Dizziness and Autonomic Nervous System Disorders

Q: Dizziness and Autonomic Nervous System Disorders

Hello Mr. <br>Li： <br>You mentioned experiencing several episodes of syncope while walking, feeling as if you suddenly lost consciousness... <br>Your symptoms are more likely caused by syncope. <br>When cerebral blood flow drops below 30 ml per minute, it can lead to loss of cons

Dizziness, autonomic nervous system issues?

Hello Doctor,
Subject:
1.
I experienced several episodes of fainting in early December 2022 after performing 100 sit-ups in a short period as part of my exercise routine.
A few days later, while walking on the street, I suddenly lost consciousness multiple times, although I retained full control of my limbs.
I immediately stopped to rest, and during these episodes, I was only unaware of my surroundings with my head.
In the following period, I became more cautious while walking, but the fainting episodes continued to occur sporadically.
2.
Coincidentally, this period coincided with a change in weather.
Several years ago, I also fainted while bending my head down (while washing my hair), but I felt fine once I lifted my head.
Afterward, I consulted an otolaryngologist, who concluded that it was due to an anatomical issue with my ears.
3.
After the recent episodes, I consulted a neurosurgeon and underwent X-rays and an MRI, suspecting that the sit-ups might have caused a neck injury that compressed a nerve.
However, I later sought a second opinion at another hospital, and both doctors ruled out any neck issues.
4.
Currently, I am continuing my consultations with cardiology and neurology because I have been experiencing some chest tightness, occasional pain, anxiety, palpitations, migraines, and autonomic nervous system dysregulation (such as insomnia and night sweats).
Additionally, after receiving my third dose of the AZ vaccine in January 2022, I experienced myocarditis.
I am concerned that there may be issues related to my brain nerves, poor blood circulation, or cardiovascular problems.
Is this direction correct, and do you have any recommendations? Thank you.

Mr. Li, 40~49 year old female. Ask Date: 2023/02/10

Dr. Jiang Junyi reply Neurology

Hello Mr.
Li:
You mentioned experiencing several episodes of syncope while walking, feeling as if you suddenly lost consciousness...
Your symptoms are more likely caused by syncope.
When cerebral blood flow drops below 30 ml per minute, it can lead to loss of consciousness, usually due to a rapid drop in blood pressure or vasoconstriction, resulting in reduced cerebral blood flow and subsequent hypoxia in the brain.
Syncope is more likely to occur when a person is standing, as this position results in the least cerebral blood flow and a greater cardiac output.
If cerebral blood flow decreases suddenly, the body may not be able to respond quickly enough, leading to syncope.
The likelihood of syncope is lower when sitting and almost nonexistent when lying down.
Common causes of syncope include reflex syncope, which can result from excessive vagal stimulation leading to bradycardia and decreased cardiac output.
Other triggers include transitioning from a lying to a standing position, standing up suddenly from a squat, certain medications causing hypotension, significant blood volume reduction, peripheral vasodilation in a hot environment, and peripheral neuropathy.
Cardiac causes of syncope should also be considered, such as arrhythmias, valvular heart disease, cardiac myxoma, acute myocardial infarction, or coronary artery spasm leading to arrhythmias and hypotension.
Metabolic causes, such as hypoglycemia or hyperventilation, should also be differentiated from seizures and vertigo.
Currently, following up with both neurology and cardiology is the correct approach for your condition.
It is advisable to find a nearby hospital with an emergency department to consolidate your medical information in one place.
If there are multiple issues, consider switching doctors for different treatment perspectives, while still seeking care at a nearby hospital with an emergency department.
Additionally, you may consider wearing a smartwatch with blood oxygen monitoring capabilities, such as the Apple S6 or higher, to track your sleep, heart rate, and blood oxygen levels.
Thank you for your inquiry.
If you have further questions, feel free to discuss! Wishing you good health and peace.

Dr.
Jiang Junyi, Taoyuan Medical Center

Reply Date: 2023/02/10

More Info

Hello! Thank you for sharing your concerns regarding dizziness and potential autonomic nervous system disorders. Based on your description, it seems you are experiencing a complex interplay of symptoms that may involve both your cardiovascular and nervous systems.

Firstly, it’s important to understand that the autonomic nervous system (ANS) regulates involuntary bodily functions, including heart rate, blood pressure, and digestion. It consists of two main branches: the sympathetic nervous system, which prepares the body for 'fight or flight' responses, and the parasympathetic nervous system, which promotes 'rest and digest' activities. Dysregulation of the ANS can lead to symptoms such as dizziness, fainting, palpitations, and anxiety.

