Syncope during a Doctor's visit

[JamesAA]

First of all I want to thank everyone here who has opened up and shared their stories.  This site has been a wealth of knowledge for me, as well as a very calming place to come to in times of need.  

To begin, I'm a worrier--agoraphobia/panic attacks.  I'm an in shape, healthy 36 year old male, and I exercise regularly.  Normal blood pressure, resting heart rate of usually 54-58, good O2 levels, etc.  As of about 2 months ago I've been having PVCs daily.  Some days not so bad, some days TONS.  I have had my heart checked and all the MDs assure me that my heart is structurally ok and that the PVCs are totally benign.  They still make me nervous but knowing that my heart is "ok" has helped to take a bit of the edge off.  However just 24 hrs ago I didn't know that my heart was "ok."  I was having a nasty run of PVCs for 7 hours before I went to the urgent care at Kaiser.  After the MD listened to my heart I started feeling really weird.  Bear in mind I was quite nervous all day and only ate a banana w/some crackers at 130pm (my apt was at 830pm).  I did drink water, however, throughout the day.  At any rate I was nervous and at the hospital I was even more nervous and pretty sure that the MD was going to say something bad (or just that something bad was about to happen).  That's when I started feeling very flushed, weak, and nauseous.  I was very nervous and I started to reach for cold water, but the MD instructed me to lie down.  I did and then I was out.  I came back around shortly after but I was flat out, and when I did come to my senses I was covered in a pool of sweat.  When I woke up I was certain that I fainted due to a heart condition.  They put me in a gurney and wheeled me to the ER.  I was conscious during this time and EXTREMELY stressed.  I was certain I was going into cardiac arrest.  As it turned out my heart was fine and they were pretty sure I had a vasovagal syncope episode due to extreme stress.  This was nothing like that feeling you get standing still for a while (like at a wedding where you get a little light headed).  Not at all.  I felt very nauseous and I knew I couldn't stop it no matter what I did.  It really sucked.  Given that I only fainted once in my life (when I was 11, in Hawaii after being in the sun for 2 straight days), it seemed plausible that my fainting was due to stress...I mean I was very nervous right before I passed out.  I have only felt this queezy feeling a few times in my life before--once when I crashed my knee on asphalt during a basketball game, and once when I saw blood being drawn--not from the pain of the needle, but actually seeing the blood come out of me).  I never fainted those times but I felt as if I got close.  

Anyhow my question is this.  Now, being the worrier that I am, I am TERRIFIED of passing out again.  What if it's in public, or while I'm driving?  I'm worried SICK about this.  Can these syncope episodes be isolated, as in I may never get one again, or has this opened up pandora's box to more to come????  Usually when I get extremely nervous I have panic attacks, which don't feel one thing like the feeling I had before I passed out.  To be honest, I prefer panics.  In panics I have an adrenaline rush.  So now I'm afraid to go to my gym to workout...what if I get so nervous thinking about fainting that I actually faint?  Also if I make sure to eat/drink often can this reduce the likelihood of fainting?  

I think it's time for me to start taking meds such as Zoloft and/or Xanax.  I believe it's my worrying that has caused PVCs and now this syncope episode.  

If someone can help me I would really be thankful.

[JamesAA]

Thank you guys so much.  All very helpful!!!   I think the one common points all of you addressed is the anxiety/stress, and I think you are all absolutely right.  I definitely like the idea of starting w/Xanax on an as need basis as opposed to being on an SSRI, just to see how that goes first, so I appreciated that suggestion TatiSD...i think that's a great one!  This forum is very helpful and I hope I will be able to help you guys and others w/any issues you have.  
~James :)  

[rilesnic]

Hello,  It sounds to me what you described was a full blown panic attack.  It is very possible to pass out while hyperventilating, and the nausea, sweating, flushing are all signs of anxiety/panic.  I too suffer from panic attacks.  I am 37 and I get sooo dizzy when I get behind the wheel I know I'm going to pass out.  I also struggle in social situations that I can't get out of quickly ei. funeral homes, movie theaters, malls, etc.  I do have PAC's and tachycardia as well.  I always go back to my heart when I have a panic attack.  When I have one, my heart goes completely out of rythym.  I have had my heart checked since I was 22 and all seems to be fine.  I am just symptomatic, which I believe is a direct cause of my panic attacks.  I do take atenolol (BB) 12.5 mg once a day and xanax 0.25 as needed for panic/anxiety.  I usually take half of one if my PAC's get really bad or I feel that funky feeling in my stomach which seems to precede my panic attacks.  Getting a handle on the anxiety/panic is the biggest task.  I wish I had an answer for you, but taking baby steps may be a good beginning.  Having a good support system is important as well.  I do eat several small meals a day and make sure I have bottled water and snacks with me wherever I go.  Low blood sugar can contribute to all the things you were feeling and can also cause panic feelings.  Exercising is good for your heart and the anxiety, so maybe you can bring a buddy with you to workout.  Of course your heart rate will increase, but you'll know it is supposed to, so you can work out that adrenaline.  Keep us posted on how you're doing.  Best wishes!

