Various cardiac symptoms

26 year old male. In the last year I have had a number of tests due to various physical symptoms. I've had a normal echo and several normal EKGs that showed only infrequent PVCs.

Have recently noticed several symptoms.

When I stand from a seated position, especially if I'm dehydrated, I'll feel momentarily lightheaded, or even sometimes a brief feeling of fullness or mild pain in my head. Most of the time I can barely feel anything and have to be focusing on the sensation to notice anything, but even in these instances I still do notice a brief feeling that feels like a change in pressure. I believe this may be orthostatic hypotension.

The other episode occurred about 2 nights ago.  As I got back into my car from the grocery store, I sat down in the car and felt a PVC. I checked my pulse near my jugular vein, which I tend to do after PVCs. I didn't feel a pulse for 2-3 seconds. A feeling of panic came over me, and I sat and thought about what was going on for another few seconds, and checked my pulse again, and felt nothing. I then got out of the car, and stood up, and checked my pulse again, and could feel a normal, albeit somewhat fast, pulse. Overall, this episode lasted about 12 seconds (I've estimated). I didn't feel any other symptoms, other than anxiety and panic. I also have noticed that the way my body is positioned when I'm in my car sometimes, I cannot detected a pulse even though my pulse is normal.

Quetions:

1.  Is it normal to feel a change in pressure upon standing if one pays close attention to it?

2. Would any other tests be recommended for the presumed orthostatic hypotension?

3. The episode in my car has really scared me, but I feel that the reality of the situation was that I was sitting in a position where I couldn't feel my pulse. Common sense tells me that I'd have certainly passed out after 12 seconds or so with no heartbeat. Would you agree?

4. What recommendations would you give me as I go forward?

Thanks

[Michael J. McWilliams, M.D.]

1. It is normal for some people to feel lightheaded when they stand up, especially if you are dehydrate.  It is also normal for some people to pass out in this setting.  It is important to understand that if you are one that is sensitive to these changes, to be ready to sit rapidly if needed to keep yourself from passing out.

2. If I saw a  young person like yourself in clinic and  you had a normal EKG and echo, I would not order any other tests.

3. If you had no pulse for 6 seconds, you would pass out.


4. It sounds like you know what is going on, but there is just and element of panic that wants reassurance.  Talk to your doctor.  They know you better and can reassure you face to face that this is normal for you.

[Ky2289]

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