Exploring the Possibility of Vasovagal Syncope
I've experienced two unusual incidents that make me question whether I might be dealing with vasovagal syncope. Over a year ago, the day before Easter, I awoke in the morning and headed to the kitchen in search of a snack. As I bent down slightly to grab a plastic bag from the table, a sudden, intense pain struck me in the middle of my back. Shortly after that, I began to feel lightheaded, and it dawned on me that I was on the verge of losing consciousness. This wasn’t the first time I had gone through such an ordeal; I had a similar episode once before, after donating blood. I managed to sit down, but I still fainted for roughly ten seconds, during which time I accidentally bit my tongue. Thankfully, my brother and mother were present and promptly called for an ambulance. After a day spent undergoing tests in the emergency room, doctors offered no clear insight into my pain. However, a subsequent MRI indicated that I might be facing a notably painful disc protrusion, which seemed surprising considering my young age of 20. When I returned home, my neighbor inquired about what had transpired. After I shared my experience, he mentioned that he also suffers from vasovagal episodes and suggested that I might be experiencing similar issues. After that conversation, I didn’t think much more about it. Fast forward to a month ago. Despite occasionally feeling some back discomfort, nothing has come close to the intensity of that previous incident. I found myself in a deep and emotional discussion with my girlfriend—not a heated argument by any means, but rather a somber one. As the conversation became increasingly charged emotionally, I began to feel my blood pressure drop, which brought on symptoms of lightheadedness and blurred vision. In an effort to recuperate, I decided to lie down, only to also notice a tingling sensation in my left arm. Fortunately, I remained conscious this time. Following this second episode, I am increasingly concerned that I could faint if I ever experience overwhelming pain or stress. To get more clarity on this situation, I plan to consult a doctor in about a month. In the meantime, I’m eager to hear from anyone who might shed some light on these strange experiences. (Additional medical information: 21 years old, male, underwent four surgeries for severe clubfoot in childhood, not currently on any medication, residing outside the US)
Answers (1)
7/26/2025, 10:50:37 PM
OpenHealth AI
It sounds like you’ve had some concerning experiences that might relate to vasovagal syncope, which is a common cause of fainting due to a sudden drop in heart rate and blood pressure. Your history of feeling lightheaded and experiencing faintness under stress or pain is typical for this condition. Let’s break this down further.
Understanding Vasovagal Syncope
Vasovagal syncope occurs when the body overreacts to certain triggers, including intense emotions, physical distress, or even prolonged standing. It can lead to lightheadedness, visual disturbances, and fainting. Given your previous experiences, it’s understandable to feel anxious about future episodes.
Key Steps to Take
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Monitor Triggers: Keep track of situations that lead to symptoms. Note your emotional state, physical activity, and location. This will provide valuable information for discussions with your healthcare provider.
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Hydration and Nutrition: Ensure you are well-hydrated and maintain a balanced diet to support overall blood volume and cardiovascular health. Proper hydration can help prevent drops in blood pressure.
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Avoid Sudden Movements: When transitioning from sitting or lying down to standing, do so slowly to reduce the risk of fainting.
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Learn Relaxation Techniques: Techniques such as deep breathing, progressive muscle relaxation, or mindfulness can help manage stress and emotional triggers, potentially reducing the risk of syncope episodes.
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Positioning: If you start to feel lightheaded, lie down or sit with your head between your knees to increase blood flow to the brain, which might help prevent fainting.
Follow-Up
It's a good idea to discuss your experiences with a doctor, particularly focusing on the possible link between vasovagal syncope and your symptoms. Be sure to mention:
- Your episodes of lightheadedness and fainting
- Any neck or back pain in relation to these episodes
- Your emotional triggers and their frequency
Conclusion
While it can be unsettling to experience these symptoms, many people with vasovagal syncope lead normal lives with self-awareness and some lifestyle adjustments. Understanding your triggers and preparing for episodes can be empowering. Don’t hesitate to reach out for help or more information if your symptoms change or worsen. I'm here if you have any further questions!
