[24F] With dizziness, shortness of breath, and fast heartbeat

Patient Description

A 24-year-old female has been experiencing dizziness, shortness of breath, and a fast heartbeat for the past six months. The dizziness is the most bothersome symptom and is accompanied by moderate shortness of breath, which is triggered by activities such as standing up, bending over, or stretching. These symptoms typically last for 10-20 minutes and are alleviated by sitting down. The patient experiences a fast heartbeat a few times a week, lasting for 10-20 minutes each time. She has a history of rheumatoid arthritis, PTSD, severe anxiety, panic disorder, and severe depression, and is currently taking Cymbalta (80 mg daily), hydroxyzine (25 mg up to three times a day), birth control, and pantoprazole (40 mg daily) for the past five years. The patient uses tobacco and occasionally weed. She maintains a diet with adequate fluids and electrolytes. There is a family history of heart disease, autoimmune disease, diabetes, cancer, and psychiatric illnesses. The patient has medication allergies but did not specify which medications.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, here are some possible explanations:

  1. 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 dizziness, lightheadedness, rapid heartbeat, and sometimes shortness of breath.
    • Typical Treatments/Testing: Diagnosis often involves a tilt table test, blood tests, and heart rate monitoring. Treatment may include increasing fluid and salt intake, medications to regulate blood pressure and heart rate, and lifestyle changes.
  2. Anxiety and Panic Disorders:

    • Rationale: Given your history of severe anxiety and panic disorder, these conditions can sometimes manifest with physical symptoms such as rapid heartbeat, shortness of breath, and dizziness, especially during periods of stress or panic attacks.
    • Typical Treatments/Testing: Management typically involves therapy (such as cognitive-behavioral therapy), medications (like those you are already taking), and stress management techniques.

What you can do

Dizziness and Shortness of Breath:

  • Immediate Steps:
    • When you feel dizzy or short of breath, sit or lie down immediately to prevent fainting or falling.
    • Stay hydrated by drinking plenty of water throughout the day.
    • Avoid sudden changes in posture, such as standing up quickly or bending over rapidly.
  • Long-term Management:
    • Consider wearing compression stockings to help improve blood flow.
    • Increase your salt intake if recommended by your healthcare provider.
    • Engage in regular, gentle exercise like walking or swimming to improve circulation.
    • Keep a journal of your symptoms using MDandMe to track patterns and share with your healthcare provider.

Fast Heartbeat:

  • Immediate Steps:
    • Practice deep breathing exercises or meditation to help calm your heart rate.
    • Avoid stimulants like caffeine and nicotine, which can exacerbate rapid heartbeats.
  • Long-term Management:
    • Discuss with your doctor whether any adjustments to your current medications might help manage your symptoms.
    • Regularly monitor your heart rate and note any triggers or patterns in your MDandMe journal.

General Tips:

  • Ensure you are getting enough rest and managing stress effectively.
  • Maintain a balanced diet rich in fruits, vegetables, whole grains, and lean proteins.
  • Avoid alcohol and recreational drugs, as they can worsen your symptoms.

What you should look out for

Given the severity and duration of your symptoms, it is important to seek medical care to rule out any serious underlying conditions. You should seek immediate medical attention if you experience:

  • Severe chest pain or pressure
  • Fainting or near-fainting episodes
  • Severe shortness of breath that does not improve with rest
  • Any new or worsening symptoms

Remember, while I can provide information and suggestions, it is 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 our conversation.

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5 mo ago


People Also Ask


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

Postural Orthostatic Tachycardia Syndrome (POTS) is a condition that affects blood flow and involves the nervous system. It is characterized by an excessive increase in heart rate when moving from lying down to standing up, often causing dizziness, lightheadedness, and rapid heartbeat. Diagnosis typically involves a tilt table test, blood tests, and heart rate monitoring.


Can anxiety and panic disorders cause physical symptoms like dizziness and a fast heartbeat?

Yes, anxiety and panic disorders can manifest with physical symptoms such as dizziness, rapid heartbeat, and shortness of breath. These symptoms often occur during periods of stress or panic attacks and are a common part of these disorders.


What lifestyle changes can help manage symptoms of dizziness and shortness of breath?

To manage symptoms of dizziness and shortness of breath, it is recommended to stay hydrated, avoid sudden changes in posture, wear compression stockings, increase salt intake if advised by a doctor, and engage in regular, gentle exercise. Keeping a symptom journal can also help identify patterns and triggers.


How can I differentiate between symptoms caused by anxiety and those caused by a potential heart condition?

Differentiating between symptoms caused by anxiety and those from a heart condition can be challenging. Anxiety-related symptoms often occur during stress or panic attacks and may improve with relaxation techniques. Heart-related symptoms may persist or worsen with physical activity. Consulting a healthcare professional for a thorough evaluation is essential to determine the cause.

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