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Autonomic Dysfunction?

Hi all! I added this over on the Autonomic Dysfunction forum too but that one doesn't seem as active as this one. Forgive me for posting it in two places if that was wrong.

My question isn't for me but rather my son. He is 20 years old, currently in the military and stationed overseas. Having said that, this is his story. Oh and, aside from the stuff I will explain below, he is otherwise healthy. No other issues and not taking medication for anything. Not a drinker or a smoker.

About a month after getting to his current duty station, he started experiencing the following symptoms at various times:

Chest pain
Irregular heartbeat
Trouble breathing and very fast breathing
Sweating (a few times)
Dizziness and sometimes shaky (a few times)
Sometimes hot flashes (depends on how sudden the pain came on, etc)
Light headed

He said some or all of those things happened during or after physical activity and sometimes while just sitting there doing nothing at all. He said he actually first noticed something wasn't right when he started getting short of breath just walking up the stairs. And, as you know, soldiers are usually physically fit and exercise is the norm for them every day.

Anyway, at first when it started happening during exercise he didn't think too much of it. After all, they have some pretty rigorous routines. He said it wasn't until the breathlessness going up the stairs that he started thinking something may be going on. Because there really isn't a reason for someone who is physically fit to be breathless after walking up some stairs. My husband and I told him to go to the doc and see what they said. He blew it off for a while because he said it didn't always happen (except it always did during PT).

Then, about two months later, he was at work just sitting there doing nothing and suddenly his heart went nuts. Beating really fast and irregular, he was dizzy and short of breath and feeling like he was gonna pass out. The SGT sent him right over to get checked out.

The doc hooked him up to the EKG and mention that it spiked irregular but said that usually that sort of spike is usually nothing to worry about. BUT, because my husband has hypertrophic cardiomyopathy, he wanted to send my son over to the hospital to see a cardiologist to rule that out. He also took a chest x-ray and said it looked fine. And his BP was also normal.

So he met with the cardiologist who then sent him for the following tests:

EKG
ECHO
Stress Test
Blood test
Urine test
Chest X-Ray
24 Hour heart monitor
CT Scan of the heart and lungs

The results went as follows:

EKG - Again, some spikes
ECHO - Came back fine (and he does NOT have HCM)
Stress Test - During the test his heart started beating too fast after only like a minute on a slight jog and they had to take him off
Blood Test - Fine
Urine Test - Fine
Chest X-ray - Fine
CT Scans - Fine...shows no signs of any abnormalities/blockages/etc. (and he does NOT have HCM)

Now when it comes to the results for the 24 hour heart monitor, the doc said it showed his heart rate fluctuating from one extreme to the next. At one point it was 42 BPM and withing the next 5 minutes it was up to 179 BPM. He asked my son, who had written down any time he felt out of breath, strange, etc., what exactly happened during "x" time and my son responded saying that all he was doing was walking up a hill to get to work. Other times he asked about my son said he was just sitting there doing nothing. Doc said those extremes should NOT happen for during such things as walking up a hill and just sitting there.

The doc said clearly to him the heart and lungs look fine therefor they are not the issue. He said he thinks it may be an autonomic dysfunction. He also said maybe abnormal hormone spikes could be causing it. Either way, SOMETHING is causing it and since the heart and lungs are fine, he doesn't think it's them and they now must look into other areas, so he's sending him to a neurologist and cardiologist again on Dec. 8th. He's also due to start a fasting in a few weeks then said he has to take two pills and drink fluids and collect his urine over a certain period of time? Then the next day turn that in and get blood taken. I guess that's all for the hormone tests? Doc said he would have given him beta blockers to slow the heart down for when it gets so fast, BUT, because of it also getting so low, he was NOT gonna give it to him because he worries it will slow his heart even more to a dangerous, or even deadly, low.

After he told me this I of course started researching Autonomic Dysfunction and I have to say, some of the underlying reasons for it scare me. Especially when it comes to stuff like MS or Parkinson's.

So I guess my questions are:

1. Does it sound like he may have this Autonomic Dysfunction? If so I cannot imagine what an underlying cause could be? Wonder if one of the shots/vaccines he had to get for the military could have caused something to happen?

2. If it doesn't sound like that, what else could be causing this since the heart and lungs checked out fine and all those other tests came back as they did?

I really don't know what else to ask right now. I just worry, of course. I imagine one of the next tests they will do is the Table Tilt Test. But who knows.

