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911DOC, Board Certified Dr.
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Experience:  Emergency Medicine Physician
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Our daughter who is 20 years old has been experiencing

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Hi. Our daughter who is 20 years old has been experiencing symptoms which her doctor says relates to low blood pressure and has stopped trying to treat. We wonder nonetheless if another might have a different perspective and perhaps be able to offer advice. She feels faint after working out, and often has to lie down in order not to lose consciousness. This often happens at about the same place on her way to the changing rooms after her workout, where she feels the same progression of symptoms as her pulse rate drops. She feels unbalanced, a bit naseous, and then dizzy. Once she fainted for some seconds, but once - not related to working out but rather to dancing at a party, about 1.5 hrs. after consuming some wine and a mixed drink - she fainted for about 15 minutes and was taken by ambulance to the hospital. She almost never drinks alcohol and claims that on this occasion, she had not had much and that a long time before, and she was fully aware and sober and remembers everything up to the point of fainting. She says she felt a need for fresh air, and a few of her friends were on their way outside, when she felt a need to sit down on the stair. An employee at the "Club" asked her not to sit there but go outside, so she rose up but thereafter fainted.
She does not have any other health conditions, has always been healthy and active, is normal to slim weight, and uses no other medication but for birth control pills which are of a type that prevents menstruation.
She has known low blood pressure (ca. 90-100/60-70), and under one of these episodes of not feeling well, my brother who is a doctor found it difficult to feel her pulse; it was "thin and thready".
She is white Anglo-Saxon of English/Polish/Swiss descent.
She is reluctant to ask her doctor again, since he feels these symptoms are related to her low blood pressure and therefore not treatable. She has taken many bloodtests which have not shown anything unusual, though I do not have the results of these to know exactly what has been tested.
Thank you in advance for any advice you can give! She is travelling to another country in August and we would appreciate preparing her as well as possible to deal with her condition before she leaves.

your daughter needs to be evaluated by a cardiologist.

i do not believe that blood pressure is the primary culprit here, I am more concerned that in a young and otherwise healthy woman that she is experiencing exertional syncope (fainting during exertion).

this is not something her physician should be ignoring.

here is a helpful link on fainting (syncope)....

notice that this link speaks specifically about the benign cause of fainting, but if you read about testing, you will see that specific tests including an ultrasound of the heart and cardiac monitoring are essential in ruling out dangerous causes.

I would not hesitate to ask to be referred to a cardiologist for 'exertional syncope'. this is where you should start.

please let me know if you have questions about my answer.


Customer: replied 4 years ago.

Hi, and thank you for your good response. My only question relates to the fact that our daughter never feels faint WHILE exercising, only as her heart rate returns to normal afterward. She also says that it never comes on unexpectedly, but always with the recognizeable sequence of "signs". Do you still consider this "exertional syncope"?

If there were heart irregularities associated with these symptoms, could you please indicate what they might be?

Again, thank you for any help you might be able to offer in helping us to understand our daughter's condition.

I think that's the place to start... in your original post you state that after excercise she has to lie down in order not to pass out.

This is not as worrisome as passing out while exercising to be sure, but it still points to a possible problem with the heart. A rhythm disturbance for instance.

A holter monitor (computer recording of her heart rhythym) would be a good place to start, and an ultrasound of the heart could find any structural abnormality such as Hypertrophic Cardiomyopathy.

I'm not suggesting she has either a rhythym disturbance OR hypertrophic cardiomyopathy, and it may well be that she has a problem with her blood pressure and the neurological pathways that maintain adequate blood pressure, but what I AM suggesting, is that this is not something to simply blame on low blood pressure and be done. Her condition requires further investigation to take the 'bad' diagnoses off the table. Since her doctor is not interested in pursuing this I would not hesitate to get a second opinion, and I think the best place to start would be with a cardiologist.

As you can see from THIS LINK, the evaluation of fainting (syncope) is quite complex as there are so many possible causes. The point is to start looking.


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