Syncope

[Guest guest]

Docs:

My 83-year-old father suffered

two spells of syncope this past week, one at my nephew's double-header

basketball game and one during a lengthy church service this past weekend.

The rooms were crowded and rather warm in both instances. The first episode

occurred while sitting, the second while standing. He was transported to

Salem Hospital immediately following he first incident and all tests were

negative, including EKG, blood work, etc. Although not fully diabetic,

he was placed on Amyrl about a year ago to stimulate insulin production.

The EMTs said his blood sugar was 195 when they checked it on Sunday, but

weren't too concerned since he had eaten about 45 minutes earlier. My father

has also had glaucoma for about 30 years and uses pilocarpine HCL and Cosopt

(Timoptic) eye drops daily. He also takes 1 tab of Zestril for mildly elevated

BP. His twin brother, who also has glaucoma but no glucose or BP problems,

began experiencing syncope about a year ago and subsequently was given

a pacemaker due to episodic cardiac arrests. However, he still experiences

syncope about once a week despite the pacer. By the way, they also had

an older brother who required a pacemaker at age 90 and lived 5 more years;

and they have a younger brother who fell (syncope?) while taking his daily

walk a few years ago, striking his head on the pavement and subsequently

requiring a permanent shunt to relieve increased intracranial pressure

due to recurring fluid build-up.

Anyway, a couple of doctors

at church this past weekend suggested that my father wear a Holter monitor

for a week to see if any cardiogenic factors show up. No one at the hospital

suggested that last week, since all of the real-time cardiac tests were

negative. However, my father has an appointment with his GP today to, hopefully,

get a monitor. But since both episodes occurred in warm rooms with tons

of people (low O2 / high CO2),

and he as wearing a tight-collared shirt and tie at the time of the most

recent event, I'm wondering if he may simply be suffering from a carotid

sinus dysfunction. An article by and Green titled "Evaluating and

Managing Syncope" on Medscape leads me to believe that it's more of a carotid

sinus hypersensitivity perhaps combined with some orthostatic factors rather

than a cardiogenic syncope. They also suggested performing a "carotid sinus

massage" test and a tilt-table test. Do any of you know how to perform

these? I tried the carotid sinus massage, one side at a time as suggested

by the authors, but could not reproduce the syncope. However, I'm not sure

I was performing the test correctly and massaging the right areas. Furthermore,

I'm not sure what their definition of "massaging" meant (heavy, light,

fast, slow), since no description was given and my attempt to find more

specific postings on this subject were unsuccessful.

If any of you have had experience

with these tests and can give me more specific instructions, I would appreciate

it.

Sincerely,

Lyndon McGill, DC

Salem, Oregon

(503) 362-5555