Your experience of fainting episodes, especially after intense physical activity like doing 100 sit-ups, could be indicative of several factors. One possibility is that the sudden exertion may have led to a temporary drop in blood pressure (orthostatic hypotension) or a vasovagal response, where the body overreacts to certain triggers, causing a sudden drop in heart rate and blood pressure. This can lead to dizziness or fainting.

The fact that you have a history of dizziness when bending down, which resolved upon standing up, suggests that you might have experienced similar episodes of orthostatic hypotension. This condition can be exacerbated by dehydration, prolonged standing, or sudden changes in posture, especially if you have been engaging in intense physical activity without adequate hydration or rest.

Your ongoing symptoms of heart discomfort, anxiety, and sleep disturbances further complicate the picture. Anxiety can significantly affect the ANS, leading to increased sympathetic activity, which may manifest as palpitations, sweating, and feelings of panic. Additionally, your history of myocarditis following vaccinations raises valid concerns about your cardiac health. It’s crucial to monitor any cardiovascular symptoms closely, as they could indicate underlying issues that may require further evaluation.

Given your symptoms and medical history, it would be prudent to pursue a comprehensive evaluation that includes:
1. Cardiac Assessment: Since you are experiencing chest discomfort and palpitations, a thorough cardiac evaluation, including an electrocardiogram (ECG), echocardiogram, and possibly a Holter monitor, would be beneficial to assess your heart's function and rhythm.

2. Neurological Evaluation: Although initial imaging studies (like MRI and X-rays) have ruled out significant structural issues, a follow-up with a neurologist may be warranted to explore the possibility of autonomic dysfunction or other neurological conditions. Tests such as tilt-table testing can help assess how your body responds to changes in position.

3. Blood Tests: Comprehensive blood work, including electrolyte levels, thyroid function tests, and markers of inflammation, can provide insights into potential metabolic or endocrine issues that could contribute to your symptoms.

4. Lifestyle Modifications: In the meantime, consider lifestyle adjustments such as staying well-hydrated, avoiding sudden changes in posture, and managing stress through relaxation techniques or cognitive behavioral therapy. Regular, moderate exercise can also help improve cardiovascular fitness and autonomic regulation.

5. Follow-up Care: Regular follow-ups with both cardiology and neurology specialists will ensure that any emerging issues are addressed promptly and that you receive appropriate management for your symptoms.

In conclusion, your concerns about potential brain or cardiovascular issues are valid, and pursuing a multidisciplinary approach involving cardiology and neurology will likely yield the best outcomes. Please continue to advocate for your health, and don’t hesitate to seek further evaluations if your symptoms persist or worsen. Wishing you the best in your journey towards better health!

Similar Q&A

Understanding Autonomic Nervous System Disorders: Symptoms and Connections

Hello doctor, two years ago, I suddenly felt a wave of dizziness one day, as if I were about to faint, but I never actually lost consciousness. Since that day, I have felt like I am constantly swaying, as if I were on a boat, whenever I am awake, although it doesn’t feel like the...

Dr. Cai Zongzhang reply Neurology
Hello, it is recommended that you maintain a regular sleep schedule and a balanced diet, identify sources of stress in your life, and practice stress-relief techniques. This should help improve your condition. If the issues persist, it is advisable to have regular follow-up appoi...

Understanding Dizziness and Nausea: Autonomic Nervous System Disorders

Hello Doctor: I have been experiencing issues with autonomic nervous system dysregulation and have been on medication for over six months. Since last week, I have been feeling dizzy and lightheaded, which is affecting my sleep. Whenever I close my eyes, I feel like the room is sp...

Dr. Lan Shengxing reply Neurology
Dear Lai, if you are only eating one meal a day for several weeks and experiencing dizziness, this is called hunger, which can be more harmful to your body than any disease. Please make sure to eat properly; do not worry about autonomic nervous system issues. Once your diet and l...

Understanding Autonomic Nervous System Issues: Symptoms and Solutions

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 sometimes I experience tinnitus. Recently, I have been feeling fatigued easily, and my hands tremble when I a...

Dr. Liang Sunyuan reply Psychiatry
Hello: There are many possible reasons, including anemia, autonomic nervous system issues, vertigo, or other factors. It is recommended that you seek medical attention for a more detailed evaluation. Wishing you all the best.

Understanding Autonomic Nervous System Disorders: Symptoms and Treatments

Doctor, I have experienced symptoms such as dizziness, cold sweats, vomiting, and diarrhea. After using the restroom, my mental clarity and discomfort gradually improve. I have seen reports that these symptoms resemble autonomic nervous system dysfunction. Is there a treatment fo...

Dr. Xu Jiazhen reply Otolaryngology
Hello: In response to your question, there are many conditions that can cause dizziness. I recommend that you undergo further detailed examinations.