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Vasovagal Syncope, is it the answer to so many symptoms?
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Vasovagal Syncope, is it the answer to so many symptoms?

Over the course of a year I lost a significant amount of weight through strict dieting and overexercising (75 lbs in about 11 months), I ignored a lot of symptoms for six months such as night sweats, dizziness, low heart rate (resting went from 70's to 40's) worsening hypoglycemia then on May 2, I collapsed and lost consciousness and have never been the same since.

Since my initial black out I am in a constant state of panic. First my Resting HR went up to 120s and my BP which was normally 100/60 was around the 135/80 mark.  I exhibited severe postprandial issues causing insulin and adrenaline to rise after meals with low blood sugar (avg 80-90 after meals), I could no longer tolerate any sugar or carbs without pouring sweat, racing heart rate and feeling faint.  The smallest amount of stress would send my adrenal glands into overdrive, HR over 200 BPM, pinpricks in fingers, arm numbness, feeling faint.  TONS of neuro issues, hourly brain fog, confusion, sometimes slurred speech, short term memory loss, constant feeling of being "drunk".  Endo, Cardio, Neuro initially said everything checked out (other than high insulin, cortisol and a bright spot on brain MRI), My PCP ran some viral tests and my viral load was extremely high for EBV, CMV and HHV6 (up to 30x higher than the positive value) he started me on antivirals and when symptoms didn't improve in six months went for tilt table test.

15 minutes standing during test all was normal then dr gave me nitroglycerin and within 3 minutes my vitals started to rise and then within 30 seonds my heart rate went from 120 to 52 and my BP went from 130/92 to a reading to low to register and I blacked out on the test.  Diagnosed me with Vasovagal Syncope but that doesn't seem to include endocrine and neuro symptoms or does it?  My cardio can't explain why the symptoms are daily even without blackouts, can anyone give me any info on what avenues to explore?
Avatar_dr_m_tn
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 cannot tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

I am sorry to hear you have been suffering from such a multitude of symptoms. I am glad though that you seem to have had a thorough neurological and cardiac workup.

I am presuming that you have had routine blood tests like complete blood count to rule out anemia, electrolytes, liver and kidney function tests, hormonal tests like thyroid function tests.

I think that your history of losing such a large amount of weight in a short period of time may be relevant. I am not sure what kind of diet you followed but sometimes people can develop nutritional deficiencies of vitamins or minerals.
Your tilt table does sound that it was positive since you lost consciousness and your heart rate fell so low. One venue to explore would be to rule out an autonomic neuropathy.

The organs of our body, such as the heart, stomach and intestines, are regulated by a part of the nervous system called the autonomic nervous system (ANS). The ANS is part of the peripheral nervous system and it controls many organs and muscles within the body. In most situations, we are unaware of the workings of the ANS because it functions in an involuntary, reflexive manner. For example, we do not notice when blood vessels change size or when our heart beats faster.

The ANS has two major arms: the sympathetic and parasympathetic nervous system. One of the functions is to slow down or speed up the heart rate according to the situation faced. Example, if you need to run then the heart rate will speed up appropriately.

If the autonomic nerves controlling cardiac functions are affected then you can experience syncope.

There can be a lot of causes for autonomic neuropathy. The labs to test (especially given your history of the weight loss) comprise of B12, MMA, B1, B6, folate, HbA1c, urine and serum electrophoresis, ESR, CRP, ANA, heavy metal screen (if you have any exposure). This list is not exhaustive and can be expanded according to your history. Some of the vitamin deficiencies can also contribute to some of the other neurological symptoms like confusion, brain fog.

I would recommend checking with your neurologist whether above tests have been looked at.

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

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