[23M] With chronic dizziness and vision loss upon standing

Patient Description

A 23-year-old male reports experiencing heart palpitations, high blood pressure, loss of vision when standing, dizziness, and night sweats for approximately 10 years. The dizziness is severe, rated 8-9 out of 10, and occasionally leads to falls. Vision loss episodes occur a few times a week, lasting a few seconds or longer if he falls. These symptoms are primarily triggered by standing. Night sweats result in waking up soaked, particularly around the chest and back. Weight fluctuates between 185 to 200 pounds. Blood pressure is typically 140/90, and heart rate can increase to 150 bpm during episodes of vision loss and dizziness. Occasional chest pain is reported. Stress is considered a likely contributing factor. Family history includes heart disease, with the father having had two heart attacks and high blood pressure. The patient is currently taking Bupropion XL 300mg and Hydroxyzine 25mg for the past three months. No pre-existing conditions, allergies, or adverse reactions to medications are noted. The patient has undergone an EKG and echocardiogram, both showing no abnormalities, and is scheduled for another echocardiogram soon.

Arora's Assessment

What might be happening

Based on your symptoms and history, there are a few possible explanations for what you might be experiencing:

Orthostatic Hypotension: This condition occurs when your blood pressure drops significantly when you stand up, leading to dizziness and vision changes. It can be caused by dehydration, certain medications, or underlying health issues. Your symptoms of dizziness and vision loss upon standing align with this condition.
POTS (Postural Orthostatic Tachycardia Syndrome): This is a condition where your heart rate increases significantly when you stand up, which can cause dizziness, palpitations, and sometimes fainting. Your increased heart rate and dizziness when standing could suggest this condition.
Hypertension and Heart-Related Issues: Your high blood pressure and family history of heart disease could be contributing to your symptoms. While your EKG and echocardiogram were normal, it's important to continue monitoring your heart health.
Anxiety or Stress: Stress and anxiety can cause or exacerbate symptoms like palpitations, night sweats, and dizziness. Your mention of stress being a possible factor suggests this could be contributing to your symptoms.

Typical treatments or testing for these conditions might include lifestyle changes, medication adjustments, or further cardiovascular testing. It's important to follow up with your healthcare provider for a formal diagnosis and treatment plan.

What you can do

Vision Loss and Dizziness:

Since these symptoms are severe and impact your daily life, it's important to follow up with your healthcare provider. They may recommend tests to evaluate your cardiovascular and autonomic nervous systems.
Stay hydrated and consider increasing your salt intake if advised by your doctor, as this can help with blood pressure regulation.
When standing up, do so slowly to give your body time to adjust.

Heart Palpitations and High Blood Pressure:

Continue monitoring your blood pressure and heart rate. Keep a record of these readings to share with your healthcare provider.
Practice stress-reduction techniques such as deep breathing, meditation, or yoga, which can help manage palpitations and blood pressure.

Night Sweats:

Ensure your sleeping environment is cool and comfortable. Wearing breathable fabrics and using lighter bedding can help.
Keep a symptom journal using MDandMe to track when night sweats occur and any potential triggers.

What you should look out for

Given the severity and duration of your symptoms, it's important to seek medical care if you experience:

Fainting or severe dizziness that doesn't improve with sitting or lying down.
Chest pain that is persistent or severe.
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 treatment plan.

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2 mo ago

People Also Ask

What is orthostatic hypotension and how can it be managed?

Orthostatic hypotension is a condition where blood pressure drops significantly upon standing, causing dizziness and vision changes. Management includes staying hydrated, increasing salt intake if advised by a doctor, and standing up slowly to allow the body to adjust.

What are the symptoms and treatment options for POTS (Postural Orthostatic Tachycardia Syndrome)?

POTS is characterized by a significant increase in heart rate when standing, leading to dizziness, palpitations, and sometimes fainting. Treatment may involve lifestyle changes, such as increased fluid and salt intake, wearing compression garments, and medications to manage symptoms.

How can stress and anxiety contribute to heart palpitations and night sweats?

Stress and anxiety can trigger or worsen symptoms like heart palpitations and night sweats by activating the body's stress response, which increases heart rate and blood pressure. Managing stress through techniques like deep breathing, meditation, or yoga can help alleviate these symptoms.

What lifestyle changes can help manage high blood pressure and heart palpitations?

Lifestyle changes to manage high blood pressure and heart palpitations include maintaining a healthy diet, regular exercise, reducing salt intake, avoiding caffeine and alcohol, and practicing stress-reduction techniques. Monitoring blood pressure and heart rate regularly is also important.

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2 Comments

Anonymous#4896

2 mo ago

What's the likely diagnosis?

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Arora (Bot)#28060

2 mo ago

Hi there! It's understandable to want some clarity on a likely diagnosis based on the symptoms described. While I can't provide a definitive diagnosis, some possibilities have been suggested, such as Orthostatic Hypotension or POTS, which relate to blood pressure and heart rate changes when standing. It's also important to consider stress or anxiety as contributing factors. However, the best course of action is to work closely with a healthcare provider who can perform the necessary tests and evaluations to determine the exact cause and the most effective treatment plan. Please encourage the patient to keep in touch with their doctor and share any changes or new symptoms they experience. Take care!

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[23M] With chronic dizziness and vision loss upon standing

What might be happening

What you can do

What you should look out for

Experiencing symptoms?