Managing Dizziness and Fainting: Symptoms and Seeking Help

Dizziness and syncope?

Hello, Doctor.
Since high school, I have experienced similar symptoms multiple times.
The symptoms include weakness in my limbs, vision going black, cold sweats, and nausea, lasting about 5 to 10 minutes.
If I do not sit or lie down immediately, I will lose consciousness.
This is generally the situation.
I have thalassemia, but my daily routine is mostly normal.
Although I go to bed a bit late, I still manage to sleep for about 6 hours each night, with consistent sleep and wake times.
I previously consulted a family medicine doctor who checked for orthostatic hypotension, and the results were negative.
Later, I was referred to a cardiologist, who conducted tests for arrhythmia and heart structure, both of which returned normal results.
The doctor advised me to maintain a regular routine if these episodes do not occur frequently.
I have followed this advice, but I recently experienced a similar episode, so I would like to ask how to prevent this from happening again and which specialty I should consult if I need medical attention.
Currently, I can rule out excessive stress, as these symptoms do not occur during particularly stressful times (no exams, no assignments, etc.).
I can also rule out orthostatic hypotension.
I am unsure if my mild thalassemia could be a factor.
I have read some responses from doctors regarding anemia causing shortness of breath when climbing stairs, but I do not typically experience shortness of breath (unless I am climbing rapidly over many flights).
I can rule out structural heart issues.
The first episode occurred at home, where I lost consciousness; this was the only time my blood pressure and heart rate were measured (systolic: 80s, diastolic: 40s, heart rate: 39 bpm).
The second episode happened during a blood test when I lost consciousness.
The third and fourth episodes occurred while cycling outdoors, and I remained conscious.
The fifth episode occurred while standing on a train, and I was fine until it suddenly happened.
I have awareness just before losing consciousness each time.
Although I do experience dizziness during my menstrual period, these five episodes did not all occur around that time.
My usual blood pressure is around the 90s systolic and 50s to 60s diastolic.
I apologize for the lengthy message and appreciate your response.
Thank you, Doctor.

ky, 20~29 year old female. Ask Date: 2017/03/01

Dr. Chen Taicheng reply Family Medicine

● There are many causes of syncope, and the first thing to rule out is cardiac-related issues, including arrhythmias and structural heart problems (including valve issues), which have already been evaluated by a cardiologist.
Please pay attention to whether your pulse is too slow (normal is about 60-90 beats per minute) or if you occasionally feel palpitations (or irregular heartbeats).
If so, a 24-hour Holter monitor may help identify any arrhythmias.

● The most common cause of syncope is neurogenic reflex syncope, with vasovagal syncope being the most prevalent.
The vagus nerve is part of the autonomic nervous system, controlling internal organs and blood vessels.
Situations such as prolonged standing, sitting, sudden position changes, stress (like blood draws), pain, or lack of sleep can trigger this type of syncope, as can situational factors (such as coughing or using the restroom).
This type of syncope is common but has a good prognosis.
A small number of individuals may have hypersensitivity of the carotid sinus (which monitors and regulates blood pressure), where excessive sensitivity can cause drops in blood pressure and heart rate, often triggered by compressing both carotid arteries or bending the neck.
● For orthostatic hypotension, measure blood pressure while lying down or sitting, then quickly stand up and measure blood pressure again.
A positive result is indicated by a drop of 20 mmHg in systolic or 10 mmHg in diastolic pressure.
● Your baseline blood pressure is already low, and anemia can worsen this condition (thalassemia cannot be corrected, but your age may suggest iron deficiency anemia due to menstruation, which can be corrected).
To raise blood pressure, it is important to stay hydrated (to avoid dehydration causing low blood pressure, such as when cycling outdoors), eat something, or consume a bit more salt.
● Blood draws and riding the train can both lead to vasovagal syncope, or syncope due to prolonged standing causing low blood pressure; syncope while cycling may be due to dehydration or hypoglycemia.
Of course, it is also important to rule out the possibility of seizures.
● It is recommended to confirm your anemia status, measure blood pressure in detail, and document the circumstances during syncope.
To diagnose vasovagal syncope, you may undergo a head-up tilt test (HUT) at a major hospital's cardiology department.
● Suggested order of consultations: Cardiology (to rule out vasovagal syncope and carotid sinus hypersensitivity) → Family Medicine or Internal Medicine (to rule out anemia, blood sugar, electrolyte issues, etc.) → Neurology (to rule out seizures).
Wishing you good health, Dr.
Chen Tai-Cheng from Taoyuan Hospital cares about you~

Reply Date: 2017/03/01

More Info

Managing dizziness and fainting can be quite challenging, especially when symptoms are recurrent and have a significant impact on daily life. Based on your description, it appears that you experience episodes characterized by weakness in your limbs, visual disturbances (seeing black), cold sweats, and nausea, which can lead to loss of consciousness if not managed promptly. Given your medical history of Mediterranean anemia and previous evaluations by healthcare professionals, it’s essential to delve deeper into the potential causes and management strategies for your symptoms.

Understanding Your Symptoms
1. Dizziness and Fainting: The symptoms you describe suggest a possible vasovagal response, which is a common cause of fainting. This 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. This can result in reduced blood flow to the brain, causing dizziness and fainting.

