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I had my first VV episode in 1993 after a heart attack. Luckily, I was already in the hospital. I was subsequently hospitalized more than 30 times in 5 years for these attacks. Nobody could figure it out.
I have noted that the episodes are usually in the morning. Usually when I am very hungry. Usually when I am very tired. Usually when I am under some degree of stress. The most severe is during insertion of an IV or prep for surgery.
I think its gastro-intestinal. When I feel the symptoms coming on I pop a Pepcid Complete and it seems to handle the situation just fine. If I still feel a little shakey after the Pepcid I will take 1/2 to a full Immodium AD (chewable). The VV will cause diarrhea which will contribute to dehydration.
I think VV is at least in part caused by reflux and digestive malfuctions which upset the body's dynamic equalibrium.
Be proactive with the Pepcid and Immodium and it may help.