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What Causes Severe Chest Pain When Diagnosed With Dysautonomia?
Question: Hi, I got sudden severe chest pain on taking a mouthful of an icey drink and instantly got sudden severe chest pains to doing that. Within about 20-30 seconds of that, I went unconscious (I dont even remember the fall to floor, I must of went completely unconscious when I was still standing trying not to cry over the chest pain I was in).
When I came too, I no longer had heart pain and was fine but phoned for medical advice and they had me ring an ambulance. At the hospital the 2 doctors I saw didnt know what had gone wrong with me as my ECG? (the test where they put electrodes on the chest) came out fine so they say it wasnt my heart.
I have many severe health issues including severe dysautonomia and have this morning read online that dysautonomia can give chest pain in response to experiencing something cold but it didnt say anything about it causing "severe" chest pain nor someone going unconscious with the chest pain from it. (I'd just recieved IV saline fluids the day before for the POTS and was well hydrated at time and that wasnt flaring).
My question is, is my problem with such a dramatic response to something cold (swallowing a mouthful of icey soda) likely to have been from my dysautonomia? Secondly if it was and was bad enough cause my heart to spasm to the degree I went unconscious. does this pose any heart risk to me?
Can heart spasms kill a person?
thanks
When I came too, I no longer had heart pain and was fine but phoned for medical advice and they had me ring an ambulance. At the hospital the 2 doctors I saw didnt know what had gone wrong with me as my ECG? (the test where they put electrodes on the chest) came out fine so they say it wasnt my heart.
I have many severe health issues including severe dysautonomia and have this morning read online that dysautonomia can give chest pain in response to experiencing something cold but it didnt say anything about it causing "severe" chest pain nor someone going unconscious with the chest pain from it. (I'd just recieved IV saline fluids the day before for the POTS and was well hydrated at time and that wasnt flaring).
My question is, is my problem with such a dramatic response to something cold (swallowing a mouthful of icey soda) likely to have been from my dysautonomia? Secondly if it was and was bad enough cause my heart to spasm to the degree I went unconscious. does this pose any heart risk to me?
Can heart spasms kill a person?
thanks
Brief Answer:
Possible Vasovagal response in response to intense esophageal discomfort.
Detailed Answer:
Good day! I'm sorry to hear that you are experiencing such symptoms. I believe I have a reasoning for your symptoms which may possibly describe what is going on. As it seems you have had the full workup for Cardiac Chest pain, I'll assume that your troubles are not heart related from a conventional sense (i.e. heart attach, ischemia, myocardial damage). However I do believe that this issue is stress, neurologic, and blood-flow related. There is a well documented response in the body that human beings have to severe stress, emotional duress and pain called "VASOVAGAL RESPONSE" or Neurocardiogenic Syncope. What happens is; a sensor in the artery leading to your brain detects either discomfort, pain or severe emotional distress, and the reaction is a rapid but temporary decrease in blood pressure and heart rate. It is enough to cause an individual to faint, but nothing to cause heart and or brain damage (Unless you fell and hit your head!). As such, if this is what it is, there are indeed treatments for you. They all revolve around maintaining an adequate blood pressure so no falls in Blood Pressure or Heart Rate will lead to significant symptoms or even dizziness/fatigue.
First and foremost is to stay hydrated. Secondly, there are medications for low blood pressure, along with selective serotonin inhibitors which can ensure that the blood flow to the brain is maintained with any drop. To be prescribed these medications I would speak to your primary care physician on what we discussed, and see how you feel.
Ultimately, though I think this may be innocent and fixable, I still recommend an Echo-cardiogram (Different than Electrocardiogram) to visualize your heart and the larger vessels leading from it to assess for any causes of syncope (fainting). It is a very valuable tool into discovering what else could be causing your symptoms.
I hope my answers have proved useful. I wish you the best and you can reach me whenever you please to discuss this further.
Possible Vasovagal response in response to intense esophageal discomfort.
Detailed Answer:
Good day! I'm sorry to hear that you are experiencing such symptoms. I believe I have a reasoning for your symptoms which may possibly describe what is going on. As it seems you have had the full workup for Cardiac Chest pain, I'll assume that your troubles are not heart related from a conventional sense (i.e. heart attach, ischemia, myocardial damage). However I do believe that this issue is stress, neurologic, and blood-flow related. There is a well documented response in the body that human beings have to severe stress, emotional duress and pain called "VASOVAGAL RESPONSE" or Neurocardiogenic Syncope. What happens is; a sensor in the artery leading to your brain detects either discomfort, pain or severe emotional distress, and the reaction is a rapid but temporary decrease in blood pressure and heart rate. It is enough to cause an individual to faint, but nothing to cause heart and or brain damage (Unless you fell and hit your head!). As such, if this is what it is, there are indeed treatments for you. They all revolve around maintaining an adequate blood pressure so no falls in Blood Pressure or Heart Rate will lead to significant symptoms or even dizziness/fatigue.
