Repeated syncope after by-pass surgery
Patient: Dear Doctor, My father (63) had by-pass surgery in 2011 and off late we noticed repeated syncope. After ruling out cardio-related problems we switched now to a potential Neuro issue. EEG was found to be normal. Doppler Carotid was conducted yesterday. It had following statements and along with his other medicines, he has been advised to take Levipil 500 twice a day: 1. Evidence of calcified atheromatous plaque in left distal common carotid artery. Bulb diameter reduction of around 45%. Atheromatous plaque with similar characteristics on the right 2. Normal Flow Velocity and Flow Patterns. No Flow reversal or Disturbance 3. No significant hemodynamic stenosis on both the sides (left and right). Await your advise. Doctor: Hello and thank you for using HCM.I carefully read your question and I will try to explain you something and give you my opinion.When we deal with a syncope we have to evaluate cardiac and neurological problems.According to cardiac issues. There are different cardiac reasons that might cause a syncope. The most important one are rhythm issues like atrio-ventricular block, severe bradicardia, long heart pauses, arrhythmia.All sow it is quite known in cardiology that sometimes several people do heart blocks after cardiac surgeries.To exclude cardiac factors it is mandatory to do some examinations.It is very important to verify in what situations does the syncope happen each time, in what situations.So, if I was your treating doctor i will recommend cardiac echo-cardiography and the most important a holter rhythm monitoring for minimally 48 h. This rises the possibility to catch any problem. You must know that the rhythm monitoring is random, it might happen that you do it but it doesn't happens anything with your rhythm during that day and so we don't catch anything, So it is mandatory to take it as long as possible and repeat it.According to the Carotid result, it doesn't explain the syncope.So my opinion is to continue and do holter rhythm monitoring and if no result, maybe a head CT scan.Hope I was helpful. Wish your father good health.Best regards.