Be sure you’re interested in Lightheadedness, not the “dizziness” we call Vertigo
- Vertigo — room or person spinning or being thrust, in just one direction
- Lightheadedness — a vague sense of being woozy, wobbly, unsteady, fuzzy, tipsy, etc., in any or all directions
The following represents the clinician’s condensed thought-process when face-to-face with a patient. For more in-depth discussion & explanations, see Lightheadedness — Full Text.
Anxiety is the most common cause of Lightheadedness. We suspect it if:
- Lightheadedness comes & goes (not continuously present)
- Especially if worse at night, or while resting
- Especially if also feels heart pounding, or tingling in hands or lips (hyperventilation)
But we have to rule out more serious conditions, by asking:
1. Does it occur mainly with exertion?
- Also short of breath = maybe heart or lung disease. See topic Shortness of Breath.
- Also chest pain = maybe heart disease. See topic Diagnosing Coronary Artery Disease
- Also nausea / cold sweats = maybe heart disease. See Diagnosing Coronary Artery Disease
2. Is there also a Fever? We seek serious infections. See topic Fever
3. Occurs upon standing up (from sitting or lying)? We measure Postural Vital Signs. Maybe due to:
- Certain new medications
- Low blood pressure of any cause (if very new & acute, maybe even Shock)
- Conditions causing Postural Hypotension: Parkinson’s, Adrenal Insufficiency
4. Frequent falls, or new unsteady gait?
- Needs neurological exam (rule out Stroke, other diseases of brain / spinal cord)
- We observe their gait; see if they can stand with feet tight together, balance on one leg
- Refer to Neurologist if a concern
5. Acute & Continuous (recent onset, currently present, doesn’t come & go)? We’d have to:
- Check Pulse & Blood Pressure for extremely high or low values
- If normal, recheck them for a change from lying down to standing up (see Postural Vital Signs)
- Evaluate patient for Heart Diseases if risks: older age, hypertension, diabetes, smoker
- Probably obtain a variety of tests: complete blood count, maybe pregnancy test, Comprehensive Metabolic Panel (blood tests for sugar, liver & kidney function, potassium, calcium, sodium, etc.)
- Above work-up most easily done in ER.
6. Distinct episodes that begin & end abruptly — Might be Heart Arrhythmias
- Not often serious, but bothersome
- Heart beats very fast (>140 / min.)
- Diagnosed by continuous EKG monitoring (tests can be for 2, 14, or 30 days)
- Different symptom (see Fainting)
7. Elderly patient with new Lightheadedness:
- Needs exam & a variety of tests mentioned above
See Lightheadedness — Full Text for more in-depth explanations and discussions.