How to diagnose the difference between vasovagal syncope and Bradycardia?
My 15 year old son has the following symptoms:
-low blood pressure
-low heart rate (45)
-loss of vision
-near loss of consciousness
-blue and tingely fingers and toes
-shortness of breath
-occasional chest pain
These episodes happen 3-4 days per week, sometimes multiple times in a day, can occur when getting out of bed,
standing or sitting, after exercise or at anytime of the day. This has been ongoing for months with no improvement.
He has had blood work (all normal), a holter monitor which shows slower heart rate, an xray of his heart, multiple EKG's
showing a change which was described to me as the electrical signals were coming from a different place in his heart,
a tilt table test in which he passed out within 3 minutes. An electropyshiologist has prescribed him Florinef to raise his blood pressure because extra water and salt are not helping.
How can you differentiate between these 2 conditions as one is more serious than the other? Will an Echo help in this diagnosis?
Without having all of the data to review, I cannot say for sure which of these diagnoses your son has. However, a heart rate of 45 is not life threatening in someone his age. That said, it would be helpful to know if he passed out during the tilt table test with his heart rate going very fast or very slow. If his heart rate was very fast (at least 30 beats per minute above baseline), he may actually have postural orthostatic tachycardia syndrome POTS). If his heart rate dropped, he may have cardioinhibitory syncope. The treatments for these two syndromes are very different. There are numerous therapies that are used for POTS; I recommend that you see www.dinet.org and www.dynakids.org for further information. Treatment of cardioinhibitory syncope, however, includes selective serotonin reuptake inhibitors, vagolytic medications, and, occasionally, placement of a pacemaker. You should discuss these findings with your cardiologist. If your cardiologist is not able to help you with this information, I would recommend obtaining a second opinion.
Florinef is a helpful therapy in increasing blood pressure and blood volume. It is a medication that is used for treating syncope that does not respond to simple salt and fluid volume addition. However, there are other medications that are helpful, as well, which you can discuss with your cardiologist. Finally, an echocardiogram will not help to make the decision in this process.
The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We offer this Site AS IS and without any warranties. By using this Site you agree to the following Terms and Conditions. If you think you may have a medical emergency, call your physician or 911 immediately.