I recently went for a comprehensive health screening and it included a treadmill stress test. During the stress test, they noticed a brief episode of ventricular tachycardia. They then prescribed Atenolol (a beta blocker) as a precaution and ordered a contrast CT scan to follow up. The CT scan did not show anything out of the ordinary, so they ordered a cardiac MRI. I started to suspect this was becoming a cash grab but since the insurance was paying I did not question it. Anyway, during the health screening a gave several blood samples, and for the CT scan I was hooked up to a “thingy” which allowed them to inject the contrast fluid. It’s not like I found these experiences enjoyable, but I tolerated them fine.
The episode
I was told not to have any caffeine for 12 hours before the procedure, but not given any specific instructions other than that. In particular I was not told to avoid alcohol and the night before I had a few drinks, and arrived at the clinic with a slight hangover. The nurse hooked me up to another “thingy” and injected some fluid to prevent the vein from collapsing. When she inserted the needle, I noticed it was a bit more painful than usual. Usually it is a barely noticable pinch but this time was a bit more pain, but I just ignored it. Anyway, shortly after she injected the fluid, I fainted. It’s a really strange experience; it felt like parts of my brain came back online at different times. Very confusing, not knowing where I am or what is going on.
They laid me down to lead the blood rush to my head, after a while, sat me back up, and shortly thereafter, I fainted again. I also started sweating profusely.
This has never happened to me before. I have done needles in arms many times before, so I don’t think I have any psycosomatic issues in this regard. I don’t recall feeling anxious at the time.
But I have never had a needle in the arm, with saline injected, while on Ateolol, and while having a hangover. Maybe all these factors somehow add up to vasovagal syncope. But since this is so unusual for me, I wonder if something else could have been going on. Was the increased pain in the beginning a sign that the nurse somehow messed up, ultimately leading to a loss of consciousness?
It may have been Vasovagal Syncope. I’ve had it all my life, and I have never fainted because of a needle stick, but that may be your specific trigger, although you wrote “This has never happened to me before … and I have done needles in arms many times before”. I think it would be unusual for it to start occurring now if it has never happened before, and it is more likely due to the other medical factors at the time.
One key question is did you feel it coming on before you fainted, or did it happen suddenly without any warning? For just about everyone with vasovagal syncope you get a distinct warning (presyncope), a specific feeling of of dizziness, weakness, or unsteadiness, prior to the episode happening. That feeling gives me time to get down on the ground and to put my head between my legs, and that often, although not always, keeps me from fainting. After five or ten minutes, the feeling passes and I am back to normal. Please note IANAD.
The Mayo Clinic page on intravenous Atenolol doesn’t say anything specific about alcohol other than a generic statement of “Using alcohol or tobacco with certain medicines may also cause interactions to occur,” but in general it is wise to avoid or at least moderate the use of alcohol while taking a beta-blocker which can result in incidences of dizziness and fainting (syncope). Alcohol can have significant effects on blood pressure and heart rate that vary from person to person, and in general you should avoiding consuming alcohol before any medical procedure, and especially anything requiring general anesthesia.
I guess it could be vasovagal syncope. You should discuss it with your PCP to see what they think.
If you don’t mind me asking, how old are you? Ive never heard of it being acquired later in life. It just may never have triggered for you before. I think needles are a fairly common trigger for people. If it happens again, and needles are involved, make sure you are in a safe position in case you do faint, and if someone is around tell them you are going o faint so they can be prepared to help you if need be. The key is that when you get that weird feeling put yourself in a position so you don’t end up hitting your head on something when and if you pass out. It takes a little practice, but I’m sure you can master it.
Of course the best way to avoid vasovagal fainting is to avoid your specific trigger as much as possible. My trigger is seeing something shocking or bloody, whether is real life, in a movie or on TV. Nowadays it only happens about once every 10 years. I once had a vivid dream that led to a fainting episode after I got out of bed and was heading to the bathroom to throw up. Fun times.
I had one fainting incident in my life. There was no obvious trigger. I was just walking into my kitchen and the next thing I knew I was waking up on the floor. I talked to my doctor and he said it’s not unusual for such a thing to happen out of the blue, with no obvious cause, and no subsequent incidents. However since it happened to the OP twice in quick succession, it seems plausible that there was some specific cause for these events. I agree that the alcohol intake seems likely, but IANAD.
