[51M] Experiencing nervousness, sweating, and blood pressure irregularities

Patient Description

A 51-year-old male has been experiencing intermittent sweating, constant nervousness, and fear, as well as irregular blood pressure since November. The nervousness is most intense in the mornings, lasting all day but abating at night, and is exacerbated by stressful events. Episodes of sweating are random and last about 10 minutes, mostly on the forehead and hair. The patient also experiences Premature Ventricular Contractions (PVCs) that are not linked to the level of nervousness and tend to lessen with exercise. Additionally, there are occasional headaches at the top back of the head when nervousness is high, rated as a mild ache (4/10 in severity). The patient forces himself to eat despite a loss of appetite when very nervous, maintaining weight. Shaky legs and hands occur when the nervousness is extra high, resembling a tremor. Upon standing from lying or sitting, the patient experiences a wooshing sound in the ears and a mild beating feeling in the head for about 2 minutes. The patient has been on Effexor XR 37.5mg daily since 2011, which he suspects might be contributing to his symptoms. No family history of anxiety disorders or cardiac issues was reported, and no other medications are being taken. The patient also notes hyperpigmentation on the left knee and two knuckles, as well as darkened healed lacerations on the shins.

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Arora's Assessment

What might be happening

Based on the information you've provided, possible diagnoses include:

  • Generalized Anxiety Disorder (GAD): This is a common condition characterized by persistent and excessive worry about different aspects of life. The constant nervousness, fear, and physical symptoms such as sweating, shaky hands and legs, and occasional headaches you described are common symptoms of GAD.

    • Treatment for GAD often involves psychotherapy, medication, or both. Cognitive-behavioral therapy (CBT) is effective in treating GAD. Medications include antidepressants, buspirone, and benzodiazepines.
  • Panic Disorder: This is a type of anxiety disorder characterized by recurrent unexpected panic attacks. Panic attacks are sudden periods of intense fear that may include palpitations, sweating, shaking, shortness of breath, numbness, or a feeling that something terrible is going to happen. The highest level of symptoms lasts a few minutes.

    • Treatment for panic disorder often involves psychotherapy, medication, or both. Cognitive-behavioral therapy (CBT) is effective in treating panic disorder. Medications include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), benzodiazepines, and others.
  • Orthostatic Hypotension: This is a form of low blood pressure that happens when you stand up from sitting or lying down. The "wooshing" sound in your ears and lightheadedness you described when standing up are common symptoms of orthostatic hypotension.

    • Treatment for orthostatic hypotension often involves lifestyle changes such as standing up slowly, avoiding alcohol, drinking plenty of fluids, and wearing compression stockings. Medications may also be prescribed.
  • Hyperpigmentation: This is a common, usually harmless condition in which patches of skin become darker in color than the normal surrounding skin. This darkening occurs when an excess of melanin, the brown pigment that produces normal skin color, forms deposits in the skin.

    • Treatment for hyperpigmentation often involves over-the-counter creams, prescription creams, procedures such as chemical peels and microdermabrasion, and others.

Please note that these are possible diagnoses based on the information you've provided and are not definitive. You should consult a healthcare professional for a formal diagnosis and treatment.

What you can do

  1. Consult a healthcare professional: They can provide a formal assessment and order relevant tests if necessary. They can also provide appropriate treatment for your symptoms.

  2. Practice stress management techniques: This can include activities such as yoga, meditation, and deep breathing exercises. Regular physical activity and a healthy diet can also help manage your symptoms.

  3. Monitor your symptoms: Keep track of when your symptoms occur, their severity, and any potential triggers. This information can be helpful for your healthcare provider.

What you should look out for

Reasons to seek immediate medical attention:

  • If your symptoms worsen or if you develop new symptoms
  • If you experience severe headache, chest pain, or shortness of breath
  • If you have thoughts of harming yourself or others

Remember, I'm an AI and this advice is based on the information you've provided. It's always important to consult with a healthcare professional for an accurate diagnosis and treatment.

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1 yr ago

Top picked over-the-counter products for Tingling or Cold Sensations at the Back of Your Head

People Also Ask


What are the common symptoms of Generalized Anxiety Disorder (GAD)?

Common symptoms of Generalized Anxiety Disorder (GAD) include persistent and excessive worry, restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances. Physical symptoms can also include sweating, trembling, and headaches.


How can orthostatic hypotension be managed or treated?

Orthostatic hypotension can be managed by making lifestyle changes such as standing up slowly, avoiding alcohol, staying hydrated, and wearing compression stockings. In some cases, medications may be prescribed to help manage the condition.


What are the potential side effects of taking Effexor XR for a long period?

Potential side effects of long-term use of Effexor XR (venlafaxine) can include nausea, dizziness, dry mouth, insomnia, constipation, and increased blood pressure. It's important to discuss any concerns with a healthcare provider.


What causes hyperpigmentation and how can it be treated?

Hyperpigmentation is caused by an excess of melanin in the skin, which can be due to sun exposure, hormonal changes, or skin injuries. Treatment options include over-the-counter creams, prescription medications, and procedures like chemical peels or laser therapy.


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