[42F] With postprandial dizziness and other systemic symptoms

Patient Description

A 42-year-old female has been experiencing a moderate spinning sensation of dizziness that requires her to lay down, ongoing for the past 4 months. The dizziness is triggered by eating and lasts from 1 hour to an hour and a half. She has tried adjusting her diet without success. She has gained weight and feels constantly hungry. Other symptoms include extreme tiredness, a throbbing sensation in her face, and sometimes shakiness and sweating after eating. She also experiences heart palpitations, chest discomfort, and shortness of breath after meals. She does not have a history of diabetes or other metabolic disorders and does not consume alcohol, caffeine, or use recreational drugs. Current medications include Multivitamin, Calcium, Claritin (1-3 times a day), Busiporne (15mg twice a day), and oxygen as needed. She also uses a rescue inhaler as needed and takes Tylenol (500mg as needed). Family history includes heart attacks, strokes, brain aneurysms, blood clots, diabetes, alcoholism, and hypothyroidism. Her menstrual periods are regular. Past medical history includes Polycystic Ovarian Syndrome, Interstitial cystitis, Sleep Apnea, IBS, Anxiety/Panic, Trigeminal neuralgia, Asthma, CPTSD, and hypoxia, with diagnoses made from 2003 to 2023. She has allergies to Penicillin and Estrogen.

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Arora's Assessment

What might be happening

Based on the symptoms and history you've provided, here are some possible explanations for your condition:

Postprandial Hypotension

  • Explanation: This condition involves a drop in blood pressure after eating, which can cause dizziness, fatigue, and the need to lie down. It is more common in older adults and those with certain chronic conditions.
  • Typical Treatments/Testing: Blood pressure monitoring before and after meals, dietary adjustments, and sometimes medications to manage blood pressure.

Reactive Hypoglycemia

  • Explanation: This condition involves a drop in blood sugar levels after eating, leading to symptoms like dizziness, shakiness, sweating, and fatigue. It can occur in people without diabetes.
  • Typical Treatments/Testing: Blood glucose monitoring, dietary changes to include more frequent, smaller meals with balanced macronutrients, and possibly medications.

Vestibular Disorders

  • Explanation: Conditions affecting the inner ear, such as benign paroxysmal positional vertigo (BPPV) or Meniere's disease, can cause dizziness and a spinning sensation, especially when triggered by certain activities like eating.
  • Typical Treatments/Testing: Vestibular function tests, physical therapy, and medications to manage symptoms.

Cardiac Issues

  • Explanation: Given your family history of heart disease and your symptoms of heart palpitations, chest discomfort, and shortness of breath after eating, a cardiac issue such as arrhythmia or angina could be contributing to your symptoms.
  • Typical Treatments/Testing: Electrocardiogram (ECG), echocardiogram, stress tests, and possibly medications or lifestyle changes.

What you can do

Postprandial Hypotension

  • Dietary Adjustments: Eat smaller, more frequent meals. Avoid large meals that are high in carbohydrates.
  • Hydration: Drink plenty of water before and during meals.
  • Positioning: Sit or lie down for a while after eating to help manage symptoms.

Reactive Hypoglycemia

  • Balanced Diet: Include a mix of protein, healthy fats, and complex carbohydrates in your meals to help stabilize blood sugar levels.
  • Frequent Meals: Eat smaller, more frequent meals throughout the day to prevent blood sugar dips.
  • Monitor Symptoms: Keep a journal of your symptoms and what you eat using MDandMe to identify any patterns.

Vestibular Disorders

  • Physical Therapy: Vestibular rehabilitation exercises can help manage dizziness.
  • Avoid Triggers: Identify and avoid activities or positions that trigger your symptoms.
  • Medications: Over-the-counter medications like meclizine can help manage dizziness.

Cardiac Issues

  • Medical Consultation: See a cardiologist for a thorough evaluation and appropriate testing.
  • Lifestyle Changes: Adopt a heart-healthy diet, engage in regular physical activity, and avoid smoking and excessive alcohol consumption.
  • Monitor Symptoms: Use MDandMe to track your symptoms and share this information with your healthcare provider.

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, seek emergency medical attention immediately.
  • Fainting or Severe Dizziness: If you faint or experience severe dizziness that doesn't improve with rest, seek medical care.
  • Shortness of Breath: If your shortness of breath worsens or is accompanied by chest pain, seek emergency care.
  • Unexplained Weight Loss: If you notice significant, unexplained weight loss, consult your healthcare provider.

Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and appropriate treatment. Use MDandMe to journal your symptoms, track your progress, get insights, and share longitudinal medical notes with your provider.

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4 mo ago

Top picked over-the-counter products for Orthostatic Hypotension: American Heart Association Guidelines

People Also Ask


What is postprandial hypotension and how can it affect me?

Postprandial hypotension is a condition where blood pressure drops significantly after eating, leading to symptoms like dizziness, fatigue, and the need to lie down. It can be managed by eating smaller, more frequent meals, staying hydrated, and monitoring blood pressure.


What are the symptoms of reactive hypoglycemia and how is it managed?

Reactive hypoglycemia involves a drop in blood sugar levels after eating, causing symptoms such as dizziness, shakiness, sweating, and fatigue. Management includes monitoring blood glucose, eating balanced meals with protein, healthy fats, and complex carbohydrates, and having smaller, more frequent meals.


How do vestibular disorders cause dizziness and what are the treatment options?

Vestibular disorders affect the inner ear and can cause dizziness and a spinning sensation, often triggered by certain activities. Treatment options include vestibular rehabilitation exercises, avoiding triggers, and medications like meclizine to manage symptoms.


What cardiac issues could cause symptoms like heart palpitations and chest discomfort after eating?

Cardiac issues such as arrhythmia or angina could cause symptoms like heart palpitations, chest discomfort, and shortness of breath after eating. These conditions can be evaluated with tests like an ECG or stress test, and managed with lifestyle changes, medications, or further medical interventions.


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