[indaemed] Re: Re NMS
- From: USM Bish <bish@xxxxxxxxxxx>
- To: indaemed@xxxxxxxxxxxxx
- Date: Mon, 15 Mar 2004 20:27:12 +0530
On Mon, Mar 15, 2004 at 06:40:51PM +0500, anujc@xxxxxxxx wrote:
>
> I agree 110% that the diagnosis of VVS MUST NOT be done based
> on LOC in a altitude chamber. Let me clarify that this was not
> the case. If I remember correctly, the diagnosis of VVS was
> made independent of the LOC episode. I may be corrected on this
> since I was not privy to the initial work up of this cadet.
>
This puts a new dimension on the case. As of now, all that I
was going by was the inputs of the OP. Could somebody aware of
the full case enlighten us on issues not brought out earlier ?
> My aim of posting the VVS and HUT part was since somebody
> mentioned that HUT was not done for this subject during the
> last review and suggested that it should have been done. Since
> I was the one who turned down the HUT request in this case, I
> thought I must share my POV. I may also add that in a large
> percentage of cases labelled as VVS, none of the ANS studies
> show any abnormality. If one goes thrrough available literature
> on the subject, the etiopathology of VVS may vary from ANS
> dysfunction to cerebral blood flow autoregulation problems to
> peculiar neural activity in the brain. There are even reports
> to suggest that VVS may be a manifestation of abnormal
> electrical act ivity in the brain, on the lines of temporal
> lobe epilepsy!
You are dead right here. I think the suggestion for ANS study
was more or less an attempt at completing the full battery of
tests. A positive result would definitely give a clue, whereas
a negative perhaps, does not mean anything at all. Repeat HUTs
scarcely give altered responses ...
> It would be worth remembering that if this cadet did have a VVS
> as an independent occurence, he could be prone for other reflex
> neural phenomenon as well. (this is documented in literature. I
> think even Gillies mentions this somewhere.) In such a setting
> his LOC under hypoxia is not surprising at all!
This is the first time that I am reading on this thread that
the cadet had a VVS as an independent episode ... I got the
impression that it was hypoxia induced only.
> The second factor that should be kept in mind is his high
> degree of aerobic conditioning. He had a resting HR of about 50
> beats per min. I have seen syncope cases in NDA cadets while at
> AFMC where simply going easy on aerobic conditioning cuts down
> the recurrence of syncope. The point however in this case is
> that the cadet had a solitary episode of syncope and not
> recurrent ones. Whether this was in any way subsequently
> related to his LOC in the chamber can be argued.
High aerobic conditioning need not mean a predisposition to
VVS. Bjorn Borg had a basal HR of about 40, and Mike Tyson
about 44 without VVS episodes. Kip Keino too had a similar
basal HR. Whereas on the other hand, we lost a Medical Officer
with probable VVS in a swimming pool 2 years ago ! He had a
basal HR of about 48. Prediction of possibility of a VVS in a
case of low basal HR is perhaps a rather grey area ...
Bish
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