I have fallen twice within the last 8 weeks. Saw my General Practioner...he thought it might be ataxia...sent me to neurologist...all the test results were great he said. Neurologist sent me to cardiologist...had blood work, Holter monitor for 24 hours, ekg, echocardiogram, and tilt table test. Blood work normal, echo revealed pericardial effusion and tilt table test (I thought I was dying).....gave me nitroglycerin under my tongue...I was hot, sweating, pressure in my chest...was brought to point of unconsciousness...but did not completely pass out....wet my pants and the nurse said she did not have a bp on me for 5 minutes...call from cardiologist today....said test was normal but wants to change my TOPROL XL to Pindolol and follow up in one week.... please explain all of this to me.....if nothing is wrong (although I think something is not right) why change my meds...I don t adjust well to med changes......
Hello. Ataxia is a condition where there is imbalance during walking - conditions causing it are those affecting the cerebellum part of the brain or the inner part of ear. Your general practitioner thought your falls were due to ataxia and hence referred you to a neurologist. Since, your neurological tests were normal and there were no abnormalities in the brain like a blood clot or tumor in the cerebellum part, the next cause to be ruled out was syncope due to any heart issue. Hence, your neurologist referred you to a cardiologist. Syncope is temporary loss of consciousness which may be caused by temporary decrease in the blood supply to the brain. This might be the cause of your falls. Heart issues like inadequate pumping or irregular heart beat may cause syncope. The pericardial effusion on echocardiogram suggests that you have some fluid in the space between your heart and its covering i.e. pericardium. This fluid if sufficiently large in quantity may compress the heart and prevent enough blood from filling inside it. It may also be the cause of your syncope. However, if it was minimal fluid, it causes no symptoms. The tilt table test is done to basically reproduce the symptoms of syncope while continuously monitoring your heart beat and blood pressure and other vital signs. It was positive in your case as it caused syncope i.e. decreased the blood supply to your brain for a short time - which caused the dizziness and near loss of consciousness. The tightness in the chest is also a symptom of decrease in the blood supply to your heart. Your cardiologist must have deduced that something similar might have happened which caused your falls i.e. your blood pressure must have been below that which is needed for blood to reach your brain especially when you stand up (this is called orthostatic hypotension). Hence, he changed your BP or heart medication from tool XL (metoprolol) to indoor to reduce the variation in BP. The new medication might cause lesser reduction in BP so that the brain will get enough blood supply. This new medication should not cause any adverse effects, so you need not worry. Hope I have cleared your doubts. Wishing you good health. Chat Doctor. 