First and foremost is to stay hydrated. Secondly, there are medications for low blood pressure, along with selective serotonin inhibitors which can ensure that the blood flow to the brain is maintained with any drop. To be prescribed these medications I would speak to your primary care physician on what we discussed, and see how you feel.
Ultimately, though I think this may be innocent and fixable, I still recommend an Echo-cardiogram (Different than Electrocardiogram) to visualize your heart and the larger vessels leading from it to assess for any causes of syncope (fainting). It is a very valuable tool into discovering what else could be causing your symptoms.
I hope my answers have proved useful. I wish you the best and you can reach me whenever you please to discuss this further.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
thank you for the responses
thanks for telling me this cant cause actual damage passing out due to this.
Maintaining a blood pressure which isnt swinging has been very difficult in my case and the doctors havent been able to get this under control.
Ive been put on Florinef for the postural othostatic tachycardia I have but it only helps some. I also have been put onto clonidine for the orthostatic hypertension I get with the form of POTS I have - secondary Hyperadrenergic POTS. (my BP can go from a normal range to up to 197/138 on just one minute standing or it can do the opposite and fall to 40/0 so I also have orthostatic hypotension at times. I can get narrowing of the pulse pressure of only 7 ).
I used to wear medical compressions for this but only about 10% functional improvement with them. (my dysautonomia is so bad I have to use a wheelchair if I go out).
SSRIs in my case have caused me bad reactions, Im sensitive to many medications and have had issues with the few SSRIs we tried.
I try to stay hydrated (I drink 2 to 3 Litres per day, sometimes more if its hot or Im getting close to collapsing to try to ward off a collapse as long as I can). I was well hydrated when I had the last unconscious collapse to a mouthful of icey soda water. (I would of still had also most of the saline IVs I had night before in me so obviously though hydration helps my POTS and POTS collapses, it doesnt help this new trigger thing to cold soda water).
Saline IVs when I have them stablise my wildly swinging BP for a short time so I stop getting BP swings to standing (the hospital always checks that) and then actually my BP usually hardly varies at all for a while. So Im surprised to hear that my BP would of fallen with last incident. Hospital did a laying standing test on me when I was taken there right after the collapse and the IV saline was still working as my BP hardly shifted during the testing.
Ive also tried the taking extra salt thing (it hasnt seemed to help much) and also tried the strengthing the calve muscle thing with exercises to try to stop POTS blood pooling in lower extremeties.
any other ideas? The other thing which really helps me a lot but obviously doesnt with the latest collapse trigger is saline IVs.
Are you in my country of Australia at all? if you are, is there a way I can get my IVs when needed at home instead of having to ring an ambulance and go to the hospital all the time when I need them which causes me big problems as I also have multiple chemical sensitivity and the hospital doesnt always follow my states policy for those who have MCS while Im there. (chemicals are another thing which I think is affecting my autonomic problems at times and can actually also cause me a collapse so i can have great issues at the hospital with peoples deodourants).
I also get stuck there with no way home as I cant catch taxis with that issue and the dysautonomia (thou the othr day the hospital used an ambulance to get me home, the time before they didnt and I ended up collapsed in their car park due to a taxi drivers deodourant where I could of ended up being hit by a car).
Last time I had my POTS getting bad, I tried to give myself an IV at home rather then going to the hospital for IVs. So if you are australian and know how I could get my IVs I need at times done at home, could you please let me know.
also do have any other advice on maybe what to help me seeing Ive already tried those things.
thanks XXXXXXX
thanks for telling me this cant cause actual damage passing out due to this.
Maintaining a blood pressure which isnt swinging has been very difficult in my case and the doctors havent been able to get this under control.
Ive been put on Florinef for the postural othostatic tachycardia I have but it only helps some. I also have been put onto clonidine for the orthostatic hypertension I get with the form of POTS I have - secondary Hyperadrenergic POTS. (my BP can go from a normal range to up to 197/138 on just one minute standing or it can do the opposite and fall to 40/0 so I also have orthostatic hypotension at times. I can get narrowing of the pulse pressure of only 7 ).
I used to wear medical compressions for this but only about 10% functional improvement with them. (my dysautonomia is so bad I have to use a wheelchair if I go out).
SSRIs in my case have caused me bad reactions, Im sensitive to many medications and have had issues with the few SSRIs we tried.
I try to stay hydrated (I drink 2 to 3 Litres per day, sometimes more if its hot or Im getting close to collapsing to try to ward off a collapse as long as I can). I was well hydrated when I had the last unconscious collapse to a mouthful of icey soda water. (I would of still had also most of the saline IVs I had night before in me so obviously though hydration helps my POTS and POTS collapses, it doesnt help this new trigger thing to cold soda water).