[cindy707]

Happy Valentines Day James.....sorry that this has happened to you.  Tati may be right w. her post and i would definately listen to the finer points that she pointed out....but my bet is on anxiety driven.  The symptoms that you have described are almost textbook in extreme anxiety thus causing your system to move into shock.  The nausea, the dizziness, flushed, weak, sweaty all of it.  First off remember you were super worried enought that you felt you needed to get the the E,R, so there's a red flag, you suffer from panic attacks the second red flag, you were in an environment where you felt you were going to go into cardiac arrest the third red flag, , and we could go on and on and on.  I would say that the odds are with you that this won't happen while you are at the gym, (unless your gym is in the E,R, LOL) because obviously you have an aversion to hospitals as many of us do.  Your body did to me exactly what i would have expected it to do...it protected you because things were moving at too fast of a pace, your mind was moving even faster and all of a sudden your body just said....enough is enough James i'm shutting this puppy down and re setting everything...which it did and sometimes in a controlled environment it simply is not a bad thing.  I am sure after it happened you were probably a little scared and worried but i bet most of the symtoms were gone.  Funny how our body reacts.  Stress and anxiety could cause PVC's and they in themself are not necessarily a dangerous or bad thing...the little buggers just sort of sneak in between the normal contractions of your heart and remember James literally millions of people on this earth have them and don't even know it.  The gym sounds like a great thing to me for you to do.......diverts, helps your body, levels out all kinds of things in the body.....if it has been that many years between a bout of fainting...well you sound like a smart man to me.....read it for what it is....maybe it will happen in another 20 some odd years and maybe never again......try to remember when you go to the E.R, the creed is "treat em and street em" so keep it in the back of your mind that you'll be on your way home pretty quickly once you are examined or treated.  I when i had my heart problems forced myself to think...okay in 3 hours i'll be home doing..........or tomorrow i have to............take your mind off of what is happening w. some sort of diversion...sounds like you and your body are on the same page...don't worry about the driving, passing out in public and all of the what ifs....it just makes it harder.....good luck James...........................

[TatiSD]

Hi James, It's very likely that you passed out due to low blood sugar.  They should have checked your glucose level right after that event.  What you describe is what happens during a hypoglycemic event.  You ate practically nothing for too many hours and a banana and crackers take your sugar levels high only to make them plummet severly.  All your anxiety increase could also have been very likely due to the low sugar.  
A typical response when the sugar is too low - you get nervous, confused, weak, shaky, full of anxiety, and you don't even feel hungry, so taking some food doesn't even enter your mind in that state.  Low blood sugar also contributes to pvc's.
Most likely this will not happen again if you stay prepared throughout the day and don't go more than 3-4 hours without eating a little something that can sustain you ( a healthy choice, otherwise you get thrown into the same spin).  Having been diagnosed with hypoglycemia, what you experienced sounds very similar to incidents I've had when my blood sugar dove for long periods of time.  You can confirm this yourself with a glucose device that diabetics use, or even cheaper, just eat something regularly.  Have something ready after the gym workouts too since exercise can lower your sugar levels quickly.  A healthy drink with electrolytes is good too and without a ton of sugar.
Take it slow and don't let this anxiety that you're feeling right now gobble you up.  It's always freaky when you get confronted by these new and strange manifestations of the body, but they do pass and you survive.  
Just a suggestion, before you start the Zoloft which is a long term commitment to an anti-anxiety drug, why not see how you calm down with Xanax, an as-you-need-it type drug. This way you can reassure yourself that all the crazy stuff you feel is anxiety (once the sugar levels are addressed).  I use to take SSRI's, but I find it less intrusive to just take something (Ativan) when I feel like I can't handle it on my own.  The downside to Ativan is that it can turn addictive, however I take it a couple times a month and I do not have any feeling of "needing" it.  But only you know best what may soothe you most effectively.  Do look at all the side effects of what you're considering.  Some SSRI's contribute to more pvc's, but at the same time, you may not care that much about them since they lower your anxiety response.  
Take care of yourself and try to stay calm as you figure things out.  And eat  :)