syncope bradycardia - like IBS but for the heart?

A few months ago I had an episode where I passed out for no known reason and with no warning. Went to the ER (I am a 50 year old male, very good cholesterol, good stress tests and ekg's, slightly elevated bp (130-80) and need to lose about 20 lbs. I did have Rheumatic Fever at age 7 but was told there was no heart damage. Also have intermittently been diagnosed with an RBBB which sometimes is there and sometimes isn't but when they first noticed it they put me through everything up to and including a Thallium Stress Test that came back perfect.

This past weekend I had another blackout, no warning, no symptoms before it happened. Wife took me to the ER again and same thing, everything looked great. After a long discussion with the ER doc we decided to hold me overnight for monitoring. About 4:30 in the morning, as I felt myself falling asleep suddenly I was awakened by a lot of activity in my room. Turns out my HR had plummeted and I actually had a pause of about 6 seconds during the event where my heart didn't beat. It came back on its own and the beats all looked perfect sinus except for the fact that it seemed to go to sleep for a while. Same thing happened, again as I was sleeping about two hours later. Immediately they wanted to put a pacemaker in but had no ideas on the root cause of my issue since all the tests came back clean (they did ekg, cardiac echo, head CT, did all the blood work, checked my previous tests from my physical I had had just a month before) and when I was not in an event everything looked great. My normal resting HR is usually in the low 60s and I work out 3 times a week at around 85% and usually once a week pushing 90% without any issue of chest pain or abnormal shortness of breath.

Anyway, after a full day of research, talking to my GP, talking to my cardiac care nurse, two other cardiologists and everything else I could think of I decided that simply due to the syncope episodes I would probably have to have a pacemaker but still wasn't committed. When I decided to take a nap on it and had another event, this time with a 9 second pause preceded by a 4 second pause and followed by a 6 second pause it was decided the pacemaker would go it. There were no tachy episodes involved in any of the brady or in any previous tests so now I am paced for anything dropping below 50 and it is set to monitor for anything tachy but not to do anything about faster HR's so I can begin excercising when I heal from the surgery.

My problem is all we have done is treat the symptoms and I am a root cause person. As an IBS sufferer (IBS-C) I already have one unexplained condition (which I usually control with diet and fiber although it has been acting up recently). But now this syncope/brady thing is another mystery that has been treated but not explained as to why it is happening. While I have resigned myself to 30 or so years with a pacemaker it still doesn't make me not to want to know what went wrong and if there is another way to prevent it from happening in the future. Any ideas? My docs are shrugging their shoulders and seem now that the pacemaker is in not all that interested in finding out why this started in the first place.

10 Comments

I TOTALLY understand

by ela-girl - 2009-06-25 02:06:18

Hi there COBradyBunch!

You may want to use the "search" feature in the upper right hand corner of this site to look for other posts on syncope, bradycardia, VVS, and NCS. I'm not a doctor, but it sounds to me like you could have vasovagal/neurocardiogenic syncope (there are lots of terms for the same syncope). I say this because your experience is a lot like mine.

When I was 24 and getting ready for work one morning, I just suddenly blacked out. That was the start of it all for me. I had never had any heart issues before and nothing really runs in my family. I went to the ER and neurologists and cardiologists...all to no avail. I had tons of tests done, and they all came back fine. I wore event/holter monitors but nothing. Yet I was still blacking out--sometimes many times a day, sometimes once a day for a week straight, sometimes only a few times a month. The problem, as I like to say, was consistently inconsistent; therefore, it was never getting captured on tape or tests. How frustrating to say the least. Doctors just randomnly prescribed me meds that just made matters worse. Not to mention that it would take my body days to recover homeostasis after just one episode--and sometimes I was having them ALL day! Ugh.

It wasn't until I moved states, dropped 'dead' in my classroom before school started that I was rushed to the ER where they finally caught it all on tape. I also got a great EP out of the deal. My heartrate was 4 BPM during these episodes and my blood pressure would drop to 60/40 or a bit lower. But it would stay there for minutes on end and stop all together from time to time. I'm lucky I don't have permanent short term memory loss--the doctors couldn't believe it. I had emergency pacemaker surgery and for me, I have been great ever since. I am going on 3 years with my titanium buddy.

