Diagnosis Update

Things have been going pretty well over the past week. I have felt a lot better and have not had any more fainting spells. Until today, that is.

I went to the cardiologist on Friday and he preliminarily diagnosed me with neurocardiogenic syndrome. I found this explanation of the syndrome on the Comprehensive Cardiovascular Care Group website:

In this condition blood vessels tend to expand, which leads to pooling of blood in the lower parts of the body. As a result, less blood reaches the brain and this causes fainting. The usual stimulus for this action resides in the nerves of the heart-hence the term neurocardiogenic. A head-up tilt test can uncover the underlying cause of the fainting in this syndrome. Neurocardiogenic syncope is usually treated with medications that reduce the probability of cardiac nerves triggering the cycle that leads to lightheadedness, dizziness or fainting.

When a normal individual stands up, gravity causes blood to pool in the legs, and return of blood to the heart is decreased. In order to compensate for this reduction, the body releases a surge of adrenaline (epinephrine). The heart beats faster and more forcefully, thereby pumping blood more efficiently to vital organs (especially the brain).

In an individual with neurocardiogenic syncope, the reduction of blood return triggers a miscommunication between the heart and the brain. Just when the heart needs to beat faster, the brain sends out a message that the heart rate should be slowed down, and that the blood vessels in the arms and legs should dilate. These actions take even more blood away from the central part of the circulation where it is needed. As a result, the individual feels lightheaded or may faint because not enough blood is getting to the brain. Fainting is helpful, in that it restores a person to the flat position, removing the pooling effect of gravity on the blood, and allowing more blood to return to the heart. Following the lightheadedness or syncope, most individuals feel tired and their mental abilities are somewhat foggy.

I went to St. Joseph Hospital this afternoon for a "table-tilt test." The purpose of this test was to induce syncopation (fainting) by taking me quickly from a lying position to a standing position. I laid on the table for 30 minutes and my blood pressure was taken every 5 minutes. The only painful thing about the test was that I had an IV, and when the blood pressure cuff would tighten around my left arm the IV burned like fire from the pressure. Then I was moved to an upright position, where I immediately felt very lightheaded and like I was going to pass out. I didn't pass out though and held on for 15 minutes. At the 15 minute mark I went down, when my heart rate plummeted from the 160's to the 40's. The technician immediately laid the table back down and I came to. She said that a positive tilt test confirms that I have neurocardiogenic syndrome.

The name makes it sound bad, but it is very treatable and manageable with diet and exercise (high sodium and high fluid diet) and medication, if necessary. The technician also thought that I may have Postural Orthostatic Tachycardia Syndrome (or POTS) due to my rapid heart beat upon standing, but that will be determined by the cardiologist on Wednesday. That can be controlled by medication as well, so that is good.

After laying down for about 5 minutes after the test I was able to get up and walk back to my room, where the nurse brought me a sandwich, fig newtons and a Sprite. I had driven to the hospital, with plans of driving home, but I didn't feel comfortable driving home after passing out so Chad and our friend Jeremiah came to my rescue. Jeremiah drove Chad to the hospital so that Chad could then drive me home. I was absolutely starving when we left the hospital so we stopped at Chick-Fil-A and I scarfed down a grilled chicken club sandwich, waffle fries and a delicious sweet tea. I feel a lot better now and I'm trying to get caught up on things around the house.

The best thing that came out of all of this is that my mom was able to come visit us this past weekend. We picked her up in Louisville on Friday evening, spent Saturday running errands, relaxing and going to a friends' baby shower, and then we had to take her back to the airport on Sunday afternoon. It was a brief visit but very fun and very comforting to see my mama amidst all of these tests and diagnoses. The only thing I would have changed was the temperature - it was just too cold for my southern mother. Chad and I caught her going to bed with her overcoat on Saturday night! It was pretty funny, and we gave her some more blankets so that she didn't have to sleep like a cowboy, as Chad put it.

Well, that's the story for now. I am going back to the cardiologist on Wednesday for an echocardiogram and to hopefully talk to Dr. Brewer about the tilt-table study. The echocardiogram will also let me know if it will be safe for me to continue running and training for the marathon in April. I am itching to get back to the gym and to my training plan, so I am praying for good results on the echo.