Barbell Medicine Doctors:
I was posed a question several days ago, by a resident during some downtime in the ER, which has me stumped.
The question was, “ . . . how do you approach weightlifting in someone who has strong history of vasovagal syncope?”
Apparently, from an early age, this person has suffered from post-exertional dizziness and syncope.
This limited his participation in sports as a child, keeps him from squatting more than about 80lbs, and has resulted in syncope while running stairs as a medical student. He has found that the safest exercise for him is rowing.
He notes that he does not experience any symptoms until about 2 minutes post-exertion, when he senses sudden dizziness, poor balance, over whelming nausea, and occasionally syncope. He notes that his cardiology attending, who witnessed one of these episodes, noted no murmurs or arrhythmias. He has not had an echo. His resting HR is usually in the 60’s and his SBP typically lives around 115- 120. He is 6’ tall and weighs about 150 lbs and has no history of hyperextensible joints, family H/O sudden cardiac death, and no physical signs of Marfan’s.
I have reviewed the starting strength forums and note that although syncope is not an unusual occurrence it isn’t typical with sub-maximal exertion and does not occur frequently. It seems that most syncopal events occur during or seconds after a near maximal lift or anytime the carotid bulb/sinus is accidently massaged.
I’ve thought about this a bit and I suspect that this individual is not experiencing vasovagal syncope but rather a type of cardiogenic syncope. I believe this is likely related to the usual decrease in HR and resultant decrease in BP that occurs a few minutes after exertion (as usually seen on exercise stress exams). Perhaps a formal echo is indicated here to rule out HOCM. I’m not sure how else to further evaluate this person.
If there is no true pathology at play here, how would one best address this situation if this person were so inclined to pursue a strength training program? I suspect that a typical linear progression, perhaps with small weight jumps and rest periods on the floor in the corner (for safety) would be reasonable. I wonder if progressive stress/adaptation would improve this issue or would this problem continue as a lifelong issue.
Any direction here would be appreciated. Perhaps I’ve simply missed the salient post somewhere.
Please understand that I’m by no means an expert and am simply pursuing my own linear progression at this point. My medical experience being through a FM residency and 5 years of dedicated ER work.
Thank you