Tilt table: VVS and Asystolic Syncope

I am a woman in my mid-twenties who has experienced several rare medical events throughout my life.

I’ve been dealing with chronic Psoriatic toenail issues on both of my big toes for about 8 years.

My medical journey started in 2018 when I had surgery on my right big toe after suffering from Paronychia (cuticle infection) for a year. During the procedure, while being injected with a local anesthetic, I fainted while lying down. My entire life flashed before my eyes, and I lost consciousness and began convulsing. When I regained consciousness, I was very disoriented. My podiatrist was concerned but continued with the surgery, and everything ended up fine. Since then, I’ve been seeing my podiatrist every six weeks due to the risk of recurring infections and Paronychia flare-ups.

In early 2021, I sought help from a GP due to frequent fainting spells, which seemed to be linked to a flare-up of some kind. He had me wear a 24-hour Holter monitor, and the results raised some concerns. I was referred to a cardiologist, who immediately identified my issue as hypotension (low blood pressure). He advised me to drink more water, eat more salt, and prescribed some medications. However, he hadn’t yet tested my blood pressure at this point.

In early 2022, my left big toe became infected, mirroring the problem I had with my right toe. Doctors tried to treat the infection with antibiotics, and over the next 12 months, I took 11 courses, one of which caused a reaction (ciprofloxacin). Despite these treatments, the infection didn’t improve, and my podiatrist performed a nail evulsion. However, I had the same reaction as before when the local anesthetic was administered. I felt like I was dying, lost consciousness, had seizures, and woke up extremely confused. The surgery was only partially successful because they found a psoriatic nail-like mass near the joint of my toe.

A few days later, I went to my GP, and was sent straight to the ER with signs of sepsis. I was fast-tracked through emergency care, and an ER surgeon used “Happy Gas” to help me through a procedure where he removed more of my toenail, leaving the mass inside and referring me to the plastic surgery team.

The following week, I had surgery to remove the mass. At this point, I was calm because I was used to the procedure. As I was being prepared for general anesthesia, I warned the medical staff that I had passed out before, but they assured me that it wouldn’t happen because I would be lying down (despite always fainting while in that position). After they inserted an IV drip (despite me requesting not to have one due to my low body fat), my reflex response triggered again, and I had another fainting episode.

This information was passed along to my cardiologist, who ran several tests, including a 24-hour blood pressure monitor and an echo. Based on these results, he decided to send me for a tilt test.

Phase 1: During the test, I remained calm and felt fine at first, though I felt slightly nauseous after being tilted for a while. They then laid me back down.

Phase 2: They administered artificial adrenaline through an IV while I was lying down. Within seconds, I experienced a vasovagal syncope response, which led to asystolic syncope. The test wasn’t even completed, as they didn’t get a chance to tilt me.

As a result of these experiences, dentists now refuse to treat me, and I’m unsure about the safety of receiving local anesthesia or IVs during day surgeries.

My cardiologist is attributing this to stress, saying that I’m too young for a pacemaker. However, since the tilt test, I’ve had procedures done without pain relief and have not fainted. I’ve also had many different types of needles inserted without fainting.

Given these ongoing issues, should I seek a second opinion?