Vasovagal syncope?? Should I worry?

[Alanlivingstrong]

I am a 45 year old male and a seven year Hodgkin's lymphoma survivor.  Since I have finished treatment, I have taken up distance running and I did complete my 1st marathon (the Disney Marathon in Jan of '09).  

In June of '09, I had a mild heart attack.  I was running with a friend, like I have many times before in the past year since I began running.  It was a hot morning, but not unlike any other that I have run in Florida summer weather.  I was struggling to catch my breath, which is something that I was experiencing more and more at that time.  That was something that I felt even back as I was training for Disney. (I was told it was "exercise-induced asthma" but now I don’t think so)  So we were in the last half-mile of the four miles we had planned for that day and we were trying to finish strong.  Almost to the end of the run and it got increasingly hard to breathe.  I had to stop and catch my breath, I felt like I was hyperventilating.   Dizzy and light-headed to the point of vertigo, I went over to a bench to sit down.  As I sat there next to my friend, I remember struggling to catch my breath, and then I don’t remember what happened next.  My friend was standing in front of me calling my name, I had blacked out!  My head had tilted back and I was laboring to breathe.  He straightened my head up and was trying to get me to respond.  I was out for about 60 seconds.  Long story short, I did go to the ER to get checked and a cardiac catheterization showed major blockage in the coronary arteries and this was not repairable with angioplasty or stent placement.  My only option was triple bypass surgery.  It was a tough recovery from that but I have done well with it.

Fast forward to today, almost 2 years later, I have resumed training for running events and I have never felt better.  None of the symptoms that I had experienced before have been with me and I am currently training for another marathon.  Last weekend I completed a half marathon and I did pretty well through-out the entire race.  This was the longest distance that I have run in over two years

But let me frame my question.  At the end of the race after I crossed the finish line I got that familiar extreme dizziness again.  But this time it was accompanied with a near loss of vision, everything went "white."  I did not lose consciousness, but I believe if I sat down that I would have.  The feeling passed after about 10-15 minutes as I walked it off.  I have not had any symptoms since.  Because of my physical conditioning and a recent stress test, my cardiologist thinks that I had a vasovagal episode.  There is some thought that I possibly didn't "carb load" well enough before and during the race. (I only had a half a "GU" at mile 5 and I may not have drank enough water or Gatorade either)  I wear a heart monitor and I did have a significant drop in my heart-rate at the finish, but that is to be expected, right?

Should I be worried that there is more going on?  Is a vasovagal episode under these circumstances just due to the effects of a hard run or a sign of something worse?

It has been over a week now and I feel fine.  I have been restricted as to how much and what kind of training I am allowed to do until I had a scheduled "cardiac MRI.”  I went for this appointment this Monday, and I will see my cardiologist on Thursday for the results.  From there I will either have another cardio cath or get back to long distance training.  I REALLY hope for the 2nd option

[Alanlivingstrong]

Allissa

It has now been over a month since my episode, and I have had quite a bit happen since then.  The MRI confirmed that part of my heart was not getting enough oxygen and I needed the cardiac catheter to see what was going on.  That procedure led to the discovery of a 70% blockage in my right coronary artery.  They placed a stent in my artery and I'm recovering now.  This was not in the same place as the by-pass.  I will be back running very soon.

Alan

[AllissaC]

Hi Alan,
I'm not a doctor, but I am a scientist and I have Vasovagal syncope. It's been explained to me that I faint because my body responds to stress by SLOWING DOWN my heart rate, rather than speeding up (like when folks get nervous and their heart beats really fast). It sounds like your end-of-race heart rate drop could be a similar vagal reaction. Could be. Was it sudden AND dramatic? If yes, I'd suspect its a similar vagal reaction.

Also just a tip- mine is definitely linked to extreme fatigue and dehydration. And when I get dizzy and "see white" it helps to sit down, or even lie down. The point being your brain needs more blood (oxygen) and by minimizing the vertical distance it has to travel from heart to head, it helps speed the process. The body collapsing to a horizontal position allows for the blood to travel freely without much strain on the organs (heart)- talk about evolution at work!   Walking it off, as you did, probably forced your body to keep going to keep blood flowing. .... Contrary to folks who pass out after standing still too long (re: tilt table test).

Anyway, hope this gives you some starting points to look into.

Also, I'm training for my first Marathon now, and I've taken both inspiration and probably necessary caution from your post- so thanks!

Best,

Allissa