Pediatric Heart Expert Forum
Vasovagal syncope or Bradycardia?
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Vasovagal syncope or Bradycardia?

How to diagnose the difference between vasovagal syncope and Bradycardia?

My 15 year old son has the following symptoms:
-constant fatigue
-low blood pressure
-low heart rate (45)
-loss of vision
-near loss of consciousness
-blue and tingely fingers and toes
-shortness of breath
-dizzyness
-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?
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773637_tn?1327450515
Dear Hoggja,

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.
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