Patient Medical Synopsis — Cleveland Clinic Consultation

Primary Focus of This Visit

Recurrent Syncope & Suspected Dysautonomia

Alongside the GI pain, the recurrent passing-out episodes are the other primary reason for this consultation — and the question we most need answered.

The one certainty here is the event itself: Audrey loses consciousness — actually passes out — recurrently, with frequent ER visits, severe enough that she had to withdraw from college away from home. Her doctors strongly consider POTS the likely diagnosis and have raised the broader category of dysautonomia (autonomic dysfunction) as the explanation — in part on the view that her one tilt-table test may have been a false negative. Neither has been confirmed by testing yet. We are not here to chase a label; we are here to identify the real mechanism of the syncope and control it so she can safely drive and return to school.

What We're Asking Cleveland Clinic to Settle

Two autonomic studies are summarized below. They make a dangerous heart-rhythm cause unlikely, and a 2023 tilt-table study was non-diagnostic for POTS (confounded by a pre-test panic attack and read as hyperventilation — possibly a false negative). The mechanism of her syncope remains open — formal, repeat autonomic testing in a controlled setting is the goal of this visit.

Current Status

Autonomic & Neurological Picture

Recurrent Syncope (passing out)Active — under investigation

The disabling problem and a primary reason for this visit — recurrent loss of consciousness with frequent ER visits, severe enough to force withdrawal from college away from home. A dangerous heart-rhythm cause is unlikely (Holter captured only sinus rhythm), but the mechanism of the syncope is not yet identified

Dysautonomia (autonomic dysfunction)Suspected

Suspected, not confirmed — raised by physicians as the likely explanation for the syncope, partly on the possibility that the 2023 tilt-table was a false negative. Plausible because hEDS commonly drives autonomic dysregulation, but not established by testing. Confirming or excluding it is a goal of this visit

POTSStrongly considered

Strongly considered — her doctors think she likely has POTS, but no definitive positive test has confirmed it yet. The 2023 tilt-table was non-diagnostic (read as hyperventilation, possibly a false negative); the 2026 Holter showed sinus tachycardia, not arrhythmia. Formal autonomic testing is requested to confirm it

FND — Functional Neurological Disorder✓ Diagnosed

Diagnosed at Mayo Clinic — emerging literature directly links hEDS to FND presentations

PTSDSuggested

Suggested at Mayo Clinic alongside FND — not confirmed as standalone; years of chronic pain, failed surgeries, and medical trauma are themselves traumatogenic and a plausible upstream driver of autonomic dysregulation

Condition	Status & EDS Connection
Recurrent Syncope (passing out)Active — under investigation	The disabling problem and a primary reason for this visit — recurrent loss of consciousness with frequent ER visits, severe enough to force withdrawal from college away from home. A dangerous heart-rhythm cause is unlikely (Holter captured only sinus rhythm), but the mechanism of the syncope is not yet identified
Dysautonomia (autonomic dysfunction)Suspected	Suspected, not confirmed — raised by physicians as the likely explanation for the syncope, partly on the possibility that the 2023 tilt-table was a false negative. Plausible because hEDS commonly drives autonomic dysregulation, but not established by testing. Confirming or excluding it is a goal of this visit
POTSStrongly considered	Strongly considered — her doctors think she likely has POTS, but no definitive positive test has confirmed it yet. The 2023 tilt-table was non-diagnostic (read as hyperventilation, possibly a false negative); the 2026 Holter showed sinus tachycardia, not arrhythmia. Formal autonomic testing is requested to confirm it
FND — Functional Neurological Disorder✓ Diagnosed	Diagnosed at Mayo Clinic — emerging literature directly links hEDS to FND presentations
PTSDSuggested	Suggested at Mayo Clinic alongside FND — not confirmed as standalone; years of chronic pain, failed surgeries, and medical trauma are themselves traumatogenic and a plausible upstream driver of autonomic dysregulation

Completed Autonomic Workup

The Autonomic Workup — Stated Honestly

Audrey's syncope has been worked up with ambulatory heart-rhythm monitoring and a tilt-table study. We present both exactly as the readers wrote them, including where they did *not* support POTS — an honest record is more useful to a Cleveland Clinic autonomic specialist than a tidy one. Together they make a dangerous heart-rhythm cause unlikely but leave the mechanism of her syncope as the open question. Please build on this workup; do not repeat it without new clinical justification.

