OpenHealth Q&A

Experiencing Dizziness, Fast Heartbeat, and Low Blood Pressure

45-year-old female, height 5'3", weight 182 lbs. I have type 2 diabetes that's managed without insulin and has no complications; my A1C levels have consistently remained below 6.0. Additionally, I live with PTSD, autism (level 1), and ADHD. Current medications include: Jardiance, Mounjaro, Metformin, Fenofibrate, Guanfacine, Quetiapine for sleep issues, and Prasozin at 1 mg for managing nightmares. I occasionally take Klonopin, up to twice weekly for panic attacks, along with Melatonin. There haven’t been any alterations to my medication regimen for over a year. I’ve been experiencing increased dizziness upon standing, which has become more frequent over the past three months. In that same timeframe, I have lost approximately 8 pounds. A few years back, I encountered a similar episode at work where, after sitting down, my Apple Watch flagged an elevated heart rate, prompting me to be sent home with a directive to obtain medical clearance. An emergency room visit followed; unfortunately, the treatment I received was less than ideal. They attempted to administer 10 units of insulin without properly checking my blood sugar despite my last meal being at 5 AM. When they finally did take my reading, it showed 75, leading them to withhold the insulin, which further compounded a very negative experience. I wore a heart monitor during this time, underwent a treadmill stress test, and had an echocardiogram. Ultimately, the doctors found nothing significant, resulting in a lack of further investigation. Since then, episodes of dizziness appeared sporadically, but during a visit, my primary care provider's nurse observed one instance where my heart rate spiked again. I subsequently had an ECG performed, and while one of the values was slightly off, I later learned that electrode misplacement could often cause such discrepancies in obese patients. I was referred to a cardiology specialist, where I underwent another ECG and echocardiogram and was asked to wear a Holter monitor for thirty days. However, due to the infrequency of my episodes, none were recorded during that time, and both tests returned normal results. I was released from cardiology with a clean bill of health, albeit still classified as obese. My PCP speculated it couldn’t be POTS, and since cardiology had cleared me, she expressed no immediate concern. The situation has worsened, with dizzy spells now occurring multiple times a day. Unfortunately, my doctor appointments keep getting postponed due to her illness or vacation plans, with the next available appointment being weeks away; it was rescheduled from July 30 to September 26. These dizzy spells lead me to sit down on the floor or find a nearby seat at least once daily. I’ve experienced multiple falls, and I suspect I may have fainted last week while alone. The dizziness is unpredictable, but I was able to monitor my blood pressure during one episode. Before standing, my reading was 98/66, which is normal for me under non-stressful conditions. After standing, I felt dizzy, sat back down and tested again, receiving a reading of 75/47. While I did notice an increase in heart rate, I couldn’t remember the exact number since my app does not track that. I’m uncertain about which doctor to approach next. I cannot return to cardiology since I've been discharged, and my hospital network requires referrals for specialist visits, which can take weeks just to obtain, with appointment wait times stretching for months. My partner, who lives far away, has been urging me to seek medical attention, so after another fall yesterday, I reached out to my clinic. When they followed up half an hour later, my blood pressure was recorded at 96/57. They advised me to head to the ER, reminding me not to drive myself, which feels unnecessary since such incidents are often resolved by the time I would arrive, plus I lack alternative transportation. These dizzy spells are definitely not the result of low blood sugar, as I’ve confirmed my blood glucose remains stable during episodes, consistently within the target range given my eating habits. I have the option to seek specialists outside of my hospital network who don’t require referrals, but changing providers causes me significant anxiety due to my autism. Nevertheless, I’m considering this option if I can find someone who can see me sooner. The question remains: who should I approach?

Answers (1)

7/14/2025, 5:50:42 AM

OpenHealth AI

It sounds like you're facing a challenging situation with your dizziness, fast heartbeat, and low blood pressure, especially complicated by your medical history and delays in seeing your healthcare provider. Let's break down the main points:

Main Points:

1. Dizziness and Low Blood Pressure: Your symptoms could suggest a condition affecting blood flow and autonomic regulation, potentially related to your current medication or other underlying issues.
2. Recent Episodes and Falls: Increased frequency of dizzy spells is concerning, especially since they lead to falls.
3. Next Steps: Given the context and urgency of your symptoms, here are prioritized actions to consider.

Understanding Your Situation:

Persistent dizziness, especially when standing, can indicate orthostatic hypotension, which is a drop in blood pressure that occurs when you stand up. It can lead to dizziness and falls, requiring careful management. Given your history of cardiovascular evaluations returning normal, it's essential to address both symptomatic management and underlying causes, considering your other health conditions.

Prioritized Next Steps:

1. Monitor Your Symptoms:

   • Keep a detailed log of your dizzy spells, including when they occur, any preceding activities, your position (sitting/standing), blood pressure readings, and heart rate (if possible). This information can be crucial for diagnostics.

2. Stay Hydrated and Manage Salt Intake:

   • Increase your fluid intake, focusing on water and electrolyte-rich drinks (like oral rehydration solutions). If there are no contraindications (like fluid retention related to any medications), consider discussing the possibility of increasing salt intake with your healthcare provider.

3. Limit Sudden Movements:

   • When transitioning from sitting or lying down to standing, do so slowly to reduce the risk of dizziness. Sit on the edge of your bed or chair for a moment before standing.

4. Seek Quick Medical Help:

   • Given your recent falls and low blood pressure readings, consider visiting an urgent care facility or the emergency room if you experience severe dizziness, fainting, or an inability to stay safe. The fact that your symptoms are worsening warrants immediate attention.

5. Consider Specialist Options:

   • If waiting for your primary care provider is not feasible, consider seeking a neurologist or an endocrinologist (if you suspect hormonal influences on your symptoms). Research specialists who may offer more prompt appointments outside your network, especially those experienced with autonomic or cardiovascular issues.

6. Discuss Medication Review:

   • Even though you have been stable on your current medications, some can contribute to dizziness. A review of your medications by a doctor—ideally one with experience in how diabetes treatments might interact with your symptoms—can help. Specifically, ask about the potential side effects of medications like Guanfacine and Quetiapine.

Conclusion:

I understand that finding a suitable provider can be anxiety-inducing, particularly with your autism. Focus on what feels manageable, and remember that your safety comes first. Monitoring your symptoms closely and ensuring your medical history is available to any new specialists will facilitate your care. Stay vigilant, and don’t hesitate to seek immediate assistance if your situation worsens. You’re taking an important step in prioritizing your health.