Lightheaded - Negative Tests

I am a 34 year old male, slightly overweight but physically active (running). Around 7 weeks ago I had worked out in the morning and only consumed half a glass of water until lunch, along with 2-3 cups of coffee. I got very lightheaded and shaky, after eating lunch and drinking water it went away. Since then I have been hydrating myself every day with 2 liters of water.

For the last 7 weeks I have continued experiencing random spells of lightheadedness. It will last for 1-2 seconds, but they come in packs (5-6 over a 1 hour period, then no problems for several days). They do not occur after suddenly standing. I do not have any ear aches. Sometimes my urine is darker (not brown, just deeper yellow) than I think it normally should be, even though I am hydrating. I get a bit tired while lightheaded, but experience no other symptoms.

I went to my PCP 4 weeks ago and he ran a full metabolic chemistry profile on me which came back normal. I went back a week later and he ran a complete blood count and urinalysis - all came back normal. He did not have any suggestions. About 6 years ago a doctor noticed an abnormal heart rhythm, but he hooked me up to an ECG for 10 minutes and there were no problems. He said it was probably a harmless palpitation. I rarely experience any palpitations, and they do not occur before feeling lightheaded.

Sometimes my blood pressure is elevated (both numbers), but usually when I take it at home it is right around normal. I have been taking my pulse often, and it usually is around 72 while at rest, and between 55 and 65 at night in bed. I am still able to run for 30-45 minutes without any noticeable problems.

Can you think of anything I can do to try and get to the bottom of this? I don't know whether to try and see a cardiologist, neurologist, or psychologist; or whether I should just keep hydrating hoping that this is a lingering effect from that first day.

[Kevin Pho, MD]

There can be many causes for your symptoms.  The heart has been worked up.  I would also add an echocardiogram to determine if there are any structural abnormalities, as well as a carotid ultrasound to look for blockages in the carotid arteries.

If the heart and vascular tests continue to be negative, a neurology referral can be considered.  Imaging like a brain MRI as well as an EEG to determine any seizure activity can be considered.

These options can be discussed with your personal physician.  Both a cardiology and neurology referral can be considered.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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