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Dr. Andrew Rynne

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Can a syncope cause heart-murmurs?

Answered by
Dr. Ilir Sharka


Practicing since :2001

Answered : 6510 Questions

Posted on Sat, 28 Oct 2017 in Hypertension and Heart Disease
Question: I am a healthy, athletic woman, age 66, who never had any heart disease problems. I was still doing difficult climbing in my late 50s. I do have relatively low blood pressure 107/68, and it can drop from sitting to standing to 99/60. i was in a cafe last week, and after finishing a large coffee and standing up abruptly, I had a syncope, the first time in my life. I was taken to emergency, and luckily I had only bruised ribs. They took an EKG, and the doctor didn't mention anything particular. This happened on a Thursday and I saw my doctor the following Monday. He took an EKG, which showed the drop in the systolic beat and then a sharp rise in the diastolic beat. The pattern was regular. My doctor also made me a wear a monitor for 24 hours, and told me that I had pauses in my heart beat, without giving me a diagnosis. He referred me to a cardiologist whom I am going to see on Monday. He also mentioned that I may need a pace maker, which really scared me, since I never had any heart disease symptoms in my life. My mother was a cardiologist and when I was a teenager mentioned that I had a slight non-significant heart murmur. Could pauses in the heartbeat with no other symptoms require a pacemaker?
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I would explain as follows:

Detailed Answer:

Welcome and thank you for asking on HCM!

I passed carefully through your question and would explain that pauses in your heart beat could be related to several types of cardiac arrhythmia, including a conduction block or sick sinus syndrome.

Some of these disorders, may need to be treated with a pacemaker implantation.

But, I would like to directly review your ECG and Holter monitoring results, if you can upload it, for a more professional opinion.

From the other hand, you should know that Trazodone and Paroxetine (in a minor degree compared to Trazodone) can cause QT prolongation and thus, lead to cardiac arrhythmia.

Considering the presence of heart murmur that you have had before, I would also recommend performing a cardiac ultrasound to examine your heart function and structure.

So, it is necessary to carefully review your ECG to exclude QT prolongation syndrome, probably related to Trazodone.

Regarding your symptoms (drop of blood pressure while standing up), you should know that these symptoms could indicate possible orthostatic hypotension.

A Head Up Tilt test is necessary to investigate for this disorder.

Other tests to consider in this clinical situation would be:

- complete blood count for anemia
- blood electrolytes for electrolyte imbalance
- thyroid hormone levels (especially considering the fact that you are taking Levothyroxine).

I would also like to mention that Trazodone can cause orthostatic hypotension as a adverse effect in up to 7 % of the patients.

So, you may need to stop taking Trazodone and see, if your symptoms improve after this change in your therapy. This would indicate that your symptoms are related to Trazodone adverse effects.

You should discuss with your doctor on the above issues. It is necessary to carefully evaluate the above possibilities, before deciding to implant a pacemaker.

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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