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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 32993
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Dear Doctor, My Grand daughter is 14 Years old and started

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Dear Doctor, My Grand daughter is 14 Years old and started passing out last November. She has been in school and has passed out 4 different times and taken to the hospital via ambulance they could find nothing wrong. She has been taken to Syracuse to see a pediatric cardiologist and neurologist after extensive testing they found nothing wrong. About 2 weeks ago she awakened with terrible pain in her stomach, my daughter took her to the hospital and they removed her appendix. After about 3 days she started to feel a lot better and just yesterday she started to feel sick in her stomach, dizziness, light headed and started to get the feeling she was going to pass out again. My daughter took her to the hospital again and they felt it could be a mild urinary track infection and put her on a antibiotic for 3 days. We know this isn't the problem but we don't know where to turn. When she faints she has hit her head 3 times; two of which causing concussions. We don't know where to turn, from Binghamton, NY lacking the specialists needed.
Submitted: 1 year ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 1 year ago.

Hello,

I am Dr. Arun and will be helping you today.

I am sorry that your question was unanswered for long.

A passing out / fainting episode is called syncope. Sometimes it is difficult to diagnose as the initial screening investigative protocol may be negative. Thus a repeat investigations at three to six months may be detected by the same work up. Following are the commonest cause for the fainiting or syncope;

1) bradyarrhythmias; this is sudden slowing of the heart. it is mainly due to sinus and atrial node dysfunctions. Sick sinus syndrome is a prototype of these arrhythmias and is a major cause for syncope. 24 hour Holter monitoring, echocardiography etc are the investigations done for it.

2) neurocardiogenic mechanisms; this is fall of the blood pressure suddenly due to a sudden sympathetic failure (failure of the autonomic nervous system).

3) carotid hypersensitivity syndrome is an exaggerated response to carotid sinus stimulation. In some studies almost 50% cognitively normal people who had experienced non accidental fall were diagnosed with carotid hypersensitivity.

4) orthostatic hypotension is due to failure of autonomic nervous system and related heart regulatory mechanisms.

These are the more frequent causes of syncope but there can be other like hormonal issues like excessive insulin production (Insulinoma, which decreases the blood sugar suddenly). Following investigations need to be pursued or repeated in her case;

1) MRI with gadolinium contrast

2) Magnetic resonance angiography (MRA)

3) Tilt table test

4) Carotid sinus massage

5) Electroencephalography (EEG)

6) Stress cardiac test

7) Total creatine kinase (CK) and heart enzymes; done immediately after the fainting episode and would tell about the abnormal brain or heart activity which caused the fainting.

8) Following also may be done after the fainting episode; blood electrolytes and blood glucose.

These should be able to zero down the cause.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

Expert:  Dr. Arun Phophalia replied 1 year ago.

Following is the list of the causes of fainting episodes;

• Vasovagal syncope (common faint)

• Carotid sinus syncope

• Glossopharyngeal neuralgia

Orthostatic hypotension

• Autonomic failure

• Volume depletion

- haemorrhage, diarrhoea, Addison's disease

Cardiac arrhythmias as primary cause

• Sinus node dysfunction (including bradycardia/tachycardia syndrome)

• Atrioventricular conduction system disease

• Paroxysmal supraventricular and ventricular tachycardias

• Inherited syndromes (eg, long QT syndrome, Brugada syndrome)

Structural cardiac or cardiopulmonary disease

• Obstructive cardiac valvular disease

• Obstructive cardiomyopathy

• Atrial myxoma

• Acute aortic dissection

• Pericardial disease/tamponade

• Pulmonary embolus/pulmonary hypertension

Cerebrovascular

• Vascular steal syndromes.

It is privilege assisting you.

Please let me know if you have further queries or unanswered questions.

Please consider a positive rating if this interaction has been satisfactory, as this is the only way we experts are credited and compensated for the time and work. You are not charged again for giving a rating.

Thank you.

Wishing you all the very best in life.

Expert:  Dr. Arun Phophalia replied 1 year ago.

The strategy of evaluation varies according to the severity and frequency of the episodes and the presence or absence of heart disease

In general, the absence of suspected or certain heart disease rules out a cardiac cause of syncope.

Non‐pharmacological “physical” treatments (treatment without medicines) are emerging as a new front line treatment of vasovagal syncope. In highly motivated patients with recurrent vasovagal symptoms, the prescription of progressively prolonged periods of enforced upright posture (so‐called “tilt‐training”) may reduce syncope recurrence.

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Expert:  Dr. Arun Phophalia replied 1 year ago.

Thank you for the opportunity to answer completely your Question. Please make sure to rate me because that is how I am credited for my work.

Now, I will provide an Additional Service offer so that you have this option available on your question list to get a hold of me directly in the future.

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- if you would like to schedule a new, private email session or to ask me directly a new question. It's up to you.

Thank you.

Expert:  Dr. Arun Phophalia replied 1 year ago.

Let me know if I can do anything further.

Best regards,