Impantable loop recorder or 30 day event monitor

[ConcernedFainter]

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.

[ConcernedFainter]

Hey Guys! Here's some update.. I saw the EP Cardiologist. He thinks I might have IST/ sinus tachycardia after I told him about my HR and palps. Of course he wants to see it on EKG first and not rely on home monitors. Also, I'm going to completely cut back/stop coffee and eat small meals to see if it makes any difference with tachy/palps..
Here's what he wants to do :
1. Another TTT with Isopro-atenolol . Yay! I was so happy that he wants this ( I didn't even have to ask).
2. 30 day event monitor, sometime next week or the week after ( he said I'm fainting quite a bit, so it's possible to catch it in the next 30 days if it's IST /SVT causing my fainting).
3. If unable to catch on 30 day event monitor and if I want he will give me the ILR. ( He was worried about scarring, it protruding out and showing because I'm on the skinnier side. I was like... what?.. I don't care!!! I am more worried about my well-being than a 1 inch scar) Are you serious ? hahaha
4. Florinex/Midodrine for NCS ( I have tried water, salt, juice..nothing works)

He thinks most likely its NCS because people with SVT don't faint that much. They mostly have presyncopes.The thing here though is that I haven't ever fainted this much before. Last year maybe 2 presyncopes and this year 1 syncope in Feb and the last 3 happended one after the other within 1 week.( which incidentally was the day I cancelled my appointment for the 30 day event monitor..can't believe my luck :))) The rest all were presyncopes. Also, sometimes I don't know if I have lost consiousness or not because I lie on the floor .I know what's happening to me.... I can still feel the increasing ringing in my ears till there's no hearing and then I just get up and I'm fine.So, I don't really know.
I will happily accept NCS but the severe palpitations in the pool for 10 min ( felt my heart was beating in my neck) and some years back another episode where the same thing happened for 45 min-1 hr after walking on treadmill just doesn't fit with NCS. That's what has me extremely concerned to be honest.
Have any of you heard of/experienced severe palpitations with NCS/ Vaso-vagal Syncope?

[ConcernedFainter]

Thanks for the great advice, Michelle. Yeah, that's right...I will definitely try to capture episodes like this.

[MichelleP_3811]

Considering you felt palpitations and your bp appears to have been low even though you didn't pass out I would still make sure you capture any episodes like you just had if you get the 30 day monitor.  I wouldn't wait until you are passing out if you get  some tachycardia and low readings like you had.  Maybe they will be able to tell just from that.  85/53 is pretty low and you likely were probably below 80/50 during the times the monitor was failing.  Anyways I do hope that you can get this documented and figured out without needing to pass out first to get an answer.  I'll keep my fingers crossed for you.

[ConcernedFainter]

Thanks for the info Michelle! Yeah, I think you were right about the low BP because an hr back, I was feeling palpitations again (moderate but not severe), so checked my HR rate on a HR app that I have on my iphone. It was 157 (standing) and then 132, 134, 137.
I tried to take my BP with the Withings BP cuff and it kept failing (again). It does look like that home BP monitors cannot record low BPs. After 15 min, while sitting I was able to get a couple of readings.. it was 85-93 / 53-58.
I think I will buy a heart rate wrist watch or something like that to keep a track of my HR. I wish there was a home BP monitor that wouldn't fail to record low BPs.

[MichelleP_3811]

I had an svt called avnrt.  It was caused by an extra fiber leading into the avnode that sometimes caused my heart to get caught in a super fast beat of 230bpm or more.  Those episodes felt really manic and it was difficult to breath.  I had them all my life but the episodes only started to become frequent in my late 30s early 40s.  I just had the issue ablated in September of last year.  I also have ectopic beats.  These are irritated spots in the heart that fire off an extra beat.  They don't really know why they occur.  Some say that everyone gets them and will go so far as to say they get them everyday.  I do believe everyone will get them but I don't believe it is everyday.  I can have bouts of them where they are in the thousands but mostly I get a few hundred a day.  Both those conditions are not related to my bp issue.  My bp issue is minor compared to yours.  My bp would dip really low when I had an svt episode so there is a possibility that you have some sort of fast beat that you just aren't feeling, not everyone feels it.  Or you could be having pauses of some sort as well.  But then again your bp issues may not be heart related at all but just affects the heart.  When our body feels distress it will usually cause the heart to speed up to compensate.  Anyways I suspect I have some sort of dysautonmia issue because my heart is all over the place but it is a minor case and one I can still function with.   I have also had hormonal issues my whole life as well.  But again, not anything that made it hard for me to function so I never pursued any of the issues.  I had hot flashes in my 20s and thought it was normal.  Had episodes of fast beat all my life and thought it was normal.  My resting heart rate has always been near 100 and will tip quite easily and go into the 120s 130s on exertion a lot of the time but I have lived with it all my life and it never bothered me so whatever my issue is it is not a threat to me.  Unfortunately for you passing out is dangerous especially if you are driving.  Luckily like I said, I only had that happen 2 times and I believe it was also because I was anemic at the time.  The only thing I do have to pay attention to is watching changing my position too fast because very often everything goes black and it makes me feel like I will pass out and I have to stop and wait for it to pass.  But it isn't as extreme as you so definitely keep investigating your issue.  It may be totally unrelated to mine.