Neurally Mediated Syncope

[hannah]

I am interest in knowing if anyone has ever investigated the role of female hormone fluctuations in possibly trigering or aggravating neurally mediated syncope.  I was diagnosed in July 98 with neurally mediated syncope following frank syncope without warning, unconscious for about 40 minutes.  I had an 'atypical' positive tilt table, not actually losing consciousness, but erratic swings in heart rate from 60-180, some fluctuation in BP, overall weakness.  I was placed on Tenormin, could not tolerate, then Florinef.  However, in July 99 had another syncopal episode without warning.  Halter monitor at that time showed pauses around 2 seconds without symptoms.  I had a pacemaker placed and am now feeling much better without any medicines.  However, both of these episodes occured within 24 hours of my before my period started (true dysmennorhea at these times, too.).  I am now perimenopausal and having some transient arrythmias.  There is concern about hormone replacement because of an episode in July 92 where I had either a hemiplegic migraine vs TIA (also started a difficult period w/i 24 hours following this).  Has anyone been able to tie in hormone fluctuations with causing a flare in neurally mediated syncope?

[BillyboyAA]

I was wondering if you could help me with something?  Since you have pauses too.  I recently went to a Cardiologist because I was having pauses.  A Holter Monitor recorded 144 "late beats" and 4 "dropped beats" in a 24 hour period.  My doctor never said anything about them and I even went for a second opinion because when I feel them, I feel like I cant breathe for that second or so.  I am always stressed and anxious because of them and wonder if stress/anxiety can make the pauses, as it does PAC's/PVC's.
The other doctor said there was nothing to be concerned about either.  I inquired about Sick Sinus and he said I could not have that because my heart rate increases with exertion.  My rate has always been low (resting) 45-50.  He says that is due to excellent vagal toning.  I am so scared I will eventually need a pacemaker.  I am afraid it will stop on me.  Thanx for any information you can give to me..  God Bless, Billy...

[CCF-M.D.-CRC]

Dear Dr. Topcu,
Thanks for your comment.  I agree that this is most likely not cardiac in origin but is likely neurally mediated (NMS).  A good work up of syncope would first exclude cardiac causes, the most serious of which is ventricular tachycardia.   The diagnosis of NMS is best made with a Tilt table test.  If you are interested in further information on this topic I will post the listings for several good reference articles.

[MelissaA]

Hi Hannah!

WOW, someone else had the same question I posed to my cardiologist about 6 months ago.  I really didn't get a response other than maybe.

I am 30 years old and have been diagnosed with POTS (autonomic disfunction)  I have not had a tilt table test because they could pick it up checking me in the office monitoring heart rate, blood pressure in a supine, sitting and standing, with dramitic increases in heart rate standing, blood pressure falling (my blood pressure is not as bad as the heart rate or as noticible).

I am very irregualar on my cycle, I have maybe 7-8 periods a year.  I really don't know when to expect it.  I noticed that the day before I got it, my heart rate would drop and I would feel week, I would run about 50 bpm compared to my 100+.  Chest pain, leg weakness, etc.  Then my period would come and I would feel so much better.  I noticed this in about 6 of my cycles last year.  However those symptoms are coming more frequently maybe twice a month (I haven't had a cycle since January).  

I am wearing a montior right now and had one of those days yesterday and they said I am having dropped beats, not long enough to be considered a pause, but pretty close.

I found your post interesting, maybe someone else out there has the same thing.

[aytekin]

My E-mail adress is ***@****

[Jodie]

Hi Hannah,

How long is a dropped beat before they consider it a pause?  Just curious.  My heart has long pauses maybe every 18 months or so.  I just get this pause and then it beats really fast for a few seconds then everything is back to normal.  I am wondering what the difference between a "dropped beat" and a pause.  My pauses are at least 3-4 seconds, and it is enough time for me to feel for a pulse and not find it.  Very scary.

[aytekin]

Hi,

I think, I didn't understand some conditions.

In my opinion a 40 minutes duration syncope couldn't be from cardiac cause. It can be from neurogenic. CT scan or EEG were supposed.

I don't think syncopal episodes from your female hormonal situations.

Best wishes,

Aytekin Topcu, MD, Noninvasive Cardiologist
Eskisehir State Hospital, TURKEY

[CCF-M.D.-CRC]

Dear hannah,

I don't know of any studies looking at this issue but I would suppose it could be possible.  Hormone fluctuations cause shifts in fluid balance and vascualr tone so it is possible that you are more predisposed to syncope during certain times of the month.  If you can keep a log and try to document when these times are it may help in the diagnosis and management of the problem.  In addition you may wish to see a specialist in syncope.  We have a syncope clinic here at the Cleveland Clinic.  If you would like to make an appointment you can call the number below and ask to see Dr. Fouad in the syncope clinic.