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Impantable loop recorder or 30 day event monitor
Hi Everyone! I’m female, about 120 lbs, 5.4” tall. I’ve had Syncope and pre-syncope since my early 20’s and I’m 35 yrs old now. I’ve had 4-5 of these/year but this year I’ve already had 4 pre-syncopes and one full blown Syncope. During these episodes I have: Extreme nausea, palpitations, ringing/ buzz like sound in my ears and then no sound at all, feel hot and sweaty and then cold after it passes,etc..I usually know I’m going to faint because of these symptoms but I have also fainted sometimes with no previous warning or presyncope.
I’ve also had 2 episodes of very severe palpitations which lasted for 15-20 min just after I had started mild exercise ( Felt as if my heart was in my throat). I have never taken this very seriously until recently because I’ve been diagnosed with Fibromyalgia for pain in my back and arms and I started swimming as recommended by my Rheumatologist but now I’m scared to get into the pool.
On a daily basis, I feel extremely fatigued, dizzy, dis-oriented, sometimes short of breath after even slight activity. I have been recording my vitals recently. I have low normal BP of 90-100/60-70, Heart rate while sitting is in 80s and on standing is from upper 90s to sometimes in 120s. My Cardiologist said that I might have Neuro=cardiogenic Syncope but I had a negative tilt-table test result and normal Echo and Stress tests. So, now he is suggesting an implantable loop recorder since my syncope is so infrequent but I got scared and asked for a 30 day event monitor instead. He has also referred me to a EP Cardiologist.
Now, I’m having second thoughts and thinking of getting the Implantable loop recorder instead of a 30 day event monitor as I’m really desperate to find out what is wrong with me and just want to have a normal life and not worry constantly about fainting as I live alone. I’m really confused and would highly appreciate any input/suggestions on where to go from here.
I’ve also had 2 episodes of very severe palpitations which lasted for 15-20 min just after I had started mild exercise ( Felt as if my heart was in my throat). I have never taken this very seriously until recently because I’ve been diagnosed with Fibromyalgia for pain in my back and arms and I started swimming as recommended by my Rheumatologist but now I’m scared to get into the pool.
On a daily basis, I feel extremely fatigued, dizzy, dis-oriented, sometimes short of breath after even slight activity. I have been recording my vitals recently. I have low normal BP of 90-100/60-70, Heart rate while sitting is in 80s and on standing is from upper 90s to sometimes in 120s. My Cardiologist said that I might have Neuro=cardiogenic Syncope but I had a negative tilt-table test result and normal Echo and Stress tests. So, now he is suggesting an implantable loop recorder since my syncope is so infrequent but I got scared and asked for a 30 day event monitor instead. He has also referred me to a EP Cardiologist.
Now, I’m having second thoughts and thinking of getting the Implantable loop recorder instead of a 30 day event monitor as I’m really desperate to find out what is wrong with me and just want to have a normal life and not worry constantly about fainting as I live alone. I’m really confused and would highly appreciate any input/suggestions on where to go from here.
Best Answer
It sure sounds like you have found a good EP who is going to work to figure this all out. I wouldn't doubt that the stress you have been under about this has ramped up your symptoms. I was getting episodes of tachycardia once every couple of weeks until the week before my ablation when I had 7 in the one week and a number of them lasted a few hours a piece. I was extremely stressed about doing the ablation so the extra adrenaline is probably setting you off a bit more than normal. I think once you get yourself looked at and have a game plan things will settle down and hopefully get fixed. Best of luck and keep us posted on how it is all going.