Similar happened to me a couple years ago. I had been doing some yard work the day prior, and the following morning my lower back was tight and a little sore. I let our dog in from her morning routine, bent down to give her a hug and…POP! went something in my lower back. I could barely right myself from the pain. I hobbled over to the table and sat down on a chair. A wave of heat came over me and I threw off my sweater, wondering WTF was happening. Dizzy and lightheaded I decided to go for the couch to lie down. I never made it - a couple three steps and I passed out. The only thing I recall was the sound of my skull hitting the hardwood floor, like a bowling ball.
I must have been out for only a few seconds, but when I came back my face hurt and there was some blood. I was able to get in to the doctor later that morning and explained what occurred, and he said ‘vasovagal syncope’ which I had never heard of before, likely from the sudden extreme pain in my back. I got an xray to see if the orbit of my eye was cracked (it wasnt) and an ultrasound of my neck looking for artierial problems going to my brain (no issues), and I looked like I was in a bar fight and couldn’t see straight for a couple days. Definitely learned to recognize the lead-up symptoms and move to the floor if it happens again. I was lucky no major injury from the fall, and it could have been much worse.
Thanks for the update. Good to hear you had no issues this time. Believe me, having vasovagal syncope is no picnic, and I’d say you dodged a bullet. As you mentioned, there are lots of reason why you may have passed out the last time, including low blood pressure, but I wouldn’t worry about it happening again until it does. At that point you and your doctor should dig in and figure out if there is a problem to worry about or not.
Some people are prone enough to VVS that it’s a real issue every time they get stuck. Some people only have a problem if there are a lot of other compounding factors to trip their rather stiff trigger.
The fact the OP got to the age they are without prior episodes and didn’t have a repeat pretty well suggests they’re in the latter camp.
Going forward it would be prudent to take basic precautions like not showing up ill or hung over, not watching them stuff the needle in, lay down rather than sitting if practical, etc. But every future stick you get that doesn’t trigger the response helps reinforce to your emotional self that this is no big deal. If you do need a stick when you’re not in a good state phsyically or emotionally, mention to the tech at the very start of the encounter that you do have a history of occasional VVS. They’d much rather help you prevent an episode than have to deal with you getting one. Which might mean moving to the room with a couch rather than a chair, etc.
Why the hard stick last time? Good bet it was mostly dehydration which leads to difficult-to-poke veins. Hangovers and dehydration go together like, well, drinking and hangovers.
As a separate matter, your skin is covered with nerve endings. But it’s a meshwork of teeny little dots, not a smooth coat of paint. And the skin where blood draws are commonly taken don’t have a very dense mesh. If by bad luck they stuck right into the center of a nerve dot, that’s gonna hurt a bunch more than happening to stick between all the sparse nerve-dots which is what usually happens.
Anyone who is diabetic and pricks their finger regularly is well aware that most of the time it’s no big deal, but once in awhile by bad luck you get a real surprise. The nerve mesh on fingertips being especially dense.
Sometimes it’s a stick-er who isn’t good at it. Once in the ER, the tech tried about three times to insert an I.V. in the back of my hand (I’m not squeamish and never mind shots or getting stuck). Finally, I withdrew my hand and said, “Can we get someone in here who knows how to do this?” They did and it was fine. So, speak up if you’re the stick-ee. Not everyone is equally skilled at starting an I.V.
Many years ago I landed in the ER for a heart arrythmia. One of the MDs moved in to start an IV and was cut off by a nurse, who said “Oh Dr X, let me do that.” She muttered to me when he’d turned his back that the nurses were much better at inserting needles than the doctors. I was grateful.
It strikes me now that I probably wouldn’t see an MD, even in the ER, unless things were pretty dire. Sad state of medical care in the US.
Without even reading your post, just the title, you should know “vasovagal syncope” is “a diagnosis of exclusion”. You have to consider and test for other more serious causes before deciding this is a less serious thing. See a doctor if you have not done so.
From just the description in the first post, I do not see how you could exclude cardiac syncope or a medication effect from the atenolol or many other causes. It is possible it was a vasovagal reaction.
Since presumably they did basic blood tests, there is reason to consider a wearable Holter monitor to see what is going on with your heart in more detail. I would not think a CT of your heart that useful. A CT of your head might be considered. If it happens again, you might not be allowed to drive, so it is worth doing the usual tests.