Question: Hi. I am a 42 yo white female. I experience SOB with exertion, heart palpitations, dizziness, feeling like I am going to faint, and overwhelming fatigue. My right hand goes cold- at times so much so that it feels very uncomfortable. My left one tends not to get as cold. All symptoms are worse after eating. I am not able to do exertional activities: fast paced walking, stairs, exercise. I get a headache, short of breath, fatigued, heart palpitations, dizziness. Even with routine activities, I am so fatigued after a couple hours that I have to nap. I do experience the heart palpitations at random also- especially when waking in the middle of night after moving around and after eating. I also get dizzy when I stand (just for a few seconds). I have been ruled out by neurology that these symptoms are from my autonomic nervous symptoms, ruled out by endocrinology, ruled out by infectious disease, and ruled out for food allergies. Neurology felt that my blood pressure and heart rate though an autonomic reflex testing were normal. I did do a minimum exercise routine (about 5 flights of stairs and 10 squats) in his office in which my heart rate went from 80 to 150 quickly, but came back down appropriately. The headache, fatigued, etc came within about 30 minutes. I used to have a blood pressure of 120/80 before this all started, now it is usually around 80-100/55-75. Definely on the lower end after exercise. Could this be a cardiology issue?

Thank you for your reply.

The only cardiac work up I have had was echo and ECG. These were normal and I was not feeling any symptoms at the time I had them. I did a three hour glucose tolerance test that was normal. All thyroid, adrenal gland, and the complete blood count were normal. My platelets were 130. I do find my heart rate will rise from 15-30 when standing (neuro says normal). The palpitations seem to be coming through my chest when I have them- again, mostly after eating also always when I lie on the bed on my stomach. I do not get double vision after exercise, but if I did a "normal" workout- very dizzy/fatigue/typically 80/55 BP. I was concerned about some type of blood flow issue- headache after exercise and eating, SOB, cold hand. Could a vascular issue cause any of this if not cardio? Afib was also a thought.

I had progesterone and estrogen panels done through my GYN physician. He stated they were normal and that they did not indicate any issue or show that I was menopausal or even pre-menopausal. Not sure if that rules out hormonal imbalances?

I was on the Depo shot for birth control for 10yrs, but have been off of all birth control for 1.5 years with regular menstrual cycles starting back after about 3 months of being off of the Depo.

I probably should note (although it usually confuses the issue) that the dizziness when standing started about 2.5 years ago. I started an intense exercise program (mostly running). After the first month I began to feel tired after running. After a run in the third month, I found myself very very dizzy and off balance for weeks. Movement and foods triggered dizziness and that is when I started with the dizziness upon standing. Blood pressures much lower than what it had been. I modified my diet (no sugars, less carbs) and it greatly improved the day to day dizziness. I continued to have the dizziness when standing, but went on with life. About 1.5 years ago the other symptoms started. These other symptoms greatly affect day to day activities. Any exertional activity does me in for the day.

I agree, the tilt table seems reasonable, as you suggested. I suppose the orthostatic intolerance would play into the cold right hand after eating-or just after a glass of water since you explained that it does relate to blood flow.

The only things that I have found relief in:
1. drinking at least a half gallon of water a day
2. when I went to the ER, I had a saline solution that improved the dizziness and allowed me to eat foods that day that would normally cause dizziness (sugary foods), but I was still very fatigued.
3. when being worked up by endocrinology, he prescribed Actos. It was the first thing that allowed me to get through the day without napping several times a day. It also allowed me to eat (limited amount) of carbs/sugars without dizziness or feeling so fatigued after eating. After 4-6 weeks of taking this- I had to stop because it was dropping by BS, as it is suppose to work. But since we found that my BS was not the issue (NEVER had a low or high BS in the last 3yrs- tested at home) I could not continue this. I question what in the drug was the key ingredient that did help.

Any further thoughts is appreciated.

Which area would you suggest to treat ortho intolerance if I have a positive tilt table test?

Thanks for your assistance.