Medicine
Giddiness
A feeling of dizziness, unsteadiness, or lightheadedness, which can sometimes be a warning sign of a heart rhythm problem.
Dizziness and syncope (fainting) have a broad range of causes — from benign vasovagal episodes to life-threatening cardiac arrhythmias. Structured specialist assessment determines underlying causes and guides appropriate treatment.
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While giddiness can result from minor issues like dehydration, it is crucial to investigate potential cardiovascular causes such as arrhythmias or low blood pressure.
Types of Syncope
- Reflex (Neurally Mediated) Syncope — most common; vasovagal responses triggered by prolonged standing, heat, pain, or emotional stress
- Orthostatic Hypotension — blood pressure drops on standing; common in older patients and those on certain medications
- Cardiac Syncope — highest-risk category from arrhythmias or structural heart disease; requires urgent evaluation
Red Flag Features Requiring Urgent Assessment
- Syncope during exertion
- Episodes preceded by palpitations or chest pain
- Abnormal ECG findings
- Family history of sudden cardiac death in young relatives
Diagnosis
- Detailed medical history and 12-lead ECG
- Echocardiography
- Orthostatic blood pressure measurements
- Holter monitoring and implantable loop recorders
- Tilt table testing
Treatment Options
- Vasovagal syncope: trigger avoidance, increased hydration and salt intake, compression stockings, fludrocortisone
- Bradyarrhythmias: pacemaker implantation
- Ventricular arrhythmias: implantable cardioverter-defibrillator (ICD)
Concerned About Giddiness?
Dr. Peter Chang offers specialist assessment and personalised management at Paragon Medical Centre, Singapore.