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Another case of dizziness / near fainting

Posted Mar 15 2010 12:00am

History: A 29 y.o. female c/o one week history of dizziness.  She reports 2 month history of irregular periods.  Other symptoms include racing heart on and off for 3 weeks.  Symptom of dizziness worsen when standing up.  This week vaginal bleeding has been heavy and irregular.

Patient denies chest pain, shortness of breath, vertigo (e.g. spinning room), palpitations, abdominal pain.

PMH: metrorrhagia, thyroid goiter (hypothyroidism)

Physical exam:

  • BP: 140/90
  • HR: 68
  • Temp: 98.6 F
  • Orthostatic BP readings: no change supine to sit to stand (no complaints of dizziness or racing heart)
  • Cardiovascular exam: RRR, no murmurs, rubs or gallops.  No carotid bruits
  • Respiratory exam: clear to auscultation bilaterally
  • Neurological exam: CN II-XII intact, Rhomberg negative; rapid head movement – no dizziness
  • EKG: NSR at 68 beats per minute

Differential  diagnosis:

  • orthostatic hypotension due to hypovolemia/ irregular menses

    Fainting

  • vertigo
  • presyncope due to vasovagal hypotension

Working diagnosis:

orthostatic hypotension due to irregular menses

Plan:

Follow up:

1 month

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