Neurocardiogenic Shock

On April 30, 2010, in Uncategorized, by Andrea



Another common cause of syncope/presyncope is neurocardiogenic (vasovagal) syndrome. This condition, known by physicians as “neurally mediated hypotension”, is also referred to as “the fainting reflex”, “vasodepressor syncope”, “vasovagal syncope”, or “autonomic dysfunction”. In this condition blood vessels tend to expand, which leads to pooling of blood in the lower parts of the body. As a result, less blood reaches the brain and this causes fainting. The usual stimulus for this action resides in the nerves of the heart-hence the term neurocardiogenic. A head-up tilt test can uncover the underlying cause of the fainting in this syndrome. Neurocardiogenic syncope is usually treated with medications that reduce the probability of cardiac nerves triggering the cycle that leads to lightheadedness, dizziness or fainting.


In an individual with neurocardiogenic syncope, the reduction of blood return triggers a miscommunication between the heart and the brain. Just when the heart needs to beat faster, the brain sends out a message that the heart rate should be slowed down, and that the blood vessels in the arms and legs should dilate. These actions take even more blood away from the central part of the circulation where it is needed. As a result, the individual feels lightheaded or may faint because not enough blood is getting to the brain. Fainting is helpful, in that it restores a person to the flat position, removing the pooling effect of gravity on the blood, and allowing more blood to return to the heart. Following the lightheadedness or syncope, most individuals feel tired and their mental abilities are somewhat foggy.

There’s something missing on my med alert bracelet.  Something I became acutely aware at about 2.2 miles into my 3.17 mi jog tonight.  And it’s something that needs to get rectified.  Sooner than later I think.

I don’t know how many of you have read my post, “Am I glad I did it?  Would I do it again?” but I reference a condition that I’ve developed post-op called Neurocardiogenic Shock.  Some have heard it called “vasovagal syncope” but I don’t think this is quite the same as anyone can have a vasovagal reaction.  Of course, this is my opinion as someone with the condition and not a medical opinion, so take it as such.

Neurocardiogenic Shock (or NCS, please?) is a low blood pressure condition that I’ve developed.  It’s quite different from one that many, MANY! post-ops get called Orthostatic Hypotension:

From Mayo Clinic:

Orthostatic hypotension — also called postural hypotension — is a form of low blood pressure that happens when you stand up from sitting or lying down. Orthostatic hypotension can make you feel dizzy or lightheaded, and maybe even faint.


If you have mild orthostatic hypotension, you may not need treatment. Many people occasionally feel dizzy or lightheaded after standing, and it’s usually not cause for concern.

Many post-ops get orthostatic hypotension — and it’s a transitory condition.  It’s something that happens due to lack of fluids, or as the body is getting used to the new fluid balance in a smaller body.  Remember that blood volume has to change when we lose weight.  Many pregnant women get this same condition as well — due to similar reasons.. just different underlying causes.  Point is — many, many people get orthostatic hypotension.

NCS is quite a bit less common.

End of the science part.

I bring this up, rather than a fun post, or a review post, or even a lab test post (cause, well, that was what was on the agenda tonight..) because this ended up taking center stage in my evening.  Reminding me that no matter how normal I feel these days — I am not.  I am a surgically-altered freak.

Today I got new shoes.  I <3 my new shoes.  Instant love.  I mean it.  I was still feeling knee pain just walking in my old runners to the store.. I wanted them to see the wear patterns (because a GOOD running shoe store?  needs these old shoes to diagnose issues) and so we made a plan of attack.  Tried 3 different pairs of shoes and they were s0-so.  But then! she brings out a 4th pair.  And it was magical.  I swear — instant relief.  I didn’t care if they were $200 (they weren’t, but I was beyond caring) that’s how good they felt.  Got up on the treadmill, tried not to make a fool of myself in front of this very fit-looking saleswoman (who told me she even weighed more than me.. and corrected my use of “Clydesdale” — a term used for heavy runners.  Apparently I am an “Athena” which I suppose sounds better.  In any case?  It’s fitting that these shoes have gold on them as they are pure gold in my eyes.

So looking forward to my jog to try them out, I head out.  Shiny!  No knee pain!  I’m so happy!  Sure, I’m huffin and puffin, but this is normal for me around the 2 mile mark to start waning in terms of endurance and have to start doing some walking in between jogging bits.  So I start doing a walk in between a jog.. and I begin to shiver.

It’s 80 degrees.  I’ve just been jogging 2+ miles.  The sun is still high.  There’s no breeze.  My skin is heavily flushed.  Heart rate is 170 (which sounds high, but really, for me?  this is quite a bit lower than it usually is at this point) and dropping very quickly into the lower 160′s.  But shivering.

Something’s up.  Something’s wrong.  Something’s not right.

Try jogging a bit more and it’s just not happening.  I just cannot get my feet to go.

Things moving through my head..  Well, it could be blood sugar, but it shouldn’t be.  Only one other real option — blood pressure.

And then it’s confirmed — I get my BP headache.

I don’t mention this because it just ties into my headache issues, but after every jog, I get a very bad headache.  It is a very different headache, similar to how a spinal headache starts (Hey Beka — I know you can relate!) and if you’ve never had one.. well, be VERY glad for the inexperience.  Basically, this headache is different in that it starts at the base of my skull and works forward where every single one of my other headaches (including migraines) start over my eyes.  I don’t normally get this until I’m home and have settled down for a bit when my BP has truly crashed.  But I’m getting it while walking towards home (no, I’m not stupid, I AM heading towards home at this point).

So yeah, I sit down.  Just in case.  Got nuzzled on by a friendly black cat.

Got up eventually, started back, tried jogging again to get my pulse back up (1/2 mile left..) but the headache turns violent and I just give up.

When I came in, I did check my sugar just to be certain –

Seems a bit high.. but? Def. not hypoglycemic.

The irony is that I had mentioned earlier today that it had been a VERY long time since I’d had a BP or sugar crash.  Heh.

In retrospect, a few things occur to me:

  1. I treat my condition with salt (no, really, it’s how it’s medically-treated).  I’ve not been eating a great deal of salt of late and so I’m probably not holding onto as much fluids as I normally am.
  2. It was hot out there, and so sweating, not holding as much fluids as I normally do?  Recipe for lutefisk.  (If you don’t know, just don’t ask.)
  3. It’s a wonder this hasn’t happened before given that I used to have issues at the YMCA all the time when I was fatter.  I’ve been lucky this, or a blood sugar crash, haven’t happened more often given how hard I work myself while jogging.  I’m a masochist.

So of all days for someone on the RNY board to ask about complications — Yup.  I have one.  And sometimes it’s a real bitch.  It’s put a damper on my evening because we are now moving into real migraine zone territory now if I can’t get it managed.  But every time I get up, it sets off another wave of dizzies.  Maybe I’ll just sleep here.

There are days that I think about revising that post — today is one of them.  But there’s a reason I don’t.  Because there are good days, and there are crappy-assed days.  Today’s one of those really really crappy ones.  It could have been a great day — a day with no knee pain!  That I can run!  And told by a skinny person that I’m not as fat as I think I am!  But in the end, it’s going to end with a Lorcet and a Frova.

But first?  I need to find a new medic alert bracelet…

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1 Response » to “Neurocardiogenic Shock”

  1. [...] know, NEWSFLASH OF THE CENTURY, duh, right?  But it’s hot out.  Which means it kicks off my NCS like nobody’s business when I go out to jog and it’s hot and I dehydrate.  So while I [...]

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