BLACKOUTS, DIZZY SPELLS & PACEMAKERS
This is a very challenging condition to diagnose – changes in blood pressure, heart rhythm, inner ear problems or brain problems can all cause these symptoms. They are common and sometime difficult to pin down as they have a tendency to come and go.
Changes in blood pressure can be affected by medication you are on, getting older or other disease like Parkinson’s.
There are also a range of conditions where the body struggles to maintain a constant blood pressure with a tendency to faint. Fainting is called vaso-vagal syncope in cardiology. It is also related to an increasingly recognised problem call Postural Orthostatic Tachycardia syndrome (POTS syndrome). This is where there is a large change in your pulse rate on changing position from lying to standing. Postural hypotension is when your blood pressure drops on standing.
You may need to see a neurologist if there is a chance the events could be epileptic, or an Ear, Nose and Throat (ENT) surgeon if it could be an inner ear problem.
From a heart perspective, following a consultation and an ECG, we tend to do an echocardiogram to ensure your heart is normal, a prolonged rhythm recording with a 7 day Holter to ensure you don’t need a pacemaker and a tilt table test.
The tilt table test is a method of assessing the body’s response to maintain its own blood pressure in different positions – the response helps us identify whether a patient has a tendency to suffer from vaso-vagal problems.
If none of those tests are helpful we can sometimes implant a loop recorder to monitor the rhythm of the heart for up to 2 or 3 years in difficult situations. This is particularly important if we suspect there may be a rhythm abnormality of the heart when it goes too slow.
If there are very slow heart rates causing blackouts then we would advise the implantation of a pacemaker. This procedure usually takes about 45 minutes under local anaesthetic.
Patients with variable blood pressure often benefit from regular intake of fluid throughout the day and avoidance of products that make you pass water such as caffeine. We sometimes even suggest increasing the salt intake in your diet, but this needs to be considered with caution because it can have negative consequences on your health and kidneys.
One of the biggest problems with episodes of blacking out is that the DVLA has very strict rules about driving. I have attached a link below for patients to read but, in essence, if a person has a blackout they are usually prevented form driving for 1 year or until the cause of the blackout has been identified and treated.
This can be very distressing for patients to find out but it is the law and doctors are under very strict instructions to inform patients of these rules. It is helpful to know this before you attend for a consultation and please don’t drive if you think this law may apply to you. Going through these rules with your doctor will be very important for you.