[20F] With long-standing episodes of lightheadedness and dizziness

Patient Description

A 20-year-old female has been experiencing episodes of lightheadedness, dizziness, and an increased heart rate for the past four years. These episodes sometimes lead to near fainting and are described as feeling both spinning and floating, with a severity rated as 10 out of 10. The symptoms can last from a few minutes to an entire day and occur without specific triggers. Sitting or lying down helps alleviate the symptoms. The patient notes that her heart starts pounding during these episodes, and she feels hot. She has not measured her heart rate but feels it increases when moving from lying down to standing up. There is no associated chest pain, shortness of breath, or swelling in the legs or feet. The patient barely consumes caffeine and does not use alcohol or recreational drugs. There is no family history of similar symptoms or conditions. She has been diagnosed with polycystic ovarian syndrome (PCOS) and is currently taking Montelukast, Cetirizine, Estarylla (birth control), and Acetaminophen. No known drug allergies.

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Arora's Assessment

What might be happening

Based on the symptoms and history you've provided, here are some possible explanations:

Postural Orthostatic Tachycardia Syndrome (POTS)

  • Rationale: POTS is a condition that affects circulation (blood flow). It involves the nervous system and is characterized by an excessive increase in heart rate when moving from lying down to standing up. Symptoms often include lightheadedness, dizziness, near-fainting, and a rapid heart rate.
  • Typical Treatments/Testing: Diagnosis often involves a tilt table test to measure heart rate and blood pressure changes. Treatment may include lifestyle changes, increased fluid and salt intake, medications to regulate blood pressure and heart rate, and physical therapy.

Anxiety or Panic Disorders

  • Rationale: Anxiety and panic disorders can cause symptoms like a rapid heart rate, dizziness, and feeling hot. These symptoms can sometimes mimic other medical conditions.
  • Typical Treatments/Testing: Diagnosis is usually based on a clinical evaluation. Treatment may include therapy (such as cognitive-behavioral therapy), medications (like SSRIs or benzodiazepines), and lifestyle changes.

PCOS-Related Hormonal Imbalances

  • Rationale: Polycystic Ovarian Syndrome (PCOS) can cause hormonal imbalances that might contribute to symptoms like dizziness and feeling hot. However, it is less likely to be the primary cause of your heart rate changes and near-fainting episodes.
  • Typical Treatments/Testing: Management of PCOS often involves hormonal treatments like birth control pills, lifestyle changes, and medications to manage symptoms.

What you can do

Lightheadedness, Dizziness, and Near-Fainting

  • Immediate Steps:
    • Sit or lie down immediately when you feel lightheaded or dizzy to prevent fainting.
    • Stay hydrated by drinking plenty of water throughout the day.
    • Increase your salt intake if advised by your healthcare provider.
    • Avoid sudden changes in posture, such as standing up quickly.
  • Long-Term Steps:
    • Keep a journal of your symptoms using MDandMe to track patterns and triggers.
    • Wear compression stockings to help improve blood flow.
    • Consult your healthcare provider for a thorough evaluation and possible tilt table test.

Increased Heart Rate

  • Immediate Steps:
    • Practice deep breathing exercises to help calm your heart rate.
    • Avoid caffeine and other stimulants that can increase heart rate.
  • Long-Term Steps:
    • Monitor your heart rate and note any patterns or triggers.
    • Discuss with your healthcare provider about possible medications to manage your heart rate.

Feeling Hot

  • Immediate Steps:
    • Stay in a cool environment and use fans or air conditioning.
    • Wear light, breathable clothing.
  • Long-Term Steps:
    • Keep track of when you feel hot and any associated activities or foods.
    • Discuss with your healthcare provider to rule out any underlying conditions.

What you should look out for

Given the severity of your symptoms, it's important to seek medical care. Reasons to seek care more urgently include:

  • Episodes of fainting or loss of consciousness.
  • Severe or persistent chest pain.
  • Shortness of breath or difficulty breathing.
  • Swelling in your legs or feet.
  • Any new or worsening symptoms.

Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and appropriate treatment. If you have more questions or need further assistance, feel free to continue the conversation.

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5 mo ago


People Also Ask


What is Postural Orthostatic Tachycardia Syndrome (POTS) and how is it diagnosed?

POTS is a condition that affects circulation and involves the nervous system, characterized by an excessive increase in heart rate when moving from lying down to standing up. It is diagnosed through tests like the tilt table test, which measures heart rate and blood pressure changes upon standing.


Can anxiety or panic disorders cause symptoms like dizziness and increased heart rate?

Yes, anxiety and panic disorders can cause symptoms such as a rapid heart rate, dizziness, and feeling hot. These symptoms can sometimes mimic other medical conditions and are typically diagnosed through a clinical evaluation.


How can hormonal imbalances related to PCOS affect symptoms like dizziness and feeling hot?

Hormonal imbalances related to PCOS can contribute to symptoms like dizziness and feeling hot, although they are less likely to be the primary cause of heart rate changes and near-fainting episodes. Management often involves hormonal treatments and lifestyle changes.


What lifestyle changes can help manage symptoms of lightheadedness and increased heart rate?

To manage symptoms of lightheadedness and increased heart rate, it is recommended to stay hydrated, increase salt intake if advised, avoid sudden posture changes, practice deep breathing exercises, and avoid stimulants like caffeine. Wearing compression stockings and keeping a symptom journal can also be helpful.

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