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FREQUENT Near Syncope Episode . Please Help somebody!

I am what you would call a pretty healthy female individual in her late 20s and 110 pounds. I don't drink or smoke never did any of that bad crap. Im nurse so I know if my body is acting up and wheter if its serious or if i can take care of it myself. Well today I am at my wits end because for the 4th time I experienced another Near Syncope episode (fainting episode). I was at work and getting report for my patients when again I felt light headed. My co-wokers noticed how pale i had gone all of a sudden and I had beads of sweats on the side of my face. I felt hot then cold and became very nauseated. I also began to frequently yawn and i coulndn't stop. The tech took my temp and it was fine 96 but my blood pressure is what got me and the rest of my staff worried. Im skiny so yes my blood pressure can run low but this time it dropped. They took it when i was sitting and it was 109/79 then I stood up and it dropped to 92/72. They took me back to the ER and my blood pressure still sustained at its low point. They did a battery of blood works from TSH, Blood Sugar, to CBC. Everything was NORMAL well except my WBC which was low 3.8 but it didn't explain why on earth I had another sycope episode. I got a litter of fluids and my final blood pressure before they released me was 89/69 which is WAY LOWER then my usual. I feel helpless and Im looking for somebody to at least give some answer. All the docotors ive spoken to don't really know whats causing my syncope episodes. Please help. Thanks!
1 Responses
242587 tn?1355424110
MEDICAL PROFESSIONAL
That Syncope is so common makes it no less worrisome.  The proper evaluation of syncope requires a systematic diagnostic approach by a physician-diagnostician, usually a specialist in Internal Medicine.  Such an evaluation takes time, usually a 30-40 minute first visit and, for that reason is generally not within the scope of a busy primary care physician or an emergency room physician.  Fortunately there are well established protocols for determining the cause of syncope that will usually require a variety of tests

The following is from Cecil’s Textbook of Medicine and as you can see, there are many potential etiologies including neurogenic (far and away the most common), cardiac (with or without arrhythmias) .  With a good physical exam and a careful history the likely causes can be narrowed-down to a couple categories.

I suggest that you seek consultation with a specialist in Internal Medicine because of the broad spectrum of disease to be considered.  The IM specialist may, in turn, refer you to another specialist, such as a Neurologist but it would be a mistake to first seek assistance with a Neurologist or any other sub-specialist.  The cause of syncope can be determined and treated in most instances.

Good luck,

TABLE 62-1   -- Causes of Syncope and Their Prevalence
NEUROCARDIOGENIC CAUSES
   Vasovagal (8–41% of patients)
   Situational (1–8% of patients)
   Micturition
   Defecation
   Swallow
   Cough

   Carotid sinus syncope (0.4% of patients)
   Neuralgias
   Psychiatric disorders
   Medications, exercise

ORTHOSTATIC HYPOTENSION (4–10% OF PATIENTS)
DECREASED CARDIAC OUTPUT
   Obstruction to flow (1–8% of patients)
   Obstruction to left ventricular outflow or inflow: aortic stenosis, hypertrophic obstructive cardiomyopathy, mitral stenosis, myxoma
   Obstruction to right ventricular outflow or inflow: pulmonic stenosis, pulmonary embolism, pulmonary hypertension, myxoma

   Other heart disease
   Pump failure, myocardial infarction, coronary artery disease, coronary spasm, tamponade, aortic dissection


ARRHYTHMIAS (4–38% OF PATIENTS)
   Bradyarrhythmias: sinus node disease, second- and third-degree atrioventricular block, pacemaker malfunction, drug-induced bradyarrhythmias
   Tachyarrhythmias: ventricular tachycardia, torsades de pointes (e.g., associated with congenital long QT syndrome or acquired QT prolongation), supraventricular tachycardia

NEUROLOGIC AND PSYCHIATRIC DISEASES (3–32% OF PATIENTS)
   Migraine
   Transient ischemic attacks

UNKNOWN (13–41% OF PATIENTS)
Adapted from Kapoor W. Approach to the patient with syncope. In: Braunwald E, Goldman L, eds. Primary Cardiology, 2nd ed. Philadelphia: Saunders; 2003.

Because most spells of episodic loss of consciousness occur outside medical observation, the history is the most critical part of the evaluation (Table 62-2). Each syncopal episode should be reviewed in detail, with special attention to symptoms preceding the episode, events during unconsciousness, and the symptoms and time course of regaining orientation after consciousness is restored. Information from a witness can be essential to the evaluation.
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