Ambulatory ECG — ePatch Holter (2/15–2/18/26)No arrhythmia captured

Normal sinus rhythm throughout; no pauses and no ventricular arrhythmia. When she felt her heart racing, the monitor captured sinus tachycardia up to 193 bpm; during chest pain she was in sinus tachycardia at 113 bpm with no ST-T changes. The reader concluded her "symptoms correlated with sinus tachycardia of varying rates."

Tilt-table test — Mayo Clinic (9/6/23)Non-diagnostic for POTS

She had a panic attack before the test, and her supine heart rate was already elevated at 101. Across 10 minutes of tilt, orthostatic hypotension was not detected — blood pressure stayed stable and diastolic actually rose. Heart rate spiked to 146 at 3 minutes (a transient ~45-bpm rise) then settled to 113 by 10 minutes. The reader noted symptoms occurred when heart rate was normal and called the picture "suggestive of hyperventilation."

Study	Finding	Verdict
Ambulatory ECG — ePatch Holter (2/15–2/18/26)	Normal sinus rhythm throughout; no pauses and no ventricular arrhythmia. When she felt her heart racing, the monitor captured sinus tachycardia up to 193 bpm; during chest pain she was in sinus tachycardia at 113 bpm with no ST-T changes. The reader concluded her "symptoms correlated with sinus tachycardia of varying rates."	No arrhythmia captured
Tilt-table test — Mayo Clinic (9/6/23)	She had a panic attack before the test, and her supine heart rate was already elevated at 101. Across 10 minutes of tilt, orthostatic hypotension was not detected — blood pressure stayed stable and diastolic actually rose. Heart rate spiked to 146 at 3 minutes (a transient ~45-bpm rise) then settled to 113 by 10 minutes. The reader noted symptoms occurred when heart rate was normal and called the picture "suggestive of hyperventilation."	Non-diagnostic for POTS

How to Read These Two Studies Together

The Holter makes a primary cardiac arrhythmia an unlikely cause — no pauses or dangerous rhythms were captured over three days, and when she was symptomatic her heart was in sinus rhythm (responding to an upstream drive), not an electrical disease. It does not, by itself, explain why she passes out. The single tilt did not confirm POTS and was confounded by a pre-test panic attack — though her doctors still strongly consider POTS the likely diagnosis. What remains is genuine, disabling, recurrent syncope whose mechanism — POTS, vasovagal syncope, hyperventilation/functional, broader dysautonomia, or a combination — has not yet been pinned down. That is exactly what we are asking Cleveland Clinic to resolve.

Why This Fits the Bigger Picture

An elevated resting heart rate, a diastolic rise on tilt, and symptoms that track with anxiety all point toward an autonomic nervous system running hot rather than a structural cardiac or purely orthostatic problem. This is the same kind of autonomic dysregulation implicated in her GI pain (the PTSD → autonomic → enteric chain) and is consistent with her confirmed hEDS, which is itself a common cause of autonomic dysfunction. The systems are connected — the syncope should be evaluated in that context, not in isolation.

Action Items

Dysautonomia / Syncope Requests for Cleveland Clinic

Specialist Consults to Request

Autonomic Neurology — dedicated autonomic disorders program: formal, repeat autonomic testing (tilt-table plus QSART / autonomic reflex screen) to characterize the syncope mechanism in the context of her hEDS, and to confirm or exclude dysautonomia / POTS

Key Questions

Given recurrent syncope severe enough to interrupt her education — with a dangerous arrhythmia made unlikely on Holter — what is the mechanism of the passing out (POTS, vasovagal syncope, hyperventilation/functional, or a combination)?
The 2023 tilt-table was confounded by a pre-test panic attack and read as hyperventilation. Can autonomic function be formally re-tested under controlled conditions before POTS is confirmed or excluded?
What is the acute plan to prevent syncope and restore safe daily function (driving, school) while the workup proceeds?