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What causes syncope episodes, lightheadedness and flushed when diagnosed with COPD?

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Posted on Thu, 12 May 2016
Question: My husband had an episode where he wasn't feeling good and felt weak for about 4 days. He was laying down and felt flush and lightheaded. He got up and passed out. Woke up, crawled up the steps and passed out again. He went in an ambulance to the ER and spent 4 days in the hospital for tests. He was diagnosed with moderate to severe COPD, which he has had for about 5 years. They did stress test, tilt board test and said his oxygen level dropped to 88. They did an echocardiogram and CAT Scan of head & neck for injuries, there were none. They could not find what really happened and said his COPD & some emphysema could be the cause.
I don't feel we got an answer because he has had the breathing problem for a long time and would just
take it easy if he was short of breath. What happened to him was when he was lying down on the couch and he felt the flushed sensation and light headed. He also has a sharp pain in his breast area on the left side. It went away. He said it wasn't like the one they say for a heart attack that feels like pressure or weight
on your check like a heart attack does. He does a A-Fib and they have been treating it, he wore a monitor and they didn't see anything. The doctor just happened to catch it when he was in the office. They said they really couldn't tell him what happened. They took him off one of the high blood pressure medicines. (I think if was for water retention).
Any feedback / suggestions would be great.
Thanks, XXXXXXX

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Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello XXXXXXX

Welcome on HCM!

I understand your concern and would explain that your husband clinical symptomatology could be really an exacerbation of his chronic health condition (severe COPD) but some triggering factors may have contributed as well.

Because he has shown important desaturation during stress test (oxygen level dropped to 88%) this confirms the adverse implication of COPD.

During blood oxygen desaturation, pulmonary vascular resistance is shown to increase, leading to exacerbation of pulmonary hypertension with the consequent elevated to right ventricular after-load (increased pressure in right ventricular outflow tract).

All the above path-physiologic steps may produce right ventricular myocardial ischemia (because the right ventricle has thinner walls than the left and is more influenced by pressure changes) which may explain his chest pain during those moments.

Also cardiac arrhythmia may be triggered by the above processes and aggravate the clinical conditions.

Blood oxygen desaturation may lead to left ventricular ischemia as well.

An arterial blood gas analysis (checking pH, possible respiratory acidosis and metabolic alkalosis) at rest and immediately after physical exertion would give a clear picture of the degree of COPD implication in his medical status.

Also you should know that chronic pulmonary pulmonary disorders are important contributors to recurrent cardiac arrhythmia; sometimes these arrhythmic episodes are difficult to register.

In such case an implanted loop recorder (a prolonged monitoring up to several months) would be necessary.

Sometimes, also a spontaneous rupture of an emphysema bullae may be the cause of chest pain and the above clinical scenario.

If you provide me with your husband's medical tests results, I could give a more concrete professional opinion.

You can upload then here.

Hope to have been helpful!

In case of any further uncertainties, feel free to ask me again.

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 8596 Questions

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What causes syncope episodes, lightheadedness and flushed when diagnosed with COPD?

Brief Answer: I would explain as follows: Detailed Answer: Hello XXXXXXX Welcome on HCM! I understand your concern and would explain that your husband clinical symptomatology could be really an exacerbation of his chronic health condition (severe COPD) but some triggering factors may have contributed as well. Because he has shown important desaturation during stress test (oxygen level dropped to 88%) this confirms the adverse implication of COPD. During blood oxygen desaturation, pulmonary vascular resistance is shown to increase, leading to exacerbation of pulmonary hypertension with the consequent elevated to right ventricular after-load (increased pressure in right ventricular outflow tract). All the above path-physiologic steps may produce right ventricular myocardial ischemia (because the right ventricle has thinner walls than the left and is more influenced by pressure changes) which may explain his chest pain during those moments. Also cardiac arrhythmia may be triggered by the above processes and aggravate the clinical conditions. Blood oxygen desaturation may lead to left ventricular ischemia as well. An arterial blood gas analysis (checking pH, possible respiratory acidosis and metabolic alkalosis) at rest and immediately after physical exertion would give a clear picture of the degree of COPD implication in his medical status. Also you should know that chronic pulmonary pulmonary disorders are important contributors to recurrent cardiac arrhythmia; sometimes these arrhythmic episodes are difficult to register. In such case an implanted loop recorder (a prolonged monitoring up to several months) would be necessary. Sometimes, also a spontaneous rupture of an emphysema bullae may be the cause of chest pain and the above clinical scenario. If you provide me with your husband's medical tests results, I could give a more concrete professional opinion. You can upload then here. Hope to have been helpful! In case of any further uncertainties, feel free to ask me again. Kind regards, Dr. Iliri