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What Causes Dizziness Upon Sitting Or Standing?
Question: I'm having dizziness upon sitting or standing almost fainting every time (5 or more weeks now). I can feel my heart beating and breathing difficulty, especially when laying down with a wheezy/breathy cough. I'm 32, T1 diabetic, gastroparesis (no vomiting or diarrhea lately). Blood pressure is sitting around 95/60 and heart rate is always over 100 resting.
Brief Answer:
A differential diagnosis is necessary.
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I understand your concern, and would like to explain that your clinical scenario is compatible with a hemodynamic instability (relative arterial hypotension coupled with possible pulmonary and systemic increased venous pressure).
That's, heart failure is the first disorder to be excluded/confirmed.
Coming to this point, a careful physical exam, a resting ECG, chest X ray study and especially a cardiac ultrasound and a NT-pro BNP test, would definitely clarify this suspicious issue.
Another etiological factor to be ruled in/out could be an orthostatic intolerance, which is expressed with hypotension over standing or sitting, dizziness and even near fainting, etc.
This may be more emphasized in the presence of a possible diabetic neuropathy.
If heart failure is excluded, to confirm an orthostatic intolerance, a Head Up Tilt testing is recommended.
Meanwhile, I would advise to closely monitor your blood pressure values (several times daily), and frequently check your blood glucose (as episodes of hypoglycemia may be also responsible for such a clinical scenario), check some blood tests, like complete blood count, thyroid function tests, blood electrolytes, etc.
You need to discuss with your attending physician (cardiologist or internist) about the above mentioned issues.
Hope to have been helpful to you!
In case of further uncertainties, please do not hesitate to contact me!
Best regards,
Dr. Iliri
A differential diagnosis is necessary.
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I understand your concern, and would like to explain that your clinical scenario is compatible with a hemodynamic instability (relative arterial hypotension coupled with possible pulmonary and systemic increased venous pressure).
That's, heart failure is the first disorder to be excluded/confirmed.
Coming to this point, a careful physical exam, a resting ECG, chest X ray study and especially a cardiac ultrasound and a NT-pro BNP test, would definitely clarify this suspicious issue.
Another etiological factor to be ruled in/out could be an orthostatic intolerance, which is expressed with hypotension over standing or sitting, dizziness and even near fainting, etc.
This may be more emphasized in the presence of a possible diabetic neuropathy.
If heart failure is excluded, to confirm an orthostatic intolerance, a Head Up Tilt testing is recommended.
Meanwhile, I would advise to closely monitor your blood pressure values (several times daily), and frequently check your blood glucose (as episodes of hypoglycemia may be also responsible for such a clinical scenario), check some blood tests, like complete blood count, thyroid function tests, blood electrolytes, etc.
You need to discuss with your attending physician (cardiologist or internist) about the above mentioned issues.
Hope to have been helpful to you!
In case of further uncertainties, please do not hesitate to contact me!
Best regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I do have confirmed diabetic neuropathy. Having said this, I want to ensure that I don't need to go to the ER. I'm used to the tachycardia, but not this short breathing and constant dizziness.
Brief Answer:
I recommend going to the ER to exclude possible acute cardiac failure
Detailed Answer:
Hello again!
Your symptoms may be relate to diabetic neuropathy, but in this situation we can not exclude possible acute cardiac failure related to acute coronary syndrome (breathing difficulty in diabetics is very concerning for acute coronary syndrome, even in the absence of chest pain).
I recommend going to the ER for a careful physical exam, a resting ECG, and especially a cardiac ultrasound and a NT-pro BNP test to exclude this disorder, which needs emergent treatment.
Hope to have been helpful!
Best wishes,
Dr. Iliri
I recommend going to the ER to exclude possible acute cardiac failure
Detailed Answer:
Hello again!
Your symptoms may be relate to diabetic neuropathy, but in this situation we can not exclude possible acute cardiac failure related to acute coronary syndrome (breathing difficulty in diabetics is very concerning for acute coronary syndrome, even in the absence of chest pain).
I recommend going to the ER for a careful physical exam, a resting ECG, and especially a cardiac ultrasound and a NT-pro BNP test to exclude this disorder, which needs emergent treatment.
Hope to have been helpful!
Best wishes,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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