Ask a doctor on the topic of Internal medicine

Dizziness, cold hands, and AV block.

May 23, 2015 | 50,00 EUR | answered by Dr. David Meyer

Dear doctors,

I am seeking advice regarding the following problem:

My suffering began 5 years ago overnight: I had extreme dizziness, was irritable, felt like I was about to faint. So I immediately went to my general practitioner. He conducted a resting EKG, which was inconclusive. At the same time, my blood pressure was measured. The result: 160/100. At the time, I was 26 years old (male), 179cm tall, and weighed around 80 kg. I was immediately prescribed 2.5mg of Ramipril and sent to the hospital for further investigation.
VERY IMPORTANT: In every examination in my life (military, police fitness test, etc.), doctors have always diagnosed me with slightly low blood pressure and iron deficiency.
I spent a week in the hospital where various tests were conducted. Blood tests, cardiac ultrasound, hormone levels through 24-hour urine collection, stress EKG (after which I experienced a drop in blood pressure and almost fainted, but recovered after elevating my legs).
The only abnormality found was "Ketone bodies 2mmol/l, otherwise unremarkable."
EKG: also unremarkable
Exercise ECG: Aborted at 1 minute 175 W due to peripheral exhaustion and reaching maximum exercise frequency, no heart rhythm disorders, no angina pectoris symptoms, normal blood pressure and heart rate increase under stress, excessive blood pressure values of 88/68 mmHg in recovery phase, no angina pectoris symptoms, no heart rhythm disorders, no ischemic reaction
Body plethysmography: No manifest ventilation disorder. Normal oxygen levels at rest, balanced acid-base balance
Chest X-ray: Both lung apices are not fully visualized, No cardiac configuration, right central lung with markings without signs of infiltration or congestion
Upper abdominal ultrasound: In short, all organs well-assessed, normal and unremarkable
Gastroscopy: Hemorrhagic flat erosions in the stomach. Mucosal erythema in the corpus and antrum. (after 2 weeks of pantoprazole, no more complaints)
Therapy and course:
After adjusting the antihypertensive medication, the blood pressure values measured during the hospital stay were in the normotensive range. ...

I will spare you the exact wording. In short: the dizziness was gone, I felt better. A renal angiography MRI was also performed: No findings. I was discharged.
Even that was not enough for my general practitioner, and he referred me to a cardiac clinic. There, another cardiac ultrasound was performed: Diagnosis: all clear.
So I lived with 2.5mg of Ramipril for the next few years. I was doing fine, although never as well as before that fateful day, but still okay.
I started exercising regularly. When I did it very intensively (for example, 1 hour of jogging), I would always feel a bit dizzy, so I had to sit down to avoid fainting. My blood pressure settled around 130/70 with a pulse of 60. Regular 24-hour blood pressure monitoring was done, which according to my general practitioner was normal.
Now to the actual problem:
5 weeks ago, it started: one morning I had extremely cold and pale hands and feet. I didn't think much of it and went to work as usual. However, my colleagues noticed a few days later, without me saying anything, that I looked extremely pale and asked if I was okay. At the same time, I started experiencing constant dizziness, as if I were drunk. Especially when I move my head quickly, it's very bad. All day long, I feel like the ground is swaying, my knees weaken, I have to hold on tight to avoid falling. But overall, I have extreme dizziness all day and these cold, totally pale hands. The curious thing: when lying down, it's almost completely gone. Even my hands have color again. When I wake up, I feel great for about 30 minutes. Then the horror starts again.
A year ago, I was in Africa for 3 months and lost weight as a result. I had a fainting spell, turned chalk-white, broke out in cold sweat, briefly fainted, woke up on my own through a jerk, and felt relatively okay again after a short time. (Rice and beans are not very nutritious in the long run ;-) ) I now weigh about 72 kg at 179 cm and have maintained it. At that time, I also suddenly had the described fainting spell without further complaints, my general practitioner did a blood test, which was inconclusive. That was the end of it, and I was doing fine until 5 weeks ago.
5 weeks ago, I went to my general practitioner, who conducted a blood test (thyroid, inflammation

Dr. David Meyer

Dear inquirer,

You have already undergone many diagnostics, exactly the ones I would have done in your case. Fluctuating blood pressure is quite normal, even if you are young and possibly under work-related stress. A stress ECG was done, a first-degree AV block as mentioned is nothing serious, and no heart defect was found in the echocardiogram. Have you ever had a 24-hour blood pressure monitor after starting Ramipril and a 24-hour ECG done? Dizziness can have many causes. As a last resort, you could consider seeing a neurologist. How is your diet? How did you originally develop gastritis?

I would suggest continuing to stay physically active to potentially avoid the need for blood pressure medication, as they can sometimes have paradoxical effects. Can you think of any psychological stress factors that could be causing your dizziness? As for cold hands, that can happen to anyone. A stress response constricts blood vessels, and if it's also cold, you may have cold hands and feet. I assume your blood sugar level was also tested in the blood test. Maybe inquire again to see if you occasionally have a fast blood sugar drop.

Is your symptomatology fluctuating throughout the day? Or have you been feeling dizzy and pale continuously for the past 5 weeks?

Best regards,
Dr. Meyer