Othostatic Intolerance and Syncope

Neurally Mediated Hypotension and its Treatment


What is neurally mediated hypotension?

Neurally mediated hypotension is also known by the following names: the fainting reflex, neurocardiogenic syncope, vasodepressor syncope, the vaso-vagal reflex, and autonomic dysfunction. Hypotension is the formal medical term for low blood pressure, and syncope is the term for fainting. Neurally mediated hypotension occurs when there is an abnormal reflex interaction between the heart and the brain, both of which usually are structurally normal.

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Insurance Issues

At The Heartbeat Clinic, your health is of prime importance. We believe in the philosophy of taking care of patients irrespective of insurance issues. We have following policies in place

1. If you do not have insurance we will be glad to take care of you. The clinic has many plans in place to help uninsured and underinsured including free charity services.

2. If you have a pacemaker or defibrillator that was implanted at the heartbeat clinic, and you lose your insurance we will still continue to follow our devices.

3. Our clinic has the ability to do 80 % of investigations as outpatient and those facilities are available to anyone.

4. We do not control the hospital charges and those charges will be patient responsibility.

The NDRF Handbook

The National dysoutonomia research foundation (NDRF) has published a handbook for people with dysautonomias.  This book provides an invaluable source of information for many patients suffering from dysautonomias.  Please click the link below to access the book.  You can request video cassettes from our office.


Atrial Fibrillation

Atrial fibrillation is the most common arrhythmia. The chances of developing atrial fibrillation increase as a person ages; more than two million Americans have it. Less than one in every 100 people in their 50s has atrial fibrillation, but about 10 in every 100 people in their 80s have it.

Atrial fibrillation is a form of supraventricular tachycardia, in which the heart’s two upper chambers (atria) beat chaotically (fibrillate). They also do not beat in coordination with the two lower chambers of the heart (ventricles). The result is an irregular and often rapid heart rate.

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At the heartbeat clinic we specialize in implantable device procedures


A pacemaker is a small device that sends electrical impulses to the heart muscle to maintain a suitable heart rate.

Types of Pacemakers

The pacemaker has two parts: the leads and a pulse generator. There are different types of pacemakers. Some have one lead, pacing only the ventricles or the atria; others have two leads, pacing both chambers.

Single chamber pacemaker

1 lead in the upper or lower chamber of the heart.

Dual chamber pacemaker

1 lead in the upper chamber and one lead in the lower chamber of your heart

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Amiodarone Patients

Amiodarone is the most commonly prescribed anti rhythm medicaton. It is used frequently because it is one the most effective medication of its kind.  Recently FDA has issued an advisory on amiodarone.  At the end of this text is a complete copy of patient information handout on amiodarone.  It can also be viewed at Wyeth website.

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Electrophysiology Studies

Patients Guide to Electrophysiology Procedures

Cardiac electrophysiology is a medical specialty devoted to the diagnosis and treatment of abnormal heart rhythms. Electrophysiologists are fully trained cardiologists who have undertaken additional fellowship training in clinical cardiac electrophysiology. Cardiac electrophysiologists have expertise in the invasive diagnosis and treatment of cardiac arrhythmias. They perform invasive procedures including diagnostic electrophysiology testing, radiofrequency catheter ablation, and implantation of antiarrhythmic devices such as pacemakers and cardioverter-defibrillators.

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Tilt table test


Upright tilt table test is a simple, extremely safe, non-invasive test that helps to diagnose syncope of unknown origin, patients with a structurally normal heart and unexplained dizziness or lightheadedness with or without loss of consciousness, and patients with orthostatic hypotension without an underlying cause

After the physician does a thorough clinical evaluation including and not limited to history, physical examination, extensive cardiovascular and electrophysiological testing, and rules out cerebrovascular, cardiovascular, structural heart defects, the tilt table test is conducted in the autonomic lab. The physician will discuss in detail regarding the procedure, risks, benefits, alternatives of the test. The tilt table test can make you feel nervous, however if you discuss the procedure with your physician and technician, it will make it a more pleasant experience.
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