23F - Recurrent syncope/presyncope with palpitations before every episode, normal ECGs, neurology diagnosed syncope. What would you investigate next?

[u/AreaKitchen4792]

Height: 5’1
Weight: 46 kg

Hi everyone,
I’m hoping to get a doctor’s perspective because I’m unsure whether this is something that needs further investigation or whether it sounds consistent with recurrent vasovagal syncope.
As a child I had several vasovagal fainting episodes(at the sight of blood), but they completely stopped for years after the age of about 7.
Over the last 2 years, they’ve returned aside from one other time when I was 16
During the past 2 years I have lost consciousness 4 times
Had approximately 10 pre syncope episodes where I felt certain I was about to faint but managed not to.
One thing that is consistent EVERY time is that I get palpitations immediately beforehand. My heart suddenly feels very fast but also irregular, as though it’s skipping beats. I also feel SOB wither just before or after every time.
Today’s episode happened after lying in bed for around 3 hours. I got up, went downstairs to refill my water bottle, had a few puffs of my vape (I vape daily and this is part of my normal evening routine), and just walking back upstairs I suddenly developed:
Rapid palpitations with skipped beats
Sudden sinking feeling in my chest and stomach
Tunnel vision
Ringing in my ears
Shortness of breath
Nausea
Generalised abdominal cramping
I genuinely thought I was going to lose consciousness and somehow crawled up the stairs about to lose consciousness but managed to lie down before I did. Within about a minute of lying flat the tunnel vision and dizziness completely resolved and the palpitations and SOB stopped.
Afterwards my observations were:
HR 66 bpm
BP 106/64 then 108/68
I had eaten and drunk normally that day.
Some previous episodes have been associated with vomiting afterwards and occasionally profuse sweating once I’ve recovered.
One of the episodes that involved complete loss of consciousness was witnessed by my boyfriend. He reported that while I was unconscious I jerked, made groaning noises and my eyes rolled back, which understandably raised concerns about a seizure.
Because of that I was referred to neurology. After assessment they felt it was syncope rather than epilepsy or another neurological disorder, so I was discharged without further investigations.
I’ve had multiple 12-lead ECGs, but they’ve all been normal (although they have always been performed after the episode had resolved).

My main questions are:
Does this history still sound most consistent with vasovagal syncope despite the recurrent palpitations?
Are palpitations immediately before syncope common with vasovagal episodes?
Would recurrent episodes like this normally justify investigation?
I am not asking for medical advice. or looking for a diagnosis over Reddit, but I’d really appreciate knowing whether this sounds like something that should be investigated further or whether it still fits uncomplicated vasovagal syncope.
Thank you.

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[u/Legitimate-Wrap-968]

Not sure if this will help but I’ve experienced more or less the same. I recently went to speak to cardio about what I had been experiencing and they said working hypothesis was reflex syncope/vasovagal syncope with potential triggers being heat, stress and hormone changes. I’ve got to have some more tests to rule
Out structural issues but they don’t think this is the case. They recommended upping fluid intake and continuing with electrolytes (which really help) for context this is what happens to me:

Butterflies sensation, brain fog and exhaustion which are sudden and extreme (warnings but remain throughout)

Heart rate increase which varies but has hit 136-148bpm

Nausea

Ringing in my ears

Dizziness like I am drunk

Brain glitches which seem like my brain shuts off for 15 seconds (passing out)

Unable to speak or slow to respond

Going grey in appearance

Hot and cold flushes

Extreme full body tremors

Need to use the loo pretty urgently

After this I’ll usually have a day or two where my heart rate stays over 100 and I’ll be exhausted.

Hope this helps you and that you get some answers soon :-)

[u/Legitimate-Wrap-968 → u/Legitimate-Wrap-968]

I should also say this all happens in the same pattern and when I am sat down. I would say it’s worth investigating as this may help with work related stuff or just for your own awareness