I have never suffered an orthostatic syncope.  I am often required to stand in formation for long periods of time and have witnessed several others "fall out" during longer formations.  I have never been a heat casualty.  Or even close.  The one thing I will say I have had is what I can only describe as a very, very brief feeling of my heart beating VERY slowly.  I hesitate to use the term arrhythmia because I have never had one show up on a EKG.  It feels like a brief GOOOOOSH and then back to normal.  These are also infrequent.  

I am a semi-educated individual with regard to things medical, insofar as I am en EMT.  This is what makes me so hesitant to self-diagnose.  I know just enough to miss something critical and crucial to a proper diagnosis.  I have seen much that describes my problem, but nothing that gives me an A-HA! moment.  Namely, I have seen nothing on the urge to defecate, yet I know this is typically a vagal response.  I have seen nothing on being awoken from a dead sleep.  The focus is generally on situational pre-syncope.  

ANY assistance on this will be greatly appreciated.  Anyone who suffers from a similar problem would put me greatly at ease.  I am quite concerned by this condition because heart problems run in my family to include someone one generation separated who passed away when their heart simply stopped beating.  Fine one minute, the next, "I feel like I'm going to faint."  I am not an alarmist nor prone to knee-jerk reactions, however, the similarities between my condition and what she described are nonetheless there.  

I appreciate anyone's time who has read this far.  Thank you, in advance, for any input.

Justin
OneSoldierServing
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This describes my attacks to a T. It starts with horrendous pelvic pain. It progresses to cold sweating, profound weakness, dimming of vision, pallor, and lack of perceptible pulse. Then it slowly abates.

I have been going through this for more than 7 years now. I have no answers. I don't even want to discuss it anymore with my physician (who is awesome) because I have no answers. I tend to be very tired afterward, but that could be because each episode is so disheartening. To my knowledge, I have never actually lost consciousness. I just can't see and am too weak to move anything.

I too lost a lot of weight in the years before this started. These have started when I was sitting or lying down, awake or asleep. The first one happened while I was at work, and I went to the bathroom. I ended up laying on the bathroom floor during the attack. When I returned to my desk after trying to wipe my face and arms, a coworker saw me and wanted to call an ambulance (he has shellfish allergies and said I looked like I was having an allergic shock reaction). Generally, there is nothing going on before these attacks start. One time, I was on the phone with a coworker having a pleasant conversation, no anxiety - just sitting there chatting, and it started. So it definitely isn't an anxiety thing. And there is no trigger that I can locate.

I have lost my anxiety during the attacks, as I have been through so many, and know what to expect. That's a little frustrating because my husband and doctor tend to think it's innocuous because nothing "bad" has happened because of it yet. I have managed to keep my driver's license because I have a significant period of pain (warning) before I become incapacitated. I haven't told many people about this. The only people who know are my husband, my mother, my daughter, and my doctor. I think others would think I was crazy if I told them. My husband has witnessed several of them, and know that they are real, aren't anxiety attacks, and that they have a lot more impact than what is typically diagnosed as syncope (e.g. standing up too fast and passing out).

I'm sorry I don't have any answers, and for me, it hasn't gotten any better as time has gone on. But you are not alone. I note that you posted this more than a two years ago. I hope that things have improved for you since then.

Anne
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