[indaemed] Syncope yet again
- From: Sanjiv Sharma <sanjivshrma@xxxxxxxx>
- To: indaemed@xxxxxxxxxxxxx
- Date: Wed, 10 Mar 2004 22:16:03 +0530
Dear List
not a long while ago we discussed a case of syncope. Now the part II.
this Cadet underwent a hypoxia indoctrination run prior to beginning his
basic flying this term. Had a brief episode of Loss of Consciousness (LOC)
at 30,000 Ft without oxygen, regained instant consciousness with 100%
oxygen. A repeat run, similar profile next day, he remained event free. he
had an earlier run as well last year, remained event free. He had flown 09
dual sorties without any symptoms this term after the hypoxia indoctrination
run. Earlier term had done 14 sorties.
Had gone for his review, had another hypoxia evaluation run at 30,000 ft and
had LOC, regained with 100% oxygen.
Now he is permanently A4G1 for Vasovagal Syncope (VVS).
Without doubting the disposal, I still have certain lingering doubts:
(1) Is the endurance training at Academies, with emphasis on cross country
run and similar efforts leading to bradycardia responsible for his episodes
of VVS?
(2) at 30,000 ft he is already 10,000 ft above the Critical stage of
hypoxia, where LOC is an end point. Does a stress induced LOC qualify for
final determination of permanent A4? Consider, any one of us exposed to 30 K
may have similar event except the time frame may vary.
(3) If VVS is due to neural mediation leading to peripheral vasodilatation
and bradycardia and final LOC, do we not need to repeat the complete cardiac
evaluation to find any incipient cause of bradycardia or ??asystole leading
to LOC under various stresses, not just hypoxia alone. Esp. with tilt table
test being the closest gold standard, should it not be repeated with on-line
BP and Pulse monitoring, with EEG thrown in, if possible?
(4) Why not an EP study as well?
(5) Where does a pilot get exposed to 30,000 ft equivalent of Hypoxia in
actual situation. Fighters - only in cruise and with defective Oxygen system
on board. Tpt - Dornier ceiling is 11-12,000 Ft (Compensatory stage); other
ac are all pressurised. Helicopters - only glacier operations may border
between 15,000 to 22,000 Ft, ranging between stage of disturbance and
critical. So does hypoxia induced LOC alone be the deciding factor in such a
case?
For the information of the List: (a) all his previous cardio-neuro
evaluations were normal.
(b) Most importantly, the Cadet has gracefully accepted the outcome, and is
applying for change of branch.
May I request the List to comment on the pertinent issues for the sake of
academic interest in this case.
with warm wishes
Sanjiv
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