Posted by Deneb on August 16, 2009, at 22:18:19
In reply to Re: question still not answered, posted by Deneb on August 16, 2009, at 21:49:04
I posted my question as soon as the expert was available again and I got an answer back after an hour.
He recommended I stop the Risperdal, but it really helps me. I think I can live with my presyncope.
Anyways, here is my question and the answer I got:
Hello, thanks in advance for answering my question.
I'm a 27 yo female with a BMI in the high end of normal. I am wondering whether or not I need to go to the doctor and get tests done.
Ever since I could remember as a child, I've had problems with strenuous exercise. I remember I would get nauseous or vomit nearly every time I ran. It didn't have to be a long run, even short sprints would often make me nauseous.
As a result of this, I never grew to like exercise and for the most part I avoid it.
As a teen I remember one time I walked through the snow fast to catch a bus and I got nauseous and vomited. I also lost my vision, had a ringing in my ears and felt I was going to faint. This pre-syncope following exercise has happened several times, mostly following short and intense (for me) exercise. The last time was a few months ago. I decided to jog slowly. I jogged extremely slowly for half a kilometer before I had to stop. I started losing my vision and felt lightheaded. I almost fainted. I had to actually sit down in the middle of the walking path for 10 mins before I could walk back home again.
I've done some research on this and discovered that feeling faint with exercise is not normal, but I also found benign causes of pre-syncope following exercise. I read about this histamine reaction that occurs in some people that cause low blood pressure following exercise. I've also read about neurocardiogenic syncope. I guess that would have to be confirmed with tilt-table testing.
I've gone to the doctor about this and my doctor just told me I was out of shape and to start more slowly. She didn't order any tests or examine me in any way. She seemed more concerned about my eczema.
As a teen I got some testing done. While getting my blood pressure taken I held my breath because I was nervous and thought holding my breath would calm me down (stupid I know lol). My doctor found my BP to be high and my BP was different on either arm. I think she also said I had a slight heart murmur, I don't remember exactly. I think I got an echocardiogram and Holter monitoring but I can't be sure what tests they were.. I am guessing they were all normal, but didn't get any details.
My BP is normal and I don't know what kind of blood tests I've had, but I assume they were normal since the doctor never got back to me.
I am thinking my exercise induced pre-syncope is the result of over reactive histamine receptors or is neurocardiogenic in nature since I get postural hypotension often. My psychiatrist tells me it is just dehydration. She also warned me not to take propranolol before exercising. It isn't the propranolol that is causing my pre-syncope because I didn't take any on the days it happened. Should I just trust my doctors and stop worrying about things or do I need tests done?
There is also no history of sudden deaths in my family so I doubt it is long QT syndrome. There is a history of nausea and vomiting with exercise in my family. My Mom told me she used to get lightheaded with exercise.
Oh I almost forgot, about 5 years ago I was hospitalized for an deliberate ASA overdose. My heart was monitored for about a day. Would I be correct to assume nothing is wrong with my heart?
Here are the meds I am taking:
40 mg Celexa
40 mg Prozac
0.75 mg Risperdal
40 mg propranolol PRN (for tremors, heart weirdness caused by anxiety)
AnswerDear *****,Neurocardiogenic syncope only occurs when you're standing quietly, especially after exercise, but not while you're exercising. Exercise-induced presyncope is more likely for you, I think. Risperdal particularly makes orthostatic hypotension worse and can even lower sitting BP a lot. Must you take it? Celexa and Prozac may cause orthostatic hypotension. tho they are less likely than Risperdal. Yes, the monitor for a day would have showed arrhythmia, but nothing else about your heart. A normal EKG would rule out long QT, as would a normal Holter.
I recommend an EKG and an echo to be sure your heart's structure and function are normal, and that you consult a cardiologist, the latter after you've stopped Risperdal for at least a week.
Please write back if this note doesn't answer all your questions.
David Richardson
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I guess I should see the doctor or something, but how do I get my doctor to order these tests? She just thinks I am out of shape.
poster:Deneb
thread:912079
URL: http://www.dr-bob.org/babble/social/20090802/msgs/912515.html