Saline IVs when I have them stablise my wildly swinging BP for a short time so I stop getting BP swings to standing (the hospital always checks that) and then actually my BP usually hardly varies at all for a while. So Im surprised to hear that my BP would of fallen with last incident. Hospital did a laying standing test on me when I was taken there right after the collapse and the IV saline was still working as my BP hardly shifted during the testing.
Ive also tried the taking extra salt thing (it hasnt seemed to help much) and also tried the strengthing the calve muscle thing with exercises to try to stop POTS blood pooling in lower extremeties.
any other ideas? The other thing which really helps me a lot but obviously doesnt with the latest collapse trigger is saline IVs.
Are you in my country of Australia at all? if you are, is there a way I can get my IVs when needed at home instead of having to ring an ambulance and go to the hospital all the time when I need them which causes me big problems as I also have multiple chemical sensitivity and the hospital doesnt always follow my states policy for those who have MCS while Im there. (chemicals are another thing which I think is affecting my autonomic problems at times and can actually also cause me a collapse so i can have great issues at the hospital with peoples deodourants).
I also get stuck there with no way home as I cant catch taxis with that issue and the dysautonomia (thou the othr day the hospital used an ambulance to get me home, the time before they didnt and I ended up collapsed in their car park due to a taxi drivers deodourant where I could of ended up being hit by a car).
Last time I had my POTS getting bad, I tried to give myself an IV at home rather then going to the hospital for IVs. So if you are australian and know how I could get my IVs I need at times done at home, could you please let me know.
also do have any other advice on maybe what to help me seeing Ive already tried those things.
thanks XXXXXXX
Brief Answer:
Other Options!
Detailed Answer:
Welcome back,
You'll have to forgive me I am in XXXXXXX so in terms of references I cannot be of much help. However, I think at this point, blood pressure support is essential, regardless of weather it is a vasovagal/neurogenic stress/emotion/pain induced response and or POTS issue, your blood pressure certainly fluctuates, and this is one of the major causes of passing out, aka Syncope.
How are you with compliance in regards to your medication prescribed ?
Do you take them everyday at the correct times, every-time ?
Do you ever take too much ?
Another issue may be anemia. I know you've probably received a formal blood workup, but to me, volume is essential and I want to make sure that it is adequate. Fluids, blood, this must be maintained to make sure there is adequate perfusion. I noticed, you've taken a lot of care into attempting treatments.
I must ask, do you exercise often ? This can do wonders for POTS and blood pressure stabilization. Nonetheless ultimately, your blood pressure sounds like it is NOT under control. Regardless of diet and activity changes, it sounds like your medical regimen is not working, and you require further adjustments. (I"M SORRY I KNOW THAT DOES NOT SOUND VERY COMFORTING, but we must keep trying different options). Luckily, there are certainly other options out there for the symptoms you suffer.
Other medications which can treat POTS are Benzodiazapines, Betablockers, Desmopressin, Fludrocortisone and Octreotide. There are many others. It is all about finding what is right for you.
As such a formal discussion with your physician or a new consult with a Cardiologist who can read your entire history, do a thorough physician and hear your story face to face is my recommendation. I think will be essential to alter your medical regimen to a more stabilized and maintainable set of medications.
I hope this helps. And happy to discuss further. Please let me know if you have any questions.
Regards
Other Options!
Detailed Answer:
Welcome back,
You'll have to forgive me I am in XXXXXXX so in terms of references I cannot be of much help. However, I think at this point, blood pressure support is essential, regardless of weather it is a vasovagal/neurogenic stress/emotion/pain induced response and or POTS issue, your blood pressure certainly fluctuates, and this is one of the major causes of passing out, aka Syncope.
How are you with compliance in regards to your medication prescribed ?
Do you take them everyday at the correct times, every-time ?
Do you ever take too much ?
Another issue may be anemia. I know you've probably received a formal blood workup, but to me, volume is essential and I want to make sure that it is adequate. Fluids, blood, this must be maintained to make sure there is adequate perfusion. I noticed, you've taken a lot of care into attempting treatments.
I must ask, do you exercise often ? This can do wonders for POTS and blood pressure stabilization. Nonetheless ultimately, your blood pressure sounds like it is NOT under control. Regardless of diet and activity changes, it sounds like your medical regimen is not working, and you require further adjustments. (I"M SORRY I KNOW THAT DOES NOT SOUND VERY COMFORTING, but we must keep trying different options). Luckily, there are certainly other options out there for the symptoms you suffer.
Other medications which can treat POTS are Benzodiazapines, Betablockers, Desmopressin, Fludrocortisone and Octreotide. There are many others. It is all about finding what is right for you.
As such a formal discussion with your physician or a new consult with a Cardiologist who can read your entire history, do a thorough physician and hear your story face to face is my recommendation. I think will be essential to alter your medical regimen to a more stabilized and maintainable set of medications.
I hope this helps. And happy to discuss further. Please let me know if you have any questions.
Regards
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Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Answered by
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