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Daughter keeps fainting
My 14 year old daughter has been having fainting spells for about a year now. In October, she was diagnosed with Epilepsy due to an EEG that showed slowing in the left temporal lobe. This was confirmed in December by another doctor. She was on Keppra and then was added Trileptal but kept having spells. So, the docs put her in the hospital for 5 days and weaned her off the medication while on video EEG. She had one episode but it didn't record as seizure so they decided it was cardiac. She had a holter monitor last year that showed 49 episodes of ST and a heart rate that was average 96 and had a high of 166. New doc repeated holter and said it was normal. She has increased fluids and salt in her diet dramatically. Now she is being sent for a tilt table test but the docs are really confused. Any ideas?
Dr. Knee. I know you meant to spell "insipidus" instead of "insipudus". I am very frustrrated by the lack of an "edit" feature which would enable us correct mispellings. I want to crawl under a rock when I view all the spelling errors I have made in previous posts.
There is a tremendous amount of missing information in the patient history presentation.
ST is a segment of the EKG, so I am not sure what "49 episodes of ST" means. I suspect you mean PVC's or premature ventricular contractions.
Rates above 100 are considered abnormal and are known as "tachycardia". "Tacy" meaning fast and "cardia" meaning the heart.
The most common cause of fainting is a so-called vaso-vagal episode.
It is not possible to provide a diagnosis from the information provided. It sounds like your physicians are being conscientious in looking at all the possibilities.
The increase in heart rate over a short period of time concerns me. Two possibilities immediately come to mind. An iritable atrial node, commonly caused by magnesium deficiency, or a problem in the sensors in the left and right carotods.
"What is the mechanism for the variations in heart-rate?"
That is a big question.
Fainting is generally caused by low blood pressure. This in terns causes oxygen deficiency, or ischemia.
Surpise.
Ischemia can induce siezures!
If you take an ordinary cabin full of passengers in an airliner at 30,000 feet, and decompress the plane, many of them will experience epileptic siezures.
So siezures are commonly thought of as having a neurological etiology, but ischemia is another possibility.
I think the advice to "take salts" was well-intentioned, but not properly thought through. It suggests to me your cardiologist believed the fainting was due to low blood pressure.
The first thing I would do would be to get a children's hard-bound marble notebook and purchase a GOOD blood pressure cuff and a GOOD pulse oximeter. Have your daughter log her blood pressure, heart rate, and readings on the pulse oximeter several times a day at the same time, and especially if she is feeling weak, or having a "change in mentation.
The variations in the heart-rate concern me.
"Slowing in the left temporal lobe" does not define epilepsy.
Siezures define epilepsy.
And the threshold of sensitivity can vary and almost anyone can be made to "sieze" under the right circumstances.
Last, but not least, I would question your daughter and friends as to whether or not she has ingested any strange substance. I hesitate to use the words "illegal drugs".
Keep us posted.
There is a tremendous amount of missing information in the patient history presentation.
ST is a segment of the EKG, so I am not sure what "49 episodes of ST" means. I suspect you mean PVC's or premature ventricular contractions.
Rates above 100 are considered abnormal and are known as "tachycardia". "Tacy" meaning fast and "cardia" meaning the heart.
The most common cause of fainting is a so-called vaso-vagal episode.
It is not possible to provide a diagnosis from the information provided. It sounds like your physicians are being conscientious in looking at all the possibilities.
The increase in heart rate over a short period of time concerns me. Two possibilities immediately come to mind. An iritable atrial node, commonly caused by magnesium deficiency, or a problem in the sensors in the left and right carotods.
"What is the mechanism for the variations in heart-rate?"
That is a big question.
Fainting is generally caused by low blood pressure. This in terns causes oxygen deficiency, or ischemia.
Surpise.
Ischemia can induce siezures!
If you take an ordinary cabin full of passengers in an airliner at 30,000 feet, and decompress the plane, many of them will experience epileptic siezures.
So siezures are commonly thought of as having a neurological etiology, but ischemia is another possibility.
I think the advice to "take salts" was well-intentioned, but not properly thought through. It suggests to me your cardiologist believed the fainting was due to low blood pressure.
The first thing I would do would be to get a children's hard-bound marble notebook and purchase a GOOD blood pressure cuff and a GOOD pulse oximeter. Have your daughter log her blood pressure, heart rate, and readings on the pulse oximeter several times a day at the same time, and especially if she is feeling weak, or having a "change in mentation.
The variations in the heart-rate concern me.
"Slowing in the left temporal lobe" does not define epilepsy.
Siezures define epilepsy.
And the threshold of sensitivity can vary and almost anyone can be made to "sieze" under the right circumstances.
Last, but not least, I would question your daughter and friends as to whether or not she has ingested any strange substance. I hesitate to use the words "illegal drugs".
Keep us posted.
I'm sorry, I must not have been clear. My daughter is not craving extra salt and fluids. Her cardiologist told her to increase her salt and fluid intake to help avoid the fainting spells.
Thank you for your response though and I will note those possiblities as well.
Thank you for your response though and I will note those possiblities as well.
MEDICAL PROFESSIONAL
Hi
Thanks for keeping me posted!
Well, since your daughter has a craving for salt (has increased salt in her diet) and is very thirsty (drinks a lot of water), you must think in lines of adrenal gland exhaustion or diabetes insipudus. This can cause fainting spells, abnormal EEG patterns at time and also may reflect heart involvement.
Do discuss this with your doctor. Please let me know if there is any thing else and do keep me posted. Take care!
Thanks for keeping me posted!
Well, since your daughter has a craving for salt (has increased salt in her diet) and is very thirsty (drinks a lot of water), you must think in lines of adrenal gland exhaustion or diabetes insipudus. This can cause fainting spells, abnormal EEG patterns at time and also may reflect heart involvement.
Do discuss this with your doctor. Please let me know if there is any thing else and do keep me posted. Take care!
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