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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 31594
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Dr. just answered one question, which was good. I have one

Customer Question

Dr. David just answered one question, which was good.
I have one more question.
Re. Fludrocortisone for Low blood pressure.
Recently I had a wasp sting and had severe bouts of fainting despite being on this medication.It took me a month to feel back to normal due to persistent lightheadedness.G.P. cannot advise and we have no Endocrinologist lwithin100 miles of us.Dr. David advised checking aldersterone levels. What would be possibilities of treatment depending on this result?Thank you
Submitted: 1 month ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 1 month ago.

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

I am sorry that your question was unanswered for long.

Following investigations need to be pursued in your 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.

You should be evaluated for the following which are the commonest cause for fainting 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 or fainting were diagnosed with carotid hypersensitivity.

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

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 month ago.

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

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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.