I was told by my EP that I could still have the symptoms of the NCS even after the pacer because the pacer only controls the heart rate. But it has been sufficient for me and I'm off all the crazy meds. Then again, like MSpacer said, sometimes doctors don't know why you end up with what you end up with. That was the case for me. And it took years of struggling and fighting with doctors to get me "fixed." Whatever you do, YOU are in charge of your medical care. That means you might have to be a squeaky wheel to get answers. But remember...the doctors work for YOU. Get armed with information and fight the good fight if you have to.

Whatever the case, just know that you're not alone!
ela-girl

virus?

by cqmccann - 2009-06-25 06:06:14

Maybe you got a virus that affected your heart. That is what happened to me. I was 38 and was having syncope and low heart rates with lots of PVC's and an approximate 2 minute pause with CPR. This came on the heels of a stomach virus. I am also in great shape so it was a shock to me. I waited for a year and a half hoping the symptoms would go away but no luck. I had the pacer implanted in April of last year and haven't had a problem since. Happy to have it. Glad you caught your issue in time. Best of luck.

ela-girl you might have nailed it

by COBradyBunch - 2009-06-25 06:06:40

Funny, since Sunday I have been going back over my personal medical history, most of it undocumented. Three years ago I had a couple of light headed episodes but since I was working like crazy at the time, 65 hours a week, skipping lunch and going non-stop, I just wrote it off as not eating right (or at all) and stress and they did go away when the project ended. Never totally passed out but after both episodes my entire body seemed out of sorts for a week or two. Then I thought back even further and realize something that I wrote off as just 'nodding off' might have actually been another episode. Was on the phone working from home when I just seemed to drop off. The person who I was talking too was suddenly not there and called back and told me they thought the line dropped because I had just stopped replying. Again, wrote it off to being tired but did have the same issue afterward of just not feeling right for about a week.

I even went back further and wonder if my initial IBS episodes 10 years ago were tied into this all starting. They originally attacked it as possible heart related issues but when they couldn't find anything after testing me out the ying yang they turned me over to gastro and when they couldn't find anything they just called it IBS and said that was good. I modified my diet, exercised more and my symptoms went away, until 3 or 4 months ago that is, about the same time my blackouts started.

So this might have been around longer than I thought but for some reason is not hitting me more severely. I have been using my Polar as a sort of monitor and last night I did drop below 60 bpm for a total of about 1 minute. Tonight I am testing 55, tomorrow 50 until I get down to my PM setting to see if I am still episodic. Nothing during conciousness since the Saturday Night episode so it also does seem sleep related although my wife who is an RT and who has done sleep studies doesn't believe I have sleep apnia but she did say she had noticed pauses in my breathing before and had thought of sending me in for a sleep study but since they never lasted long enough for her to be truly concerned she only mentioned it and never really pushed the issue.

Anyway, thanks for everyone so far and still open to other suggestions and explainations for me to research and explore.

Hope you get to the bottom of it...

by ela-girl - 2009-06-25 07:06:14

Another interesting thing...a lot of people with syncope will get it after standing for long periods etc. when blood pools and doesn't get moving along. That was not the case for me. I blacked out whether I was standing or sitting. I mention this because you said you believe you had episodes while sitting at your desk. I blacked out a number of times while sitting down. In fact, the day I "died" in my classroom, I was sitting down.

Another thing you mentioned was "poo-pooing off" possible episodes because you just thought you were too busy and hadn't eaten etc. I remember walking fast down the halls of my school getting these "feelings" and thinking, "Oh, I must be walking too fast or or or..." I always thought, "Oh well it must be because of xyz..."

And ya know...I use my pacer THE most and just in general mostly at night (based on pacer reports etc.) So, I see some similarities with our histories. Might be worth mentioning to your doc sometime...

It's good that you keep your own records. I do that, too. When I started blacking out years ago and noticed the docs weren't so keen on helping me find the problem, I would keep a pocket calendar handy and write down ANY funny feeling I had, what time it was, how I felt, etc.

Keep me posted...
ela-girl

cqmccann - No pvc's with me

by COBradyBunch - 2009-06-25 07:06:58

One of the things that was driving my nurse crazy was the fact that other than a blood pressure drop and my heart slowing and pausing I had NO other weird things that indicated problems. No PVCs, no after event tachy, nothing. In fact she said that everything still looked like a perfect sinus except that they were farther apart than they should be. She said she had never seen it before, but when she saw the last one with several pauses in a row it did scare her and that is when she told me I had to go with the PM. Up to that point she was helping me delay and research, but the 2nd time she saw the event, and saw it appeared to be getting worse each time, she said it wasn't worth the risk of trying to just wait and see if it would go away on its own.

