dysautonomia?

I have a couple of questions about this.  I have been being treated by a cardiologist (electrophysiologist)for the last 7 years for this.  I am a 26y/o female and my only other medical problem is asthma.  I started passing out about 5x a week when I was 19.  I had a ablation on my heart and that helped with the rapid pulse.  since that time, my pulse rate at rest is over 100, but at times it is as low as 40, and my bp can get as low as 70/30.  I have only had a few episodes of syncope this year but have presyncope every time I am standing for more than a few min.  I had a tilt table test and within 7 min. I had syncope.  My hr went from 70 up to 150 then to 40 and into a junctional rythm.  My bp went from 120/80 to 64/30.  When returned to a lying position I awoke rapidly.  Does this sound like dysautonomia to you?  I am a nurse in cardiac diagnostics and am standing for 10hr a day.  I have presyncope every day and feel like I am fighting constantly to stay concious. The last week it has been really bad and I have had to sit several times so I don't pass out. I take proamatine 5mg q4h while awake. Eat a hight salt diet and drink a lot of water. Do you know of any other treatment that would help?  Who should be treating this, a cardilogist or a neurologist?  Any advice you can give would be appreciated.  Thank you so much for your time!

[CCF-Neuro-M.D.-CS]

You have not described other features of dysautonomia such as changes in sweating, problems with your bowel or bladder function, or problems with your stomach. However it is possible to have a problem only with the cardiovascular system. Your case is complex, since you have already had an ablation. What needs to be determined is whether this is a problem with the heart (or heart rhythm) or a problem with the blood vessels and their reactivity. I am not certain, but this may represent a form of postural orthostatic tachycardia syndrome or orthostatic hypotension. I would recommend that you either see a cardiologist or neurologist who specializes in autonomic function. Here at the Cleveland Clinic we have both. If you are in the area I would recommend seeing Dr Fouad who is in charge of our syncope clinic. I would not speculate on treatments since your underlying diagnosis is not clear. Good luck.