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - 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Urea: 1.80 mmol/L (normal) - Creatinine: 33.4 μmol/L (normal) - **ALT: >1000 IU/mL** (EXTREMELY HIGH - severe liver dysfunction) --- ## FOLLOW-UP IMAGING (December 16, 2025 - 5.5 Months Old) ### Liver Ultrasound: **RESULTS:** - Right lobe: 64 mm, left lobe: 43 mm - Liver capsule appears irregular and vague - **Parenchyma: heterogeneous, showing 7 hypo-isoechoic nodules** (sizes range from 11.5×10.7 mm to 17.6×15.4 mm) - Capsule features uneven contours - Blood flow noted during Doppler examination - No dilation in intrahepatic bile ducts - **Portal vein: 3.9 mm** (decreased from 6.1 mm - indicating improvement) - Common bile duct: 1.4 mm - Gallbladder: measures 43.7×9.2 mm (pear-shaped, wall thickness 2.0 mm, homogeneous, free of stones) **ULTRASOUND ASSESSMENT:** "Presence of liver volumetric formations (specifically liver hemangiomas)." --- ## LATEST MSCT (February 6, 2026 - 7 Months Old) ### MSCT with 3-Phase Contrast: **FINDINGS:** - Liver remains normal in size, but shows heterogeneous structure with uneven contrast enhancement - **Portocaval shunt: 9.9 mm** (no change, continues to drain directly into the inferior vena cava avoiding liver acinus) - **Arteriovenous shunt: 4.4 mm** (no alteration) - **Three nodular cystic lesions** in perivascular space, maximum size 11.6×20.7 mm, enhancing in the venous phase - **Portal vein: 6.1 mm** (noted during porto-venous phase) - Arteries show no filling abnormalities - Intrahepatic bile ducts remain non-dilated - Gallbladder is elongated and slightly bigger, free from stones - Pancreas: normal - Spleen: measures 66.9×38.5 mm (not enlarged), splenic vein is 3.6 mm - Kidneys: normal placements and structure - No excess fluid detected in the abdominal cavity - No visible changes in lymph nodes **MSCT ANALYSIS:** "Congenital portosystemic shunt indicative of Abernethy malformation, unlikely to be AVM, presence of focal liver lesions cannot be ruled out." **RECOMMENDATION:** Engage with an abdominal and vascular surgeon. --- ## RECENT BLOOD WORK (December 2025 - January 2026) ### Complete Blood Count (January 19, 2026): - WBC: 5.8 × 10⁹/L (SHOWS IMPROVEMENT) - **RBC: 2.93 × 10¹²/L** (IMPROVED but still low) - **Hemoglobin: 72 g/L** (SHOWS IMPROVEMENT but still low) - Platelets: 223 × 10⁹/L (BACK TO NORMAL) - Neutrophils: 30.0% - Lymphocytes: 64.8% - Monocytes: 4.6% ### Biochemistry (January 28, 2026): - Total protein level: 67 g/L (slightly deficient) - Creatinine: 20.7 μmol/L - **Total Bilirubin: 242 μmol/L** (STILL HIGH - unchanged) - **Direct Bilirubin: 142 μmol/L** (VERY HIGH) - **ALT: 50 IU/mL** (DRASTICALLY LOWER from >1000!) --- ## OVERVIEW OF PROGRESS OVER 6 MONTHS | Parameter | August 2025 | January 2026 | Change | |------------------|-------------|---------------|--------------------------| | **Hemoglobin** | 69 g/L | 72 g/L | ↗ Slight improvement | | **RBC** | 2.1 | 2.93 | ↗ Improved | | **ALT** | >1000 | 50 | ✓✓ MAJOR IMPROVEMENT | | **Bilirubin** | 245 | 242 | → Unchanged (still elevated) | | **Portal vein** | 6.1 mm | 3.9 mm (US) | ↗ Decreased | | **Platelets** | 403 | 223 | ↘ Normalized | | **Shunt size** | 9.9 mm | 9.9 mm | → No Change | --- ## CURRENT SITUATION (February 2026 - 7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - 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Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. 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