[39F] Experiencing lightheadedness and hypotension

Patient Description

A 39-year-old female reports feeling lightheaded and faint, particularly when lying down or standing up, with a severity of 4/10 to 8/10 respectively. These symptoms have been occurring on and off for a year but have become more frequent in the past week. The patient also experiences weakness in her arms and legs and has had a near syncope episode. She has a history of hypotension and Polycystic Ovary Syndrome (PCOS), diagnosed in her 20s. The patient's family history includes cardiac conditions like hypertension and stroke. She is currently taking Pristiq (100mg for 8 years) and Xanax (0.5mg as needed, last used today, with prior use a year ago). No allergies to medications have been reported. The patient denies the use of alcohol, tobacco, or recreational drugs.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are some possibilities:

  • Orthostatic Hypotension: This condition is characterized by a sudden drop in blood pressure when you stand up from a sitting or lying position, leading to lightheadedness or fainting. It can be caused by dehydration, certain medications, or underlying conditions.

    • Treatment usually involves lifestyle modifications such as standing up slowly, staying hydrated, and avoiding alcohol. In some cases, medication may be prescribed.
  • Anxiety Disorder: Anxiety can cause a variety of physical symptoms, including lightheadedness, rapid heart rate, and feelings of near-fainting. Your use of Xanax and Pristiq, both of which are used to treat anxiety, suggests that this could be a factor.

    • Treatment for anxiety disorders can involve medication, psychotherapy, or both.
  • Cardiovascular Condition: Given your family history of cardiac conditions, it's possible that your symptoms could be related to a heart condition. However, without chest pain or difficulty breathing, this is less likely.

    • Treatment would depend on the specific condition, but could involve medication, lifestyle changes, or in some cases, surgery.

What you can do

  1. Make an appointment with your healthcare provider to discuss your symptoms. They may want to run some tests to rule out serious conditions.
  2. Keep a symptom diary, noting when you experience lightheadedness and any potential triggers.
  3. Stay hydrated and try to stand up slowly to see if this helps with your lightheadedness.
  4. Continue taking your prescribed medications as directed by your healthcare provider.

What you should look out for

Seek immediate medical attention if you:

  • Lose consciousness
  • Experience severe lightheadedness that does not improve upon sitting or lying down
  • Develop chest pain, difficulty breathing, or other severe symptoms

Remember, while I strive to provide accurate information, I'm not a doctor and this advice should not replace a consultation with a healthcare professional.

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9 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 when standing up from a sitting or lying position, causing dizziness or fainting. Management includes lifestyle changes like standing up slowly, staying hydrated, and avoiding alcohol. In some cases, medication may be necessary.


Can anxiety cause physical symptoms like lightheadedness and weakness?

Yes, anxiety can cause a range of physical symptoms, including lightheadedness, rapid heart rate, and feelings of weakness or near-fainting. These symptoms can be managed with medication, psychotherapy, or a combination of both.


How does family history of cardiac conditions affect my health risks?

A family history of cardiac conditions can increase your risk of developing similar issues. It's important to monitor your heart health and discuss any concerns with your healthcare provider, who may recommend lifestyle changes or screenings.


What are the potential side effects of taking Pristiq and Xanax together?

Pristiq and Xanax can both cause side effects such as dizziness, drowsiness, and difficulty concentrating. When taken together, these effects might be more pronounced. It's important to follow your healthcare provider's instructions and report any concerning symptoms.


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