Syncope question - adrenal related vs. neurogenic
 

Last week I was prepping for a tri for Sunday, August 30th. I was hydrating, eating carbs, generally taking it easy, etc. I work up Thursday AM, got up to make the coffee, and found myself on the kitchen floor. Got up, went to talk to my wife about the episode, and went out again. We decided to go to the hospital, and went out a 3rd time. These episodes were not dizzy spells - full-on-out-like-a-light. Bruised hip, knee caps, bruised forehead, etc. I went to the hospital and had a CBC and chemistry panel done - normal. Ekg - normal. No signs that I was dehydrated with the exception that I had orthostatic hypotension - normal b/p is in the 100s and when I stood up, 80's. Heartrate - low 50s. Just a bit of history - Feb. 1 - weighed almost 222#. Now - low 170's. Train, train train - that's all I do. I do have a history of diverticulitits and I did have some pain the morning that this episode happened and the ED MD did put me on antibiotics. Nevertheless, did not feel comfortable doing the swim portion of the tri even though I swam 400 meters Friday night and did fine. I changed to a dualathon and did fine. Since Thursday, I have had zero episodes. I feel fine. But I'm concerned this might happen again - even more so when I'm out in the water. I'm in healthcare, an RN in the Cardiology field so am pretty knowledgeable in this area. I'm thinking neurogenic syncope vs. adrenal dysfunction in the setting of weight loss. Has anyone ever experienced anything like this? Any input would be appreciated. Thanks.

Please tell me that the ER doc at least got a CT scan to confirm the diagnosis before sending you home on antibiotics.

Regardless, you need to see a cardiologist and get a more thorough eval than an EKG--you should know better than to look at an EKG while you're asymptomatic and just figure everything is OK! I'm guessing at least an Echo and a Holter monitor.

Orthostatic hypotension without tachycardia is odd, and might be an endocrine issue. Either way, if your Cardiology evaluation is normal you should probably see an endocrinologist too.

And stop looking for advice on the internet--this is potentially a serious problem.

a syncope without fainting just before -lights out as described- is most likely epileptic or any other cause of abnormal electric brain activity. MRI+EEG is the next logical step. Doesn't look like cardiovascular or endocrine issue.
Good luck and soon resume training!

Given my symptoms - pain when I got up - antibiotics were appropriate. I've had a CT in the past which confirmed divertic.

Thank you for the input. I have sat down with no less than 4 cardiologists - all who I work with and respect their opinions. However, none are triathletes - hence, my post to you. I wasn't looking for Internet advice, per se, just thoughts thoughts from a triathlete's point of view. Thanks again.

From a triathlete's non-medical point of view: I had an episode earlier this year when after a run I went "lights out." Scary stuff. I suggest get tests, tests, and then more tests, and lay off the training until you figure this thing out. That was one of the hardest parts for me, pulling back, but being around for my family ranks way above whatever fitness I might lose while trying to get to the bottom of the problem. And whether you have a family or not, triathlon, no matter how much we may love it, is not worth risking your life over. Since you are an RN, sounds like you have lots of access to medical advice, but I still think having at least one doc who is actually "on the clock" working your case is a good idea. Who knows what combination of factors could have led to your episode, but I think you are wise to be cautious, especially about swimming, when these come on with zero warning. I hope you get to the bottom of it soon, and that it is something that can be taken care of.

Where do you do your swim training? Tell the lifeguard on duty before you get in the pool each day!!!!!!!! They should be scanning the pool at all times and every 10 seconds minimum of every swimmer, but they should know that you may stop swimming at any given time if you want to survive.

I will not answer anything about your health problems, but be fair to the people who are supposed to be watching you while swimming in a pool.

Or severe aortic stenosis, or cardiac arrhythmia from any of a multitude of causes... If those haven't been ruled out yet (which it sure doesn't sound like they have) then MRI and EEG will be a waste of thousands of dollars and a lot of time.

Thanks for all the input. I did have an echo and surprisingly, it was not normal. I took Fen/Phen some years ago and there is a possiblity that it may have caused some problems. The end result is another echo in a year and that's it at this juncture. I've had zero episodes since the inital ones and I continue to train. I really think it was dehydration.

On that note, has anyone ever done the Feb. marathon in Austin, TX? That's my next event.

Again, many thanks.