Long-Term Dizziness and Brain Fog: When to Seek Help

Long-term feelings of head heaviness (a dull sensation in the brain) can impact daily life?

During my student years (from 1995 to 2005), I experienced several episodes of sudden dizziness.
While standing, I would suddenly feel dizzy (not necessarily after standing up from a squat), and my vision would go black, with sounds seeming distant.
I could clearly feel my heart racing abnormally for a few seconds before returning to normal, and my face would turn pale.
This would last for several minutes before I recovered.
Between 2012 and 2013, there was an incident where I suddenly felt dizzy while washing dishes at home.
Before I could react, I fainted.
I don't remember how long I was unconscious, but I was alone at home, boiling water.
When I regained consciousness, the water had already boiled for an unknown amount of time, possibly a few minutes.
These episodes have become less frequent recently.
Based on my research, could both incidents be classified as "vasovagal syncope"? Should I seek follow-up care or treatment, and which specialty should I consult? What specific tests should I undergo?
Additionally, I have been troubled by a persistent feeling of heaviness and dizziness in my head, but it is not a spinning sensation.
Instead, it feels like my brain is dull and thinking is laborious, with a sensation of breathlessness, somewhat akin to feeling faint or experiencing heat exhaustion.
This condition has made me feel very fatigued, affecting my overall physical and mental well-being, and has persisted for at least 10 years (it was mild during my student years but has become particularly pronounced in the last five years).
Sometimes, lying down for a while alleviates the dizziness slightly, but the relief is temporary.
Regular exercise has not helped (I exercise three times a week for 0.5 to 1 hour, with a heart rate of 130).
Between 2011 and 2012, I underwent a series of tests at Linkou Chang Gung Memorial Hospital due to these issues, including evaluations by ENT, cardiology, hematology, neurology, ophthalmology, and psychiatry, all of which returned normal results (no anemia, low blood pressure, and autonomic nervous system and thyroid tests were also normal), and no cause was identified.
Occasionally, I feel a slight tightening in my heart or experience a sudden rapid heartbeat, but this has occurred less frequently recently and is not correlated with the dizziness.
Is there a connection between these symptoms?
I recently completed a physical examination, and the report is as follows.
When I inquired at the hospital, they indicated that the report confirms no anemia.
Is this accurate? However, there were abnormalities in the electrocardiogram and cardiovascular tests; could these be related to the symptoms mentioned above (previous examinations were normal)? I would appreciate your insights on this matter.
Thank you.
---- Blood Test Results ---- (all normal)
WBC 6.13
RBC 4.64
HB 12.5
HCT 37.6
MCH 26.9
MCV 81.0
MCHC 33.2
Platelets 218
---- Electrocardiogram ---- (abnormal)
Bradycardia, short PR interval, right bundle branch block
---- Cardiovascular Examination ---- (abnormal)
LDH 104 (normal range 106–211 U/L)

vivi, 30~39 year old female. Ask Date: 2016/12/16

Dr. He Dongjin reply Cardiology

Hello, your heart is fine and there is no anemia.
The electrocardiogram and cardiovascular examinations showed no abnormalities and are unrelated to your symptoms.
A series of tests conducted at Linkou Chang Gung Memorial Hospital yielded normal results with no anemia.
Blood pressure is low, and tests for autonomic nervous system function, thyroid function, and other examinations are also normal.
It still sounds like vasovagal syncope.
It is advisable to consult a neurologist for further evaluation.
Changhua Hospital cares about your well-being.

Reply Date: 2016/12/16

More Info

Based on your detailed description of your symptoms and medical history, it seems you have been experiencing episodes of dizziness and fainting, which could indeed be related to vasovagal syncope, commonly known as vasovagal fainting. This condition occurs when your body overreacts to certain triggers, such as stress, pain, or prolonged standing, leading to a sudden drop in heart rate and blood pressure, which can cause fainting.
Your past episodes of sudden dizziness, blackouts, and the feeling of your heart racing followed by a return to normalcy are characteristic of this condition. The fact that these episodes have become less frequent over the years is a positive sign, but it does not negate the need for further evaluation, especially since you are experiencing persistent symptoms like brain fog, fatigue, and a sensation of heaviness in your head.

The symptoms you describe, such as feeling mentally sluggish and having difficulty concentrating, could be attributed to several factors, including chronic fatigue syndrome, anxiety, or even a form of dysautonomia, where the autonomic nervous system does not function properly. Given that you have undergone extensive testing in the past, including evaluations by various specialists, and the results were normal, it may be worthwhile to revisit some of these specialists or consult a neurologist who specializes in dizziness and balance disorders.

Regarding your recent health check results, it is reassuring that your blood tests came back normal, indicating no anemia or other blood-related issues. However, the abnormalities noted in your electrocardiogram (ECG) and cardiac evaluation warrant further investigation. The findings of bradycardia (slow heart rate), short PR interval, and right bundle branch block could potentially explain some of your symptoms, especially if they lead to inadequate blood flow to the brain during episodes of dizziness.
It is crucial to discuss these ECG findings with a cardiologist, as they can provide insight into whether these heart rhythm issues are contributing to your symptoms. They may recommend further cardiac monitoring, such as a Holter monitor, to assess your heart's activity over a longer period, especially during episodes of dizziness.

In summary, while your symptoms may suggest vasovagal syncope, the presence of abnormal heart findings necessitates a thorough evaluation by a cardiologist. Additionally, considering your ongoing symptoms of brain fog and fatigue, a comprehensive approach involving both neurology and cardiology may be beneficial. You might also want to explore lifestyle modifications, such as hydration, dietary adjustments, and stress management techniques, which can sometimes alleviate symptoms related to autonomic dysfunction.

If you notice any worsening of your symptoms or new symptoms arise, it is essential to seek medical attention promptly. Your health and well-being are paramount, and addressing these issues with the appropriate specialists will help you find a path toward improvement.

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