I am 35 years old, and have experienced several episodes of syncope over the past 10 years. BP and heart rate are normal (120/80 and 70 bpm). Fainting when blood is taken has been common in the past - other than that, I have blacked out 5 times:
- once when an ophthalmologist was performing a pain-free test on both my eyes (10 years ago),
- once as a pain response to an object pressed on my kneecap (8 years ago),
- once 18 months ago after administration of an epidural prior to c-section (heart rate dropped to 10 bpm, also vomited),
- once 6 months ago in the car while gagging on soda that I drank wrong (I felt it coming on and was able to pull over to the side of the road), and
- twice recently back-to-back when I arose in the middle of the night with gas cramps (did not feel it coming on, resulted in a face-plant to the bathroom tile and 2 black eyes).
A 24-hour holter monitor showed no arrhythmias. My internist indicated that it looks like I have dysautonomia occurring due to a hyperactive vagal reflex. Is this the same thing as vasovagal syncope? orthostatic intolerance? or something else? What should be the next step? The dr. indicated an increased salt diet, but I am afraid that an episode could happen anytime (like driving). Any tips on avoiding syncope due to overactive vagal reflex?
Sometimes we do not know the exact trigger of syncope. Neurocardiogenic syncope is a common cause of syncope and is usually listed as a likely etiologic cause in cases where no focal cardia or neurologic cause can be elicited. It is often associated with focal triggers which activate the sympathetic nervous system such as blood draws or strss.
Orthostatic intolerace is syncope usually related to sudden changes in position and usually associated with a marked drop in blood pressure which can be documented when standing. This type of syncope can be caused by thinigs like drugs, dehydration or autonomic insufficieny.
A lot of people have a combination of these types of risk factors and histories, so it is unclear what exacltly is the cause of thier symtpoms.
Overall, since your evaluation has been essentially negative, there is no good treatment for your episodes. Depending on the type of precipitating mechanisms sometime avoidance of triggers such as sudden changes in position is advised.
overall, your prognosis is quite good given your benign course over this many years. I would continue to work with your physicians.
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