2. Blood Pressure and Heart Rate: Your reported blood pressure readings (systolic around 80s and diastolic in the 40s) and a heart rate of 39 beats per minute during an episode are concerning. These values indicate hypotension (low blood pressure) and bradycardia (slow heart rate), which can contribute to your symptoms. It's noteworthy that your heart rate should typically be between 60 and 100 beats per minute at rest.

3. Anemia: While you mentioned having mild Mediterranean anemia, it’s crucial to understand that anemia can lead to fatigue and weakness, which may exacerbate your symptoms. Anemia reduces the oxygen-carrying capacity of your blood, potentially leading to dizziness, especially during physical exertion or when standing up quickly.

Recommendations for Management
1. Lifestyle Modifications:
- Hydration: Ensure you are well-hydrated, as dehydration can worsen low blood pressure and increase the likelihood of fainting.

- Diet: A balanced diet rich in iron (to combat anemia) and other essential nutrients can help improve your overall health. Consider consulting a nutritionist for tailored dietary advice.

- Physical Activity: Engage in regular, moderate exercise to improve cardiovascular health, but avoid sudden changes in position that may trigger your symptoms.

2. Monitoring Symptoms: Keep a detailed diary of your episodes, noting the circumstances, duration, and any preceding activities. This information can be invaluable for your healthcare provider in identifying patterns or triggers.

3. Medical Evaluation: Since you have already seen a family physician and a cardiologist, consider the following:
- Neurology Consultation: Given the recurrent nature of your symptoms and the possibility of neurological involvement, a neurologist may provide further insights. They can evaluate for conditions such as seizures or other neurological disorders that could cause similar symptoms.

- Endocrinology Consultation: Hormonal imbalances, particularly related to adrenal function, can also lead to symptoms of dizziness and fainting. An endocrinologist can assess for conditions such as adrenal insufficiency.

4. Diagnostic Tests:
- Holter Monitor: A 24-hour Holter monitor can help assess your heart rhythm over time and identify any arrhythmias that may not have been captured during your previous evaluations.

- Tilt Table Test: This test can help determine how your body responds to changes in position and may provide insights into orthostatic hypotension or vasovagal syncope.

5. Emergency Plan: Given the severity of your symptoms, it’s essential to have a plan in place. If you feel an episode coming on, try to sit or lie down immediately to prevent injury. Inform those around you about your condition so they can assist if needed.

Conclusion
In summary, managing your dizziness and fainting episodes requires a comprehensive approach that includes lifestyle modifications, careful monitoring, and possibly further medical evaluations. Given your unique medical history, it’s crucial to work closely with healthcare professionals to identify the underlying causes and develop an effective management plan. If symptoms persist or worsen, do not hesitate to seek immediate medical attention. Your health and safety are paramount, and proactive measures can significantly improve your quality of life.

Similar Q&A

Managing Anxiety: Breathing Difficulties, Numbness, and Dizziness

Experiencing shortness of breath, numbness in the limbs, and dizziness several times a day can be very uncomfortable. If you've seen many doctors without relief and feel like you're suffering in silence, it's important to seek further evaluation. You may want to co...

Dr. Chen Yuying reply Psychiatry
Hello Yi-Yung: Your description resembles symptoms of panic disorder. Here are some manifestations of panic disorder; you can see if your situation aligns with them: *Rapid heartbeat* Difficulty breathing, feeling as if you can't get enough air* Headache, dizziness, or nause...

Understanding Dizziness and Blackouts: When to Seek Medical Help

Recently, I have been experiencing sudden blackouts in my vision, severe dizziness, and headaches, along with a feeling of heat and sweating all over my body, as if I am about to faint. These episodes occur not during exercise or any strenuous activity, but rather during normal a...

Dr. Jiang Junyi reply Neurology
Hello, based on your description, the reason why your dizziness symptoms improve when you squat may be due to insufficient cerebral blood circulation. Many factors can cause dizziness, such as anemia and autonomic nervous system dysfunction. It is important to rule out anemia or ...

Understanding Dizziness: Common Causes and When to Seek Help

The initial symptoms were dizziness, with mild vertigo lasting for about three days. After that, I started experiencing a sore throat, headaches, and fluctuating chills and fever while sleeping. I felt short of breath, similar to palpitations, and would experience bouts of dizzin...

Dr. Xiao Yongxun reply Family Medicine
Dear Ms. Mei: 1. You should seek medical attention as soon as possible to clarify the underlying issues. 2. Dizziness should be evaluated for conditions such as benign paroxysmal positional vertigo, Meniere's disease, vestibular neuritis, labyrinthitis, posttraumatic vertig...

Understanding Dizziness: Possible Causes and When to Seek Help

Hello Doctor: For the past four months, I have been feeling dizzy. My usual blood pressure readings are around 100 to 120. I have fainted before while donating blood, and recently, whenever I go to crowded places, hear loud voices, witness arguments, or feel anxious, I experience...

Dr. He Dongjin reply Cardiology
Hello, it seems that autonomic nervous system dysfunction may be at play. It is advisable to visit a neurology clinic for further examination. Changhua Hospital cares about you.