[36F] With sudden episodes of severe autonomic and neurological symptoms
Question
The drop in blood pressure does not seem to be a shock in the sense of mental anxieties...it's more the problem triggering these related symptoms or simultaneously with them. It starts as a overheated feeling that at a certain point I realize is excessive, I start to feel nausea and weak next with a pulsing or radiating throb of heat and my ears begin to sound fuzzy. The fuzz grows to static as it becomes difficult to swallow and breath as I need to, I often drool really bad and my voice won't get loud to ask for help...then the whole world around me slows down like slow motion, I'm told I speak very low and muted, sometimes making little sense. I feel a need to notion with my hands what I want before I can not see or hear well anymore, I know I'm not okay but just want to lay down and wait, even though logic would say get help call a doctor don't sleep. I don't think fast enough answering or reacting very delayed, I can not get up or yell for help, and have to put my head between my legs and ride it out trying not to faint, in which I have many times. The episodes come in clusters for several days or a few times in a couple weeks then go as if they never were... But I still get periods of irregular fatigue and the heated throbbing headache happens but much milder.
I should note the numbness or pressure in my face and head, as they are in the places I get what most call a headache, however I rarely experience headaches and when I do they are always related to my poor vision and corrective lenses. I do not experience pain in my forehead, my temples or top of head like most describe but I do get discomfort on those places sometimes related to sound sleep or stress, I do not however experience the sharp pain most describe or that I get behind my eyes when strained...so headaches are present during the episodes but not pain...of that's any sense I'm unsure
Also my blood pressure reads very extremely low, like in shock organ failure dying low...I've had two people say how am I not dead or um you should be dead with these numbers... One was 51/80 another 48/85 and. Third I remember was 47/110..... My normal is 125/95 give or take some dr office anxiety. My heart rate doubles though, and my chest feels like it's working super hard to push and my hands and feet feel full but my head feels extremely and weirdly dense or heavy, it feels like wet cotton wads fill the space under my forehead behind my face, more in my skull than sinus.
I never really can get to an ER in time before the episode ends so I can't have the symptoms in front of. Care team, I don't notice any specific triggers or reasons for the episodes and I don't get relief from sugar or aspirins.
Another noteworthy aspect would be I have had fainting spells for years on and off... Thought it was sugar or sleep or anxiety ..usually accompanied by nausea and totally random not related to standing or long sits in fact mostly while active or out and about, stressed or moving at work. These had similar warnings and were maybe 4 times a year with no specific cause I just thought thin blood maybe? Then 2 years ago these turned tj the episodes I'm describing and suddenly too
The symptoms either worsened or were new and very disabling, and scary because I have maybe a minute or two warning I'm going to be incapacitated soon. I'm healthy I'm tough and I don't get scared easily. I'm also very calm patient and not a panic kind of lady. I'm known by friends and family for being exceptionally pain tolerant, tough and calm in emergencies and painful situations. I don't experience the common headache I don't get ill often and I don't usually stop for pain,often I ignore it or "turn it off" as I call it, something I've always done subconsciously. I only understood this as abnormal as an adult.
Patient Description
A 36-year-old female presents with sudden and random episodes of severe symptoms occurring in clusters every month or so, lasting for about 3 days, with each episode lasting between 5 to 20 minutes. Symptoms include lightheadedness, elevated heart rate (doubles during episodes), chest tightness described as constricting with shortness of breath (severity 7/10), severe sweating (enough to make clothes wet), nausea, weakness (severity 9/10), numbness and tingling (especially in the forehead, chest, back, right elbow, and feet), tremors (particularly in the jaw, hands, and feet, described as shivering), moderate shortness of breath, blurred vision and vision blackouts, impaired cognition and confusion, buzzing or static sound in the ears (severity 10/10), pressure or throbbing feeling in the forehead, feeling extremely hot and clammy, low blood pressure during episodes (as low as 58/40), weak or sketchy voice, and headaches (particularly after episodes, with pressure in the eyes and nasal passage). The patient reports that these episodes are not triggered by specific activities or times of day and can happen both indoors and outdoors, regardless of temperature. Sitting down immediately helps to relieve the lightheadedness and prevent fainting. The patient also experiences a throbbing or radiating heat sensation all over the body, with heat pulsing or surging in waves, increasing as the episode worsens. The patient smokes about 10 all-natural cigarettes per day and has a history of major depressive disorder diagnosed 3 years ago. There are no known allergies and no regular medications, but the patient has had negative reactions to Ativan in the past.