Reason Not Always Known

by MSPACER - 2009-06-25 11:06:05

A lot of times, doctors can't really explain why a person gets heart block, or bradycardia. My doctor told me sometimes it just happens with no known cause. Since you had right bundle branch block, it could have worsened to third degree which could explain the long pauses.

As for your IBS, have you tried a good probiotic? IBS has a lot to do with an overgrowth of bad bacteria in the gut, even though most conventional doctors will tell you no. Sometimes, certain foods will trigger problems, especially, ones with sugar, and milk. A good probiotic can help your IBS. It has to be a large quantity of different strains of cultures. There are a few good ones on the market, but they are expensive.

First two days out an about

by COBradyBunch - 2009-06-27 12:06:33

Spent my first two days out and about with my new friend and found I probably need to take things a little easier at first. Both days ended up a little lightheaded after walking around in the heat but sitting and hydration helped. Will be sure to tell my docs about it when I see them for my one week break in check.

As for the rest, after monitoring my HR with my Polar to see if it looks like I am getting down to the slow HR in my sleep it looks like I bottom out pretty much at 55 bpm. First night I checked for below 60 and had one minute showing there, then checked below 55 and one night had 10 seconds there and the next zero. Since they have me set to get jump started at 40 I will be interested to see if I have had any pacemaker kick ins.

So far feel somewhat fatigued, sore and of course now that it is healing, itchy around my insertion site.

More later.

Thanks again everyone

Hard to diagnose, NO alcohol until they do

by schmerl - 2009-06-28 02:06:08

I am also 50, it was difficult to nail down my bradychardia at about 42. I had just started having acid reflux problems and that tends to cause pain just above the heart so it was confusing. My heart would pause for 4 seconds at a time and many many PVCs. Too much alcohol always brought on the a-fib, I cut way back but then overdid it once again. Docs at that ER spoke to mine at home and all insisted on a dual lead St Jude. My overnights were in the 20s. I always thought my low pulse of 43 was from years of distance running, half-marathons, 10ks etc.

6 years later I am fine (though my father just passed away from a hart attack on the tennis court at 78, he had a slight mitral valve problem but good numbers otherwise), I still run, cycle, ski. Tennis makes me out-of-breath on long points but I recover in 90 seconds or so. I had trouble sleeping and had them lower the sleep mode to 40 bpm, but still use ambien and such frequently. No heart meds, just a daily aspirin. Well, and lipitor too, genetically caused low HD cholesterol.

So my advice to COBradyBunch is if you are a drinker, stop completely for 6 months till they sort it out. No beer, no wine (and you'll lose that 20 lbs) Otherwise, sorry, no more I can add, I didn't even understand all those acronyms above.

Now a question for me: I am due for a battery change and was wondering what is the latest and best for an athletic 50 year old with bradychardia? My doc will work with me but though I might get some insights here. My HR does increase on its own but not quite enough. Current pacer is vibration sensor, I don't like that, too slow to react and nothing on hard bike rides.

Thanks

No Afib... just pausing

by COBradyBunch - 2009-06-29 01:06:45

My problem has no afib, just the pause or block. I do drink very moderately (rarely more than one beer or glass of wine) but the evening I had this event I had had nothing to drink. I also usually have a resting HR of about 62-65 but when an event strikes they could see the HR slow down and then the pauses would hit but without any intervention it would pick back up again and return to a normal rhythm. I am paced only to pick up when my HR drops to 40 bpm or below. Will find out tomorrow after my one week check if I have had any nocturnal events. Still using my Polar HRM to see if I am seeing any unexplained slowdowns during the day.

Bradycardia

by Jake93 - 2009-07-15 09:07:24

This tread has been some interesting reading. I am 48 yrs old and had the same type of thing where I was passing out. It seemed to be getting worse, so they had me do the nuclear stress test. At the end of it as soon as it stopped, I passed out and again about 10 min later. I wore a king of hearts monitor for a month and every time I would call in to down load it they would tell me my heart rate was in the low 40's and upper 30's. My next test was the tilt table test. That only took 30 min and I passed out. They said my heart rate was at 44 bpm and never responded when I passed out. I was getting dizzy sitting at my desk, or even just getting up to answer the door at home. I would go for a walk in the evening with my wife and just about had to have her go and get the car. I have had my dual lead Medtronic for 2 weeks now and have been doing great. I have also resigned to the fact that I will have a pm for the next 30 + years, but if that's what it takes I am ready.

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