How frustrating. Do you have any idea if something in particular can trigger your syncope? If so I would say try to provoke it if you can. Unfortunately most of the time it doesn't work but give it a go. Do whatever you can think to possibly trigger an episode. If it does not happen then I would definitely talk to the doctor about your bp rate concerns. I do believe there are certain types of bp meds that don't lower the pressure a lot but rather more regulate heart rate. I would do some research on the meds to see what they all do and so you will be educated a bit when he starts talking about prescribing them. Then I would most certainly keep on top of this. Keep a detailed journal and then go seek a second opinion when you can list out when it happens, how often it happens, what you are doing when it happens, if anything triggers it. Keep a diary of what you eat, how much sleep you get what you did that day so that you can track if it is possibly related to diet or what your physically do that day or the day before. Unfortunately arrhythmias can be very elusive. I had a holter my first try and didn't catch anything and didn't actually get it finally caught after 4 years so it can take some time but that doesn't mean you are out of options. Just that you have to keep persisting at this time to get it diagnosed. And you are always free to go and see someone else for a second third or fourth opinion. It is your life and your health so you just persist and you will reach a solution eventually, it is just sometimes it doesn't happen all that quickly. Hang in there. I am always here if you need to talk.
I had an appointment with my EP today and he said that based on the 30 day event monitor, I have Inappropriate Sinus Tachycardia (IST). My heart tachys upto 160. He prescribed me 5mg of Bystolic (Nebivolol) to start with and will increase dose later if needed. He said that IST doesn't cause Syncope and there is something else causing it ( I haven't fainted still with the event monitor). I have 5 more days remaining on my 30 day monitor and after this he doesn't want to do Implantable loop recorder (ILR) as he thinks that I most likely have NCS/Vasovagal Syncope. He said that even though my presentation is not typical of Vasovagal Syncope, I'm too young to have V-tach etc and that I have a structurally normal heart. I asked him if I could have afib /SVT as the EP who did my TTT said that I'm most likely having Presyncopes and not a complete Syncope and it's quite likely I have an arrhythmia. He said that ..'Well, it has to be recorded first to confirm that'.
I feel quite frustated now because the EP who did my second TTT at a Teaching hospital said I most likely do not have Vasovagal Syncope and to do ILR if I don't faint with the 30 day monitor(Please see my post above to see his report).
Please help me..what should I do? I really want to find out what is causing my Presyncopes/Syncope. Also, I just googled Bystolic..and it's used to treat Hypertension, which means it lowers BP. I already have low BP (90-100 / 60-65) and feel dizzy, tired, have blurred vision all the time. Wouldn't this lower my BP even further?
I feel quite frustated now because the EP who did my second TTT at a Teaching hospital said I most likely do not have Vasovagal Syncope and to do ILR if I don't faint with the 30 day monitor(Please see my post above to see his report).
Please help me..what should I do? I really want to find out what is causing my Presyncopes/Syncope. Also, I just googled Bystolic..and it's used to treat Hypertension, which means it lowers BP. I already have low BP (90-100 / 60-65) and feel dizzy, tired, have blurred vision all the time. Wouldn't this lower my BP even further?
Yes, the last few times I noticed that I was sitting and felt palpitations, got uneasy and therefore got up (because I felt so uneasy). It has happened while standing too but mostly happens while sitting. I'm really hoping I have atleast one episode with the 30 day monitor as I would like to avoid getting one implanted. Also, the EP Cardiologist who did the TTT today is different from my current EP Cardiologist ( The test was done at a Teaching hospital ). Let's see what my current EP has to say about all this. Thank you for all the support. Can't tell you how much I appreciate it :)
I am wondering now if you have maybe have some sort of accessory pathway svt. I know with my episodes, at least before I started to exercise regularly I would get very lightheaded and feel as though I might black out. I had to lay down for fear of passing out but once I got some cardio in I was able to tolerate them quite well But considering these seem to happen all of a sudden without doing anything it sounds like possible avnrt and maybe if you are jumping up once an episode starts it is causing you to near faint. Gosh it would be nice if this turns out to be the issue because an ablation is a pretty easy fix for most people. You do seem to have some extreme symptoms though but everyone is different. At least you can now rule out dysautonomia. To some degree this is a good thing because that can only be managed with meds. I am hoping for a cure for you. Anyways, your doctor does sound nice. And it sounds like he will keep investigating until you get if figured out so hang in there. Well I have my fingers crossed that you have an episode before you have to turn in the monitor so you don't need the implanted one. Ok, onwards and upwards till a cause is found. Hang in there.