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Arora's Assessment
What might be happening
Based on the symptoms you've described, there are a few potential diagnoses that could explain your condition. Here are some possibilities:
-
Pheochromocytoma:
- Rationale: This is a rare tumor of the adrenal glands that can cause sudden episodes of high heart rate, sweating, severe headaches, and dangerously low blood pressure. The symptoms you described, such as severe sweating, elevated heart rate, and low blood pressure, align with this condition.
- Typical Testing and Treatment: Diagnosis often involves blood and urine tests to measure catecholamine levels, imaging studies like CT or MRI scans, and sometimes genetic testing. Treatment usually involves surgical removal of the tumor.
-
Autonomic Dysfunction (Dysautonomia):
- Rationale: This condition affects the autonomic nervous system, which controls involuntary body functions like heart rate, blood pressure, and sweating. Symptoms like lightheadedness, low blood pressure, elevated heart rate, and sweating could be due to autonomic dysfunction.
- Typical Testing and Treatment: Diagnosis may involve tilt-table testing, blood pressure monitoring, and heart rate variability tests. Treatment focuses on managing symptoms and may include medications, lifestyle changes, and physical therapy.
-
Panic Disorder:
- Rationale: Panic disorder can cause sudden and severe episodes of anxiety, leading to symptoms like elevated heart rate, sweating, shortness of breath, and dizziness. The random and sudden nature of your episodes could be indicative of panic attacks.
- Typical Testing and Treatment: Diagnosis is usually based on clinical evaluation and ruling out other medical conditions. Treatment often includes cognitive-behavioral therapy (CBT), medications like SSRIs or benzodiazepines, and lifestyle modifications.
What you can do
For Low Blood Pressure and Lightheadedness:
- Immediate Action: Sit or lie down immediately when you feel an episode coming on to prevent fainting.
- Hydration: Drink plenty of fluids, especially water, to help maintain blood pressure.
- Compression Stockings: Consider wearing compression stockings to help improve blood circulation and prevent blood from pooling in your legs.
For Elevated Heart Rate and Sweating:
- Cool Environment: Stay in a cool environment and use fans or air conditioning to help manage overheating.
- Relaxation Techniques: Practice deep breathing exercises or meditation to help calm your heart rate.
- Avoid Triggers: Avoid caffeine, nicotine, and other stimulants that can increase heart rate.
For General Management:
- Symptom Journal: Use MDandMe to journal your symptoms, track progress, and get insights. This can help you and your healthcare provider identify patterns and potential triggers.
- Medical Consultation: Schedule an appointment with a healthcare provider, preferably a cardiologist or neurologist, to discuss your symptoms in detail and undergo appropriate testing.
- Emergency Plan: Have a plan in place for what to do during severe episodes, including informing family or friends about your condition and when to seek emergency care.
What you should look out for
Given the severity and complexity of your symptoms, it's important to seek medical care as soon as possible. Reasons to seek care even more urgently include:
- Severe Chest Pain: If you experience severe chest pain that does not go away, seek emergency medical attention immediately.
- Fainting: If you faint or feel like you are about to faint despite sitting or lying down, seek medical help.
- Severe Shortness of Breath: If you have difficulty breathing that does not improve with rest, seek emergency care.
- Severe Confusion or Disorientation: If you experience severe confusion or disorientation that does not resolve, seek medical attention.
Remember, while I can provide information and suggestions, I am not a doctor. It's crucial to consult with a healthcare professional to receive 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