It really stinks being so far away and not being able to be there for/with him while he's going through this. I wish I could be there to ask questions of my own. Ya know?
6 Responses
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159619 tn?1538180937
COMMUNITY LEADER
Red_Star has offered great info, let us know how it goes.
Helpful - 0
1756321 tn?1547095325
I haven't found any other condition listing fluctuating bradycardia and tachycardia except sick sinus syndrome.
Helpful - 0
1756321 tn?1547095325
Patient UK also lists various reasons for sick sinus syndrome...

"Causes include:[1]

An intrinsic disease of the sinus node:
* Idiopathic degeneration of the sinus node is the most common cause of sick sinus syndrome.
* Collagen vascular disease: amyloidosis, haemochromatosis, fatty replacement, sarcoidosis.
* Familial sinoatrial node disorders: autosomal and recessive forms.[2]
Friedreich's ataxia, muscular dystrophy.
* Cardiomyopathies: ischaemia, myocardial infarction, myocarditis, pericarditis, rheumatic heart disease, surgical injury, arteritis.
* Surgical injury.

Extrinsic causes:
* Hyperkalaemia, hypoxia, hypothermia, hypothyroidism, hyperthyroidism.
* Drugs - eg, digoxin, calcium-channel blockers, beta-blockers, sympatholytic agents, anti-arrhythmic drugs.
* Toxins - eg, result of sepsis.

Sleep apnoea may be a contributing factor by causing reduced cardiac oxygenation. "
Helpful - 0
Avatar universal
Hmmm, interesting. I was reading more about this elsewhere and it says:

"What makes the sinus node misfire?

Diseases and conditions that cause scarring or damage to your heart's electrical system can be the reason. Scar tissue from a previous heart surgery also may be the cause, particularly in children"

It also mentions medication as a cause or age. Doesn't seem like any of that pertains to him. Plus he's already had several of the tests they have listed to test for this. And they didn't mention it so I would assume he doesn't have it. But who knows.

He's also been on profile which means he cannot participate in any physical activity until further notice/clearance from the docs. And he's been on that for about 3 months now but still having the issues from things like walking up stairs, up hills and some times while just sitting around doing nothing.

Thanks for responding.
Helpful - 0
1756321 tn?1547095325
Con't from BMJ's article...

"As a therapeutic measure, a period of de-training was recommended. After an initial three week period of no physical training whatsoever, he was allowed to exercise to a maximum level of a three mile run, up to twice weekly. At follow up after three months he reported an amelioration of his palpitations and light headedness.

Follow up Holter monitor at that time yielded only seven atrial ectopics/24 hours compared with 8510 ectopics/24 hours before de-training therapy, and no atrial fibrillation. There was no further bradycardia. Repeat exercise testing revealed an excellent exercise tolerance with a peak sinus rate of 175 bpm; no atrial ectopy was noted (fig 2). This therapeutic response was sustained at follow up six months later."
Helpful - 0
1756321 tn?1547095325
At least 50% of people with sick sinus syndrome (also called sick sinus dysfunction) develop alternating bradycardia and tachycardia, also known as tachy-brady syndrome.  Sinus node activity is regulated by the autonomic nervous system.  Since your son is a soldier, this info is of interest...

Excerpt from Medscape - Sinus Node Dysfunction:

"Autonomic dysfunction

SND can be secondary to autonomic nervous system dysfunction in patients with neurocardiogenic syncope, and carotid sinus hypersensitivity. Conditions associated with marked hypervagotonia, as in well-trained athletes, can also result in SND. However, evidence suggests that there may be some intrinsic factor as well in well-trained athletes who develop SND.[13]"

Excerpt from the British Medical Journal - Arrhythmias in an athlete: the effect of de-training:

"A 53 year old athlete with a history of severe palpitations and lightheadedness presented for a second opinion. He was found to exhibit very frequent atrial ectopy, frequent runs of symptomatic atrial tachyarrhythmia, and sinus bradycardia at rest. During exercise testing, his tachyarrhythmias increased in relation to the duration and intensity of exercise. A therapeutic trial of de-training was suggested. As a result, his symptoms completely resolved with a marked reduction in the frequency of atrial arrhythmia. Repeat exercise testing revealed an excellent exercise tolerance with no atrial ectopy. De-training should be considered when athletes present with arrhythmias.

Patients who present with both tachyarrhythmias and bradyarrhythmias pose complex clinical and therapeutic challenges. Adults who are highly trained have an increased incidence of both tachyarrhythmias and bradyarrhythmias. A standard approach to symptomatic tachy-brady syndrome is likely to include long term antiarrhythmic drugs, often in combination with permanent pacing. We describe a middle aged athlete who presented with highly symptomatic arrhythmias in whom a short de-training regimen resulted in total resolution of his symptoms."
Helpful - 0
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