Dizziness While Showering: Postural Hypotension and Heart Symptoms

Dizziness while showering, orthostatic hypotension, palpitations, and chest tightness?

Hello doctor, I experienced severe menstrual cramps and abdominal pain on the first day of my period during high school.
It came on suddenly, and while walking, I suddenly felt faint and had to feel my way to the restroom.
I sat on the toilet for a while, which helped.
Sometimes, when I change positions—like sitting up suddenly from lying down or standing up from sitting—I also feel faint, but it passes quickly, and I've never fainted.
Additionally, I sometimes feel dizzy while showering (which is different from the faintness I mentioned earlier).
I only take showers, not baths, and I don't use very hot water, just shower for a longer duration.
When the water hits my chest, it feels uncomfortable.
I often experience palpitations, chest tightness, and chest pain, and I'm unsure if it's related to my heart.
I previously had a cardiac evaluation, but no cause was found.
Both the electrocardiogram (ECG) and echocardiogram were normal.
The doctor concluded that the chest tightness was likely due to gastroesophageal reflux disease (GERD).
The palpitations started occurring occasionally after I received the vaccine, but they became more frequent after the GERD diagnosis.
Since the ECG and echocardiogram were done before the diagnosis, I'm wondering if I should get re-evaluated.
The dizziness while showering has been a recurring issue for me, but the chest tightness is a new symptom since the diagnosis.

Qi, 20~29 year old female. Ask Date: 2023/01/07

Dr. Wu Xueming reply Cardiology

Based on your description, it seems more like postural hypotension.
Please slow down when changing positions and increase your fluid intake.

Reply Date: 2023/01/07

More Info

Dizziness while showering can be a concerning symptom, especially when combined with other heart-related symptoms such as palpitations, chest tightness, and chest pain. Your history of experiencing dizziness upon sudden changes in posture, such as standing up quickly, suggests the possibility of postural hypotension, also known as orthostatic hypotension. This condition occurs when there is a significant drop in blood pressure upon standing, which can lead to dizziness, lightheadedness, or even fainting.

In your case, the dizziness you experience while showering may be exacerbated by several factors. The heat and humidity of a shower can cause blood vessels to dilate, which may lower blood pressure further, especially if you are already prone to postural hypotension. Additionally, prolonged standing or the act of bending over to wash can also contribute to this sensation. It is important to note that your symptoms of dizziness and palpitations may not be directly related to heart disease, especially since previous cardiac evaluations, including an electrocardiogram (ECG) and echocardiogram, did not reveal any abnormalities.

Your mention of experiencing chest discomfort and palpitations, particularly after receiving a vaccine, raises the question of whether these symptoms could be related to anxiety or a heightened state of awareness regarding your health. Anxiety can manifest physically, leading to symptoms such as palpitations, chest tightness, and dizziness. It is also worth considering that gastroesophageal reflux disease (GERD), which you mentioned as a diagnosis, can cause chest discomfort that may mimic cardiac symptoms.

Given your history and the complexity of your symptoms, it may be beneficial to consult with your healthcare provider for a comprehensive evaluation. They may recommend further tests, such as a tilt table test, to assess your blood pressure response to changes in posture, or a Holter monitor to evaluate your heart rhythm over a 24-hour period. These tests can help determine if there is an underlying issue contributing to your symptoms.

In the meantime, there are some practical steps you can take to manage your symptoms. When showering, try to keep the water temperature moderate and avoid prolonged exposure to hot water. You may also consider sitting on a shower stool to reduce the risk of dizziness. Additionally, staying well-hydrated and ensuring you are eating regular meals can help maintain stable blood pressure levels.

In summary, while your symptoms of dizziness while showering and other heart-related symptoms warrant attention, they may not necessarily indicate a serious cardiac issue, especially given your previous normal cardiac evaluations. However, it is crucial to continue monitoring your symptoms and maintain open communication with your healthcare provider to ensure appropriate management and follow-up.

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