Presenting Complaints

• 39-year-old female patient presenting with complaints of dizziness for the past 2 weeks.

History of Presenting Complaint

• Patient reports feeling lightheaded, unsteady, and occasionally experiencing a sensation of the room spinning, especially when standing up quickly.
• Dizziness is accompanied by palpitations and a brief feeling of chest discomfort that resolves quickly.
• Symptoms are worse in the mornings and when changing positions, but occur intermittently throughout the day.
• No associated nausea, vomiting, or loss of consciousness.
• Denies any recent head trauma or injury.

Significant Positives & Negatives For Differentials

Cardiac Arrhythmia

Positives:

• Intermittent dizziness and lightheadedness
• Associated palpitations and chest discomfort
• Worse with position changes
• History of hypertension
• Family history of heart disease

Negatives:

• No loss of consciousness
• No clear triggers for symptoms
• No history of known arrhythmia

Orthostatic Hypotension

Positives:

• Dizziness and lightheadedness with position changes
• History of hypertension and medications
• No associated neurological symptoms

Negatives:

• Symptoms not consistently triggered by standing up
• No significant drop in blood pressure documented

Benign Paroxysmal Positional Vertigo (BPPV)

Positives:

• Episodic dizziness and vertigo
• No associated neurological symptoms
• No history of head trauma

Negatives:

• Symptoms not clearly triggered by head/body position changes
• Presence of palpitations and chest discomfort

Past Medical History

• Hypertension, diagnosed 5 years ago and