What are the latest treatments for syncope?

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I had a fairly sever syncopal episode ten years ago. 

I had a complete cardiac work up. I went through a number of tilt tests. I was put on at least six different meds and given tilt tests to see if the meds were helping. 

None of the meds helped, but many of them had harsh side effects. With Theophylline for example, my heart rate was running about 30 beats per minute faster than normal, I felt like I was burning up most of the time and I could only sleep about 2 hours a night. I lost ten pounds in a week. And I am in pretty good shape to begin with. 

Fast forward to now and I had another syncopal episode. 

Are there any newer treatments? Looking on the internet I see the same drugs mentioned that I was put on ten years ago with out good results. Then and now there is talk of using pacemakers, but not any enthusiasm. 

I saw two electrophysiologists ten years ago. Talking with the better of the two as I now understand, the problem, at least in my case isn't the heart. It is the medulla, the primitive part of the brain that controls blood pressure, heart rate and the other autonomic nervous system functions. 

In the end, the best advice I got was try and avoid triggers for syncopal episodes. I live a healthy life style. But there are triggers you can't avoid, now matter how much you try. 

So what are the latest treatments? Anything new out there? 

By and large it appears that electrophysiologists treat syncope. But at least in my case it seems to be more of a problem with the medulla. Wouldn't a neurologist be a better choice?

So have there been any advancements in treating syncope in the last ten years?

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  • Posted

    I found your post to be interesting. Could you please expound on what the doctor said about the medulla being the cause of your syncope? Thanks!
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    • Posted

      I am in pretty good shape for being in my mid 50's. I exercise and eat a pretty good diet. 

      My heart including the myocardium (muscle), vasculature (blood vessels) and the hearts natural pacemaker are all fine. 

      I had several tilt tests approximately ten years ago. When my blood pressure drops my brain (medulla) overreacts and the pressure drops and my heart "pauses", or put another way stops e.g. goes into asystole. I know from my records I was in asystole for over 30 seconds during one tilt test. During syncopal episodes outside of a medical setting it would be impossible to know exactly what happened. 

      When I am laid flat my heart goes back into normal operation and I regain consciousness. The down side is you feel terrible the rest of the day.

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  • Posted

    Hey Staying, I had my first blackout in 2000 and heart was checked (OK). I had another blackout in 2014 and a week in hospital with complete Cardio exam (OK). Neurologist kept insisting it wasn't Dysautonomia. In Sept 2017 I blacked out and fell over backwards fracturing my skull with concussion and brain bleeding. They finally sent me to Arizona Arrhythmia Center and Tilt Table showed Dysautonomia. Right now we are trying to get heart rate and blood pressure under control. Doctor thinks blood pressure goes real high then plummets, that is when I black out. My blood pressure has been to 189/129 and heart rate has been to 230. I am totally fatigued all the time and if I bend over or stand up I usually fall if not cautious. I don't know what the answer is but at 71 yrs old II am not to worried about myself. The first to episodes were when I was driving. The doctors have cleared me to drive but I am worried about hurting someone else. My doctor thinks the Dysautonomia is due to traumatic brain injury and affects the V10 nerve coming out of the brain.

    I wish you well and hope you find answers.

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    • Posted

      Kenaz, the heart rate of 230 alone could make you pass out. That is a SVT rate (Supraventricular Tachycardia) . When your heart rate is going that fast the chambers of the heart cannot fill up and you actual have less blood flow than at lower rates. The maximum heart rate for a 20 year old is 200, and of course as we get older it is lower.

       

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