Here's some update : Had my 2nd TTT today, upright for 20 min... after 10 min HR went up 23 bpm and systolic and diastolic BP went up too. The Cardiologist was talking to me the whole time about my history, so I was not quiet during it. He was more interested in the later part where they gave me Isoproterenol by IV. It was meant to increase my HR.. Tilted me up, heart rate increased till 150 and no symptoms/syncope or presyncope happened. Just palpitations/feeling of nervousness from Isoproterenol. The Cardiologist was very nice and he then went out of his way and gave me sublingual Nitroglycerine too ( He said ...Well! She is young but is obviously concerned about what has been going on and this her 2nd TTT..let's try Nitro also and maybe that will reproduce her presyncope/syncope). Nitroglycerine lowers BP... So, I was so confident I fill pass out or have some symptoms.. but nothing happened! No decrease in BP, HR went up by 21 bpm and I had no symptoms/pre-syncope at all!
I had a long talk with the Cardiologist during and after the test. He said that it doesn't look like I have NCS/Vasovagal syncope.... because all my symptoms usually start when I am sitting and people with NCS usually faint while standing. Also, in people with NCS, there are vision changes ( tunnel vision etc) and not the loud ringing in ears ( I never get tunnel vision but always get the ringing ears). Also, he said that I am not losing consciousness/having a complete Syncope because I know what exactly is happening to me... the ringing in ears getting louder etc. He said that I'm having pre-syncopes.
So, it's back to square one now :(
He has written in his report:
Conclusions:
Negative TTT despite paharmacological testing with Isopruel, then NTG.
Mild Postural orthostasis but not blood pressure seen.
Unusual story for vaso vagal syncope given that her onset of symptoms is while seated.
Recommendations:
Continue Ambulatory monitoring.
Consider loop recorder if no events occur on monitor.
Consider Neurological evaluation if monitoring during event is unremarkable.
Observe clinical course
I had a long talk with the Cardiologist during and after the test. He said that it doesn't look like I have NCS/Vasovagal syncope.... because all my symptoms usually start when I am sitting and people with NCS usually faint while standing. Also, in people with NCS, there are vision changes ( tunnel vision etc) and not the loud ringing in ears ( I never get tunnel vision but always get the ringing ears). Also, he said that I am not losing consciousness/having a complete Syncope because I know what exactly is happening to me... the ringing in ears getting louder etc. He said that I'm having pre-syncopes.
So, it's back to square one now :(
He has written in his report:
Conclusions:
Negative TTT despite paharmacological testing with Isopruel, then NTG.
Mild Postural orthostasis but not blood pressure seen.
Unusual story for vaso vagal syncope given that her onset of symptoms is while seated.
Recommendations:
Continue Ambulatory monitoring.
Consider loop recorder if no events occur on monitor.
Consider Neurological evaluation if monitoring during event is unremarkable.
Observe clinical course
Yes, I have been quite stressed out for these 2 weeks and maybe that's why more of these episodes. When I saw HR of 172, 157.. two days back, I called my Cardiologist's office and the nurse asked me to go to ER. That just stressed me out even more. I am feeling better after my appointment with the EP and hope this tachycardia/palpitations is just a passing phase and nothing serious :) The EP has asked me not to drive or swim (esp. alone) which is a bummer :( Hope I get some concrete answers soon with the 30 day event monitor and TTT and all this fainting can be stopped with meds.
The funny side to this is that anytime I don't pick up my phone, my friends are leaving messages like...Hey, did you faint? Call us or we are calling 911. Hahaha!
I'm glad I found this forum and have such nice people giving me some excellent advice! Thank you everyone :)
The funny side to this is that anytime I don't pick up my phone, my friends are leaving messages like...Hey, did you faint? Call us or we are calling 911. Hahaha!
I'm glad I found this forum and have such nice people giving me some excellent advice! Thank you everyone :)
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