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What Do Recurrent Episodes Of Dizziness And Headaches Indicate?
Question: I have been experiencing episodes of dizziness for almost two weeks. I am also experiencing occasional hot flashes, headaches, occasional mild chest tightness, occasional nausea, and presyncope. My heart rate is running slightly higher than normal and my oxygen is showing a bit lower at times per my pulse oximeter. I had an intense episode almost two weeks ago and I have had these since. Quick insight into my medical history: I do have anxiety/panic attacks, Sick Sinus Syndrome with Tachycardia, and EDS. I keep worrying that I had a silent heart attack during the initial episode. Is my anxiety just getting the best of me?
Brief Answer:
Get a holter done immediately
Detailed Answer:
Hi this is Dr Sameer, cardiologist from fortis hospital.
Sick sinus syndrome or tachy- XXXXXXX syndrome is a condition in which heart rate fluctuates between tachycardia & bradycardia.
The symptoms you are telling seems like symptomatic bradycardia (giddiness, presynchope, hot flushes, chest tightness).
This bradycardia can go to seriously low level & make you unconscious. Sometimes these type of patients may need a pacemaker.
I recommend you to stop propanolol & do a holter monitor immediately.
I hope you find this helpful
Regards
Dr Sameer Maheshwari
Get a holter done immediately
Detailed Answer:
Hi this is Dr Sameer, cardiologist from fortis hospital.
Sick sinus syndrome or tachy- XXXXXXX syndrome is a condition in which heart rate fluctuates between tachycardia & bradycardia.
The symptoms you are telling seems like symptomatic bradycardia (giddiness, presynchope, hot flushes, chest tightness).
This bradycardia can go to seriously low level & make you unconscious. Sometimes these type of patients may need a pacemaker.
I recommend you to stop propanolol & do a holter monitor immediately.
I hope you find this helpful
Regards
Dr Sameer Maheshwari
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Thank you. I am under the care of a cardiologist but have not seen him since this last episode. I regularly monitor my heart rate per his request. I am not at the point of needing a pacemaker yet. My lows aren't low enough and the episodes are brief. My concern is with the episode I mentioned from a week and a half ago. The symptoms from the anxiety, SSS, and EDS can all mimic heart attack symptoms. I was curious as to what your opinion on that episode was. My heart rate was not low during this time and has not been low since. I have looked back at all my heart rate data, and if anything I have been having more tachycardia than normal. I was also told to never just stop a beta blocker, as that can cause many problems.
Brief Answer:
Please refer to detailed answer
Detailed Answer:
Hi,
Thanks for this detailed history & i am really relieved to know that these were not the bradycardia episodes.
Considering all one by one
1) Anxiety attack / panic attack - patients generally experience hot flushes, racing heart beat( palpitations), giddiness, restlessness, profused sweating, extreme headache followed by vomiting. Oxygen saturation level can also show low levels as patients tend to hyperventilate.
2) SSS - extreme tachycardia can cause palpitations, chest pain & sweating or bradycardia can cause giddiness, presynchope or synchope.
3) EDS - It can associated heart conditions like mitral valve prolapse or dilated aorta. Mitral valve prolapse patients are generally asymptomatic but can have breathlessness on exertion or rest.
Aortic dilatation are also asymptomatic but can have chest pain when there is dissection which is a fatal condition.
Both could be detected on 2D Echo.
4) Heart Attack - Main symptom is chest pain which is diffused & generally radiates to left arm. It is associated with feeling of impending doom, restlessness and profused sweating.
It can be detected by ECG, some blood test(cardiac troponin) & 2DEcho.
Considering your scenario, if you would have had heart attack, the symptoms would be still there & you would be feeling chest pain & breathing difficulty on exertion.
So the symptoms you had should be a panic/ anxiety attack which generally resolve with propanolol.
So if the bradycardia episodes are not too much & rate does not get to very low than propanolol is safe. It is a very good drug which protect from future cardiac events.
Hope you find this helpful.
Wishing you a healthy life.
Dr Sameer Maheshwari
Please refer to detailed answer
Detailed Answer:
Hi,
Thanks for this detailed history & i am really relieved to know that these were not the bradycardia episodes.
Considering all one by one
1) Anxiety attack / panic attack - patients generally experience hot flushes, racing heart beat( palpitations), giddiness, restlessness, profused sweating, extreme headache followed by vomiting. Oxygen saturation level can also show low levels as patients tend to hyperventilate.
2) SSS - extreme tachycardia can cause palpitations, chest pain & sweating or bradycardia can cause giddiness, presynchope or synchope.
3) EDS - It can associated heart conditions like mitral valve prolapse or dilated aorta. Mitral valve prolapse patients are generally asymptomatic but can have breathlessness on exertion or rest.
Aortic dilatation are also asymptomatic but can have chest pain when there is dissection which is a fatal condition.
Both could be detected on 2D Echo.
4) Heart Attack - Main symptom is chest pain which is diffused & generally radiates to left arm. It is associated with feeling of impending doom, restlessness and profused sweating.
It can be detected by ECG, some blood test(cardiac troponin) & 2DEcho.
Considering your scenario, if you would have had heart attack, the symptoms would be still there & you would be feeling chest pain & breathing difficulty on exertion.
So the symptoms you had should be a panic/ anxiety attack which generally resolve with propanolol.
So if the bradycardia episodes are not too much & rate does not get to very low than propanolol is safe. It is a very good drug which protect from future cardiac events.
Hope you find this helpful.
Wishing you a healthy life.
Dr Sameer Maheshwari
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Veerisetty Shyamkumar
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