[31F] Experiencing chronic fatigue and fluctuating heart rate

Patient Description

A 31-year-old female presents with chronic fatigue lasting over a year, significantly disrupting daily activities. The fatigue is excessive, lasting hours to all day, and occurs without specific triggers. Accompanying symptoms include nausea, dizziness, headaches (frontal and temporal, with a pulsating sensation), low-grade fever, clammy skin, and fluctuating heart rate (ranging from above 120 to the 40s). The patient reports regular dull, pressure-like chest pain, especially during fatigue episodes. Blood tests have shown low ALT and AST levels since January, with a GFR of 88. Blood pressure fluctuates, with diastolic readings in the low 60s and 50s. The patient experiences sweating easily, even in cold weather, and swelling in the legs, hands, and around the eyes, particularly in the morning. Family history includes cardiovascular and autonomic disorders, such as heart attack, AFIB, fibromyalgia, and multiple sclerosis. Diagnosed with high blood pressure in 2021, degenerative disc disease in 2023, ADHD in 2015, and depression/anxiety in 2005. Current medications include Metoprolol (37.5mg twice daily), Vyvanse ER (60mg once daily), Topiramate (100mg once daily), Hydroxyzine as needed, Duloxetine (80mg once daily), Clonidine (0.4mg once daily), and Buspirone (10mg twice daily), with Tylenol as needed. Allergies to Hydrocodone and Norco.

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Arora's Assessment

What might be happening

Based on the symptoms and history you've shared, there are a few potential explanations for what you might be experiencing:

  1. Postural Orthostatic Tachycardia Syndrome (POTS) or Dysautonomia: Your symptoms of dizziness, fluctuating heart rate, fatigue, and nausea, especially when changing positions, could suggest a condition like POTS, which is a form of dysautonomia. This condition affects the autonomic nervous system and can cause the heart rate to increase significantly upon standing. Testing often involves a tilt table test or active stand test.

  2. Chronic Fatigue Syndrome (CFS): Given your long-standing fatigue that disrupts daily life, CFS could be a consideration. This condition is characterized by severe, persistent fatigue that doesn't improve with rest and is often accompanied by other symptoms like headaches and muscle pain. Diagnosis is typically based on symptom criteria, as there is no specific test for CFS.

  3. Liver Function Abnormalities: Your low ALT and AST levels, while not typical indicators of liver disease, could still suggest some liver function irregularities. It's important to follow up with your healthcare provider to understand these results in the context of your overall health.

  4. Cardiovascular Issues: The combination of chest pain, fluctuating heart rate, and blood pressure changes could indicate a cardiovascular issue. While your echocardiogram was normal, it's important to continue monitoring these symptoms with your healthcare provider.

What you can do

Managing Symptoms:

  • Fatigue and Dizziness: Try to pace your activities and take breaks as needed. Staying hydrated and increasing salt intake (if advised by your doctor) can help manage dizziness.
  • Nausea: Eating small, frequent meals and avoiding triggers like strong odors or spicy foods may help. Ginger or peppermint tea can also be soothing.
  • Headaches: Ensure you're staying hydrated and consider relaxation techniques like deep breathing or meditation to help manage stress-related headaches.

Lifestyle Adjustments:

  • Heart Rate and Blood Pressure: Monitor your heart rate and blood pressure regularly. Keep a journal of your symptoms, noting any patterns or triggers, and share this with your healthcare provider.
  • Exercise: Engage in gentle, regular exercise like walking or swimming, which can help improve circulation and overall well-being. However, avoid overexertion.

Medical Follow-Up:

  • Consult Specialists: Consider seeing a cardiologist or a neurologist for further evaluation of your symptoms. They may recommend additional tests or treatments.
  • Medication Review: Discuss your current medications with your healthcare provider to ensure they are appropriate and not contributing to your symptoms.

Use MDandMe: Utilize the MDandMe app to journal your symptoms, track your progress, and share detailed notes with your healthcare provider. This can help in identifying patterns and making informed decisions about your care.

What you should look out for

It's important to seek medical attention if you experience any of the following:

  • Severe chest pain or pressure that doesn't go away
  • Fainting or severe dizziness
  • Significant swelling in your legs or other parts of your body
  • Any new or worsening symptoms

Remember, while I can provide information and suggestions, it's crucial to work closely with your healthcare provider to receive a formal diagnosis and appropriate treatment.

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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 the autonomic nervous system, causing an abnormal increase in heart rate when standing up. It is diagnosed through tests like the tilt table test or active stand test, which measure heart rate and blood pressure changes upon standing.


What are the common symptoms and diagnostic criteria for Chronic Fatigue Syndrome (CFS)?

Chronic Fatigue Syndrome (CFS) is characterized by severe, persistent fatigue that doesn't improve with rest and is often accompanied by symptoms like headaches, muscle pain, and cognitive difficulties. Diagnosis is based on symptom criteria, as there is no specific test for CFS.


How can low ALT and AST levels affect my health, and should I be concerned?

Low ALT and AST levels are not typical indicators of liver disease, but they could suggest some liver function irregularities. It's important to discuss these results with your healthcare provider to understand their significance in the context of your overall health.


What lifestyle changes can help manage fluctuating heart rate and blood pressure?

To manage fluctuating heart rate and blood pressure, monitor these regularly and keep a journal of symptoms. Engage in gentle exercise like walking or swimming, stay hydrated, and consider increasing salt intake if advised by your doctor. Avoid overexertion and consult with your healthcare provider for personalized advice.

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