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 clinicianโ€™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?

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:

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)

6.  Fainting:

7.  Elderly patient with new Lightheadedness:

  • Needs exam & a variety of tests mentioned above

See Lightheadedness โ€” Full Text for more in-depth explanations and discussions.

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