A Case of Vaso-vagal Syncope with Systemic Hypertension and Diabetes Mellitus Type 2

Case details :

A male patient in his 30’s comes with the chief complaint of recurrent fainting attacks. He brings with him all the reports done during his hospitalization one month back for the same reason, recurrent fainting attacks.

The blood reports shows high cholesterol (borderline ), high blood sugar with fasting level starting around 170 and post lunch around 350. He was observed having high blood pressure around 150/100 and the test for vaso-vagal syncope has come out to be positive. The rest of the cardiac function tests were normal.

There were 5-6 fainting episodes in the last year. He would faint especially while doing any kind of heavy exercise like heavy weight lifting or stretching for more than 15 minutes. Once he fainted at home some time after having a bath. The fainting would be without any prior signs or symptoms except a feeling of blockage in the ears and sudden vertigo with tendency to fall. He had occasional gasping for breath from doing exercise before the attack. The fainting attacks were long lasting, about 20 – 30 minutes with absolute loss of consciousness. He sweats profusely during the attack with heat of external body parts. There is an internal feeling of coldness or chill with heat of external body parts after the attack. No memory on regaining consciousness. Profound weakness follows the attack ending in sleep.

Pain in right nape running down to shoulder, forearm and ring finger, since he started getting fainting attacks. The reason could be injury due to a fall during fainting. Feels lack of power in wrist joint and hand muscles. Drops things sometimes. Difficulty in raising the arm making certain movements difficult, causing immobility. Aggravation from sitting in cold environment for long, and from lying on painful side. Frozen shoulder or subluxation of right shoulder was diagnosed by orthopedic surgeon. X-ray right shoulder joint was normal. X-ray cervical spine showed osteophytes in C4 – C5 suggestive of early degenerative changes

General feeling of weakness. Gets tired easily. Does not feel fresh in morning even after sleeping for long hours.

Craving for sweets developed lately.

Aggravation when hungry or fasting. It causes irritation, anger, headache.

Headache if does not wear glasses.

Thermal state : More towards cold.

Appetite : Poor.

Constipation with feeling of insufficient evacuation. Gas, flatulence, bloating of abdomen. Passing of flatus

Dryness in mouth with no thirst for water.

Mental state : Generally calm person, gets irritated when things not in their right place. Becomes angry at wife and shouts and scolds.

Sensitive to loud noise, loud music. Gets irritated when wife does not listen to him.

He is under lot of stress related to his work and profession since last couple of years. Fear of losing the job is constantly there in back of his mind. He asked his wife to do some job so that they will have money in case he loses his job. He gets stressed from rude behaviour of clients but cannot answer back to them and has to listen to whatever they say, or whatever the boss says.

He thinks his current health problems could be related to his job stress, and professional and financial insecurity. The anxiety and worry about family is always there when he thinks or imagines losing his job.

Prescription :

Lauroceraus 30C was given to this patient with following understanding of the case.

Case study :

Normally, a patient with vaso – vagal syncope recovers quickly without any treatment. If the faint lasts for a long time, then there is a possibility the patient has had a seizure and not a true syncope. However, in this case it was never a neurogenic faint. The test for vaso – vagal syncope had come out positive, so it was truly a case of vaso – vagal syncope. Long lasting faints was the unusual characteristic key feature of this case.

• Mind – Unconsciousness : vertigo, during :
• Generals – Faintness ( fainting ) : vertigo, with :

A few drugs like Arsenic, Kali-brom, Laurocerasus came up.

Arsenic was first thought of, considering the anxiety about the future, family, financial matters, weakness, fastidiousness. But, when detailed reference from Materia – Medica was taken, Laurocerasus was found to be more specific to this particular case. As long lasting faint was the most unusual, characteristic feature of this case, Laurocerasus was found to have exactly the same symptom (Dictionary of Practical Materia-Medica ‘ by Sir John Henry Clarke.) Also, it was found to be cover the whole case, from patho-physiological perspective,it being a very good heart remedy. On further study of mind symptoms of Laurocerasus, effects of fear, fright, anxiety also were found, as well as lack of vitality, weakness and tiredness in general.

Laurocerasus had all the key features of this case. It was the drug of choice on the sole ground of long lasting faints and other below mentioned characteristics.

• Ailments from fright
• Fear and anxiety about imaginary evils
• Weakness, tiredness, prostration. Sleep un – refreshing
• Gasping for breath, coldness from least exercise
• Internal coldness with external heat
• Long lasting faints

Follow up :

Laurocerasus showed magical improvement in vaso – vagal syncope attacks, and also his blood pressure became normal, blood sugar became normal and he could quit anti-diabetic drugs completely. General weakness also went away. His sleep became refreshing and his energy level improved. His appetite improved and he was relieved of the flatulence and constipation.

It has been over 3 months, and with infrequent repetition of Laurocerasus 30C there are no more fainting episodes. He can do exercise now. Blood sugar is under control. Anti-diabetic drugs have been stopped completely with the permission of Diabetologist. Blood pressure is absolutely under control. No constipation. No gas trouble. General weakness has gone and appetite is improved.

Somehow Laurocerasus did not prove to be so effective for the pain in nape and right upper limb. Dulcamara 30C a few doses gave much relief and increased the movement about 60%. Accupuncture therapy and Physiotherapy were also combined with Homeopathy and that proved to be beneficial also. His movements are 90% free and painless.

Materia medica of Laurocerasus : ( From ‘ Dictionary of Practical Materia Medica – J.H. Clarke )

Prunus laurocerasus is a plant from Rosaceae family commonly called ‘Cherry laurel ‘ or ‘ Common Laurel ‘. Young leaves are used to prepare the tincture. It is a very good remedy for all kinds of cardiac arrhythmias, angina, rheumatic heart disease, vaso-vagal syncope, threatened apoplexy. The characteristic features of the remedy are as follows.

• Ailments from fright
• Fear and anxiety about imaginary evils
• Lack of reactive power. Weakness, tiredness, prostration.
• Gasping for breath, coldness, blueness from least exercise like running a short distance, walking, going upstairs. There is gasping for breath; the patient puts his hand to the heart as if there was some trouble there.
• Internal coldness with external heat
• Long lasting faints is the key feature of this remedy