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How can I be determine whether I have dysautonomia? Prone to vaso vagal syncope. Have ADHD and depression

Nov 2013
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Hello. How can I be tested to determine whether I have dysautonomia? All of my life I have been prone to fainting (vaso vagal syncope) in certain situations. Any type of medical situation, whether it is a simple check up, getting my blood drawn, getting a shot, or going to the dentist, triggers fainting in me. I even fainted last year at the vet with my dog, when the vet started explaining that my dog may have a heart murmor and was telling me about how to go see a dog cardiologist. I have even fainted while getting my hair cut when the hair stylist started speaking to another employee about her son breaking his jaw. I can barely even read about vaso vagal syncope on the internet, because I start feeling woozy. Hot heat also triggers my fainting, and heat combined with a closely packed environment (like a plane) is a huge trigger. In addition, over the last few years I have noticed that I am very overly sensitive to heat. I am a fit woman, 33, in very good health generally. But in the summer time I feel like I perspire excessively, with perspiration soaking through my shirt or shorts very soon after being outside, much quicker than other people. It seems like I can handle heat far less well than other people. When I was about 13 years old I had head exhaustion after spending a long weekend sitting in 100+ degree temperatures at a softball tournament. (I was not admitted to the hospital but ended up spending about 3 days resting at home in a very hazy state of mind, with cool water soaked towels placed on me and I drank lots of fluids.) Also, I usually have pretty low blood pressure. The last time I fainted an ambulance came with paramedics, and after checking me out they said I had super low blood pressure and they were very surprised. My father and twin sister also faint easily so I believe it is at least partly genetic. I recently read of dysautonomia and it sounds like I may have that - a nervous system disorder. I am interested in being tested for it, so I can go on medications if appropriate. I was born 5 weeks premature and was in an incubator the first month or two of my life because I wasn't fully developed yet (I am a twin and was born with my twin sister), so I see how I could have some nervous system dysfunction due to being born a preemie. I also have been diagnosed with ADHD and differing forms of depression (clinical, SAD), which I think trace back to my premature birth and also to my family, as my parents have those also. All of this leads me to believe my nervous system is dysfunctional in certain ways. Can you please tell me how I have this tested? And what kind of treatments are available for the easily triggered fainting, and heat sensitivity? Thanks very much!
Posted Sat, 29 Sep 2012 in Brain and Spine
Answered by Dr. Sudhir Kumar 4 hours later
Thank you for contacting Healthcare Magic.
The description of your symptoms are suggestive of recurrent vasovagal syncope. In this condition, the blood flow to brain reduces in certain situations (which you have listed), leading to loss of consciouness and falls.
When one is upright (as in sitting and standing position), heart has to pump the blood against gravity, so, the brain gets less blood during the triggering events for syncope. However, as soon as the person falls on the floor (in supine position), brain comes at the same level as heart, and the blood flow to brain is rapidly restored, resulting in normal consciounes within a short span of time.
This can be tested in consultation with cardiologist, who specialises in cardiac electrophysiology. They perform a test called as HUTT test (head up tilt test). Basically in this test, the person is made to lie on a table and strapped. Then the table is tilted to make the person upright. During this period, pulse, BP and ECG are monitored.
HUTT test is very sensitive in diagnosing syncope or dysautonomia.
Treating dysautonomia is difficult and is mostly supportive. It is advised to avoid as far as possible, the events that trigger syncope. In addition, elevation of the head of bed, frequent small meals, good fluid intake and high salt diet are useful. Medications are not curative, but may provide some relief. The most commonly used drug is fludrocortisone. Midodrine and anti-depressants (SSRI group, such as escitalopram) are also useful in some cases.
For detailed evaluation, please consult a neurologist/cardiac electrophysiologist.
Please get back if you require any more information.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad
Above answer was peer-reviewed by
Follow-up: How can I be determine whether I have dysautonomia? Prone to vaso vagal syncope. Have ADHD and depression 15 hours later

Thank you for your detailed answer. Can you tell me more about the medication fludrocortisone? Is it helpful in treating recurrent vasovagal syncope specifically? Would I take the medication regularly, like every day? Or only when I feel I might encounter a trigger that will make me faint? Also, having recurrent vasovagal syncope, would be be helpful to increase my sodium intake in my diet? And are there any types of vitamins or mineral supplements that may help recurrent vasovagal syncope? Thank you very much for your time.
Answered by Dr. Sudhir Kumar 7 hours later
Thank you for getting back.
I do not think fludrocortisone should be taken by you now, without any evaluation. Also, it does not help all patients with vasovagal syncope.
Increasing salt intake in your diet would be helpful.
There are no specific vitamin or mineral supplements for vasovagal syncope.
Please get back if you have any further queries.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Above answer was peer-reviewed by
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