Discussions By Condition: Medical Stories

Vasovagal Syncope, Mixed opinion complications

Posted In: Medical Stories 2 Replies
  • Posted By: Goliad
  • June 22, 2007
  • 00:28 AM

My wife has been diagnosed differently by some specialists in Cardiology with Vasovagal Syncope, associated with TWO very different ideas as to cause. Two cardiologists recommended after learning of some 8 Vasovagal Syncope spells over a 4 month period, following full open fundoplication surgery some 11 months ago, that with follow up for continued problems in this regard, plus severe fatigue and fear of more syncopes, that she needs a pacemaker. However another cardiologist of equal or better reputation, said placement of a pacemaker for bradycardia that is common with vasovagal syncopes would NOT be helpful other than possibly allow her to have MORE syncopes, but with a better Heart beat, or pulse rate. Currently upon standing, and tilt table studies, she starts having syncope reactions within about 10 minutes where she grows hot, feeling the faint coming on, and her pulse rate during this progression to vasovagal syncope starts the cycle of heart beat rates of 60 beats per minute, and on down during the passing out phase to around 40 bpm, with the diagnosis of bradycardia. The diagnosis for THIS type of syncope is the opinion that it is a Dysautonomia, or the problem originates in the brain stem vagus nerve function. It is possible that this vagus nerve malfunction resulted from the fundoplication surgery some 11 months ago leading to vagus nerve problems and gastric incontinence with many sleep problems, and digestive problems. The question is, now my wife is fearful of any more doctor visits due to the recent surgery that has compromised her for any more surgical anesthetic events that might lead to problems of bradycardia becoming a constant problem, and want no surgeries to correct a dropped bladder problem, as well as a cystocele. She is weak, has incontinence, and does NOT want a pacemaker if, as the cardiologist says it will NOT solve the problem of syncope. Some add that the best measure would be to implant a Vagal Nerve Stimulator much like the pacemaker, but routing the pacemaker to stimulate the brain and vagus function rather than a useless heart pacemaker. Her normal days activity, which now include a big fatigue factor, has altered her activity to disabled status. She cannot go away from home due to this miserable incontinence, and the anesthesia potential problem of sending her into more bradycardia events that have been typical of recent hospitalizations. She and I are confused by the variation of ideas, and the thought of putting her under for a pacemaker of questionable result make her inactive with the constant fatigue factor. She is scared to do anything that might bring on a potentially fatal heart attack due to the severity of her present condition. What do we do from here?

Reply Flag this Discussion

2 Replies:

  • I'm sorry to hear your wife is having such a difficult time. I have vasovagal syncope as well but have managed it pretty well since I usually get an advanced warning before it actually happens. I recently found this website http://cumc.columbia.edu/dept/syncope/test/level-2/diagnoses/neurocardiogenic.htm that is pretty descriptive. Hopefully it helps you and your wife. I have also heard about the pacemaker idea, but most of what I've read says that syncope episodes will still occur, only that the heart rate will not drop when they do happen. Anxiety and nervousness can be a big contributing factor to fainting. It would be a good idea for your wife to go to a therapist to talk about her fear and anxiety. It helped me immensely.
    notyetnever 7 Replies
    • August 22, 2007
    • 02:16 AM
    • 0
    Flag this Response
  • Thank you, notyetnever for your very accurate post. Yes, we've had many stress problems due to our younger daughter's 12 year battle with systemic lupus. But my wife never had constant syncope events until after Open Nissen Fundoplication surgery exactly one year ago. Within a few weeks she had Vasovagal Syncope, and this was an entirely new event in her life. She never suffered syncope until AFTER this surgery, which was very traumatic and not a measure I'd recommend for severe GERD except a last treatment of choice.This last month, July, was a hugely dramatic change for her in that she was no longer sufferering from the 11 months of chronic severe fatigue that followed those long months with constant syncope events after that surgery. There is little doubt in my mind that the trauma of the surgery which was a very dramatic 360 degree wraparound of the stomach around the lower esophagus that produced damage to Vagus nerve branches to the abdominal area that brought on a significant trauma to this very important nerve, and produced her resultant sycope events with bradycardia. Bradycardia commonly goes with sudden syncope, but her heart rate always came back to normal after she was hydrated and attempts were made to use various meds for this condition that only made her feel even sicker. The use of Florinef could not be tolerated. The switch from Prozac to Effexor/Remeron kept her sedated too much all day and feeling bad as well. 3 University Hospital affiliated Cardiologists suggested a pacemaker. A 4th opinion outside the University Cardiology unit, who was an electrophysiologist/cardiologist said just as you mentioned, that a pacemaker guaranteed nothing but maintaining a good heart rate while she continued to have syncope problems. So she was not about to have any pacemaker with those limitations. Over the next few months, no meds worked except to make matter worse and she discontinued them all with doctor approval due to the adverse effects. She was put back on Prozac, and our situation for some 12 years now has been one of much stress due to our daughter's severe systemic lupus that has basically disabled her. But the big syncope events closely followed the abdominal traumatic fundoplication open Nissen surgery, and I'm convinced this was the problem in her case. Hopefully, now that she has some energy again, after a year of worry on my part, and great concerns, the whole idea of a pacemaker in her case would have been a regretable mistake. The problem explained by the 4th cardiologist was a brain stem Vagus nerve dysfunction, or dysautonomia, that apparently was hopefully a temporary event. Time will tell. Thank you for your input.
    Goliad 1 Replies
    • August 23, 2007
    • 01:37 PM
    • 0
    Flag this Response
Thanks! A moderator will review your post and it will be live within the next 24 hours.