It’s my heart and my health.  My way of handling medical issues which I think are scary or threatening to my lifestyle is to learn a lot about the subject, and to ask intelligent questions of my doctor.  Then to question everything that doesn’t make sense.

After my first salvo of SVTs I saw my cardiologist for the first time (July 3rd, 2007).  He is specifically a rhythm specialist (or cardio electrophysiologist).  At his suggestion I started wearing a heart monitor for the next month.  Unfortunately the issue did not come back during the month.  He suggested the possibility of vasovagal syncope.  That is, passing out (or nearly in my case) due to a sudden drop in blood preasure after standing up (or other like event).  I tried to explain to my doctor that this didn’t sound like my problem and that I had never had any problem like this.  However I didn’t mind eliminating a variable.  So, we agreed to do a tilt table test.

Tilt Table Test - The tilt table test is an outpatient procedure.  I showed up at the hospital and was prepared by changing into one of those flattering hospital gowns.  After a few minutes I was transferred to the room where the test would take place.  It is exactly what you expect.  After laying down and being hooked up to a 12 lead ECG the table is tilted up, but not so you are standing.  Instead it’s tilted to about 80 degrees so your weight is distributed between the table and your feet.  This sounds easier than it is.  When standing you normally tense your legs which counteracts the blood pooling in your legs.  When on the tilt table your blood still flows down, but your legs aren’t tensed up enough to counteract the pooling.  So, your blood pressure drops.  If after 15 minutes you haven’t passed out then they give you a dose of glyceryl trinitrate (A.K.A. nitroglycerin).  This causes your heart to race and exacerbates vasovagal syncope.  If you pass out during the test then you probably have it.

After 15 minutes I did not pass out (I was really tired of standing though and my feet hurt).  So they gave me a spray of the nitroglycerin.  I immediately felt the rush and my heart raced.  Another 5 minutes went by and I decided to rest my eyes and relax.  At that very moment my doctor exclaimed “Ahah!”  I opened my eyes and said “what.. what did you see?”   He quickly calmed down and said “no… just thought I saw something on the monitor.”  So I went to rest my eyes again and exactly the same sequence occurred.  At that time I realized I’d have to keep my eyes open or face the false positive diagnosis.  Instead… I made it through the 30 minutes and my doctor, despite my protests, declared this a false negative and made the diagnosis vasovagal syncope.  In fact he quoted the statistic of 14% false negative with this test.  DOH!

That seemed rather anti-climatic and somewhat disturbing.  On the one hand I didn’t pass out.  On the other I am still no closer to a correct diagnosis than before and my doctor has given up on trying.

At 4am I awoke from my sleep and could not return.  On my mind was the clear problem of how I could acquire a correct diagnosis.  Without an ECG of this phenomenon I would not be able to prove it.

And so on the internet I searched…  To Be Continued