Syncope and Arrhythmias: Insights from Cardiovascular Health

Syncope. Arrhythmia?

Hello, Doctor.
I do not have hypertension, diabetes, or any other chronic conditions.
I have mitral valve prolapse, but I am asymptomatic and not on medication.
Since November of last year, I have occasionally experienced sudden dizziness lasting about 2 seconds, accompanied by a rapid heartbeat, which resolves within a few seconds.
On February 13, I was at a hair salon lying back for about 30 minutes while getting my hair washed.
After leaving the salon and looking for my keys to ride my motorcycle, I suddenly fainted.
I decided to take a taxi instead, but while waiting for the taxi, I fainted again.
I sustained a head injury and went to the hospital's emergency department, where blood tests, a CT scan of the head, and an ECG showed no significant issues.
Later, I consulted a neurologist, and EEG and neck ultrasound examinations also revealed no problems.
I am now seeing a cardiologist and underwent a 24-hour Holter monitor test.
The report indicates: 1.
Basically sinus rhythm.
HR 50-155 bpm, average 76 bpm.
2.
Occasional PVCs, 91 beats/day.
3.
Frequent PACs, 3936 beats/day.
4.
Occasional short runs of SVT, longest run 12 beats.
The doctor prescribed (Digoxin 150 mg, half a tablet twice daily), and it seems my pulse has decreased somewhat compared to before, sometimes dropping to the 60s and occasionally even into the 50s.
I would like to know if this is an issue related to premature ventricular contractions (PVCs).
Is it true that the half-beat from the PVCs cannot be detected by a blood pressure monitor but can be seen on an ECG? Or could this be related to the medication? I still occasionally experience sudden episodes of rapid heartbeat for a few seconds, but the frequency has decreased, and I no longer have unexpected fainting spells, which has been a significant concern for me.
Is this a cardiac issue (arrhythmia) or something else? Should I continue taking Digoxin? Thank you, Doctor.

Yunru, 80~89 year old female. Ask Date: 2023/04/30

Dr. He Dongjin reply Cardiology

Hello, previous examinations showed no abnormalities except for some arrhythmia.
It's difficult to determine the cause of the sudden fainting without warning.
It could be related to a heart rate of 50-60, premature beats, or medication issues.
Depending on the frequency of the arrhythmia, it would be advisable to continue taking your medication as prescribed.
Changhua Hospital cares about your well-being.

Reply Date: 2023/04/30

More Info

Understanding syncope and arrhythmias is crucial for maintaining cardiovascular health, especially in patients with underlying conditions such as mitral valve prolapse, as you mentioned. Your symptoms of occasional syncope (fainting) and palpitations can be concerning, and it’s important to explore the potential causes and implications of these episodes.

Syncope and Its Causes
Syncope is defined as a temporary loss of consciousness and muscle strength, often described as fainting. It can occur due to various reasons, including:
1. Vasovagal Syncope: This is the most common type, often triggered by stress, pain, or prolonged standing. It results from a sudden drop in heart rate and blood pressure, leading to reduced blood flow to the brain.

2. Orthostatic Hypotension: This occurs when standing up quickly causes a drop in blood pressure, leading to dizziness or fainting.

3. Cardiac Causes: Arrhythmias, such as bradycardia (slow heart rate) or tachycardia (rapid heart rate), can lead to syncope. In your case, the presence of premature ventricular contractions (PVCs) and premature atrial contractions (PACs) may contribute to your symptoms.

4. Neurological Causes: Although your neurological evaluations have returned normal, conditions such as seizures or transient ischemic attacks (TIAs) can also cause syncope.

Arrhythmias and Their Implications
Arrhythmias are irregular heartbeats that can manifest as palpitations, dizziness, or syncope. The findings from your 24-hour Holter monitor indicate:
- Sinus Rhythm: This is the normal rhythm of the heart, which is a positive sign.

- Occasional PVCs and Frequent PACs: While PVCs are generally benign, frequent PACs can sometimes indicate underlying issues, especially if they are symptomatic.

Medication and Its Effects
You mentioned being prescribed a medication (likely a beta-blocker) to manage your symptoms. Beta-blockers can help regulate heart rate and reduce the frequency of arrhythmias. However, they can also lead to bradycardia (slow heart rate), which may explain why you sometimes experience heart rates in the 50s. It’s essential to monitor how you feel on this medication and report any significant changes to your healthcare provider.

Recommendations Moving Forward
1. Continue Monitoring: Regular follow-ups with your cardiologist are crucial. They may recommend additional tests, such as an echocardiogram or an electrophysiological study, to further evaluate your heart's function and rhythm.

2. Lifestyle Modifications: Incorporate lifestyle changes that can help manage your symptoms. This includes staying hydrated, avoiding excessive caffeine, and managing stress through relaxation techniques.

3. Medication Review: Discuss with your doctor whether the current dosage of your medication is appropriate or if adjustments are needed based on your heart rate and symptoms.

4. Emergency Plan: Given your history of syncope, it may be wise to have a plan in place for when you feel faint. This could include sitting or lying down immediately and avoiding activities like driving until you have a clearer understanding of your condition.

5. Educate Yourself: Understanding your condition can empower you to manage it better. Ask your healthcare provider for resources or support groups where you can learn more about arrhythmias and syncope.

Conclusion
While your symptoms can be distressing, the absence of significant findings on your tests is reassuring. However, it’s essential to remain vigilant and proactive in managing your health. Continue to work closely with your healthcare team to ensure that you receive the best care tailored to your specific needs. If you experience any new or worsening symptoms, do not hesitate to seek medical attention promptly.

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