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My husband has been on ToprolXL 50mb BID for sometime now for vasovagal syncopy. They have tried numerous combinations of medications as well as different beta blockers to control the syncopy episodes. However, he still blacks out sometimes when sick or tired or dehydrated, etc. He has had numerous concussions from hitting his head. Isn't there something else that can stop these syncopal episodes?
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238668 tn?1232732330

Dear Richard,

The medical term for fainting is syncope (or near syncope if one dosen't actually pass out).  This is a common but complex condition that has many causes.  The most common cause is the common faint (neurocardiogenic or vasovagal syncope).  This is the typical faint caused by strong emotional factors (i.e. the sight of blood) and is usually brief in duration.  The person almost never harms themselves and the precipitating factor can usually be identified.  More serious forms of syncope are due to cardiac and neurologic causes.  

Syncope due to bradyarrhythmias (slow heart rate) or tachyarrhythmias (fast heart rates) are often hard to document.  Holter monitors will only reveal the source if they are being worn during an event.  "Event monitors" are devices that can be worn for months at a time and when an event occurs a button is pressed that saves the heart rhythm for the last 5 minutes.  This can then be sent to the doctor over the telephone for a diagnosis.  Other less common cardiac causes are carotid sinus irritability which is due to an abnormal structure in the neck that results in syncope when pressed upon.

Neurologic forms of syncope include autonomic nervous system diseases and seizure disorders.  These are diagnosed with tilt table testing and seizures with an EEG.  Tilt table testing is a simple test that is pretty much what it sounds like.  The patient is placed on a table and ECG and blood pressure monitoring are attached.  The table is then tilted upright so the person is in a vertical position and the heart rate and blood pressure are monitored.  People with certain types of syncope are more likely to have symptoms during this test.  The entire test lasts about a half hour.

Medications can sometimes be used for treatment of the "common faint".  A beta-blocker is the most typical medication used. Other treatments that may be recommended include liberalizing  salt intake, compression stockings and elevating the head of the bed with blocks 6 inches.  Finally, slowing rising and "bouncing" on one's toes when a faint feeling comes helps return blood circulation to the head.

If he is interested in seeing a specialist in the area of syncope two doctors that specialize in this area here are Dr. Fred Jaeger and Dr. Fetnat Fouad.  You can make an appointment with either of them by calling the number below.  Good luck.

I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.

If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.

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