Can A Syncope Cause Heart-murmurs?
I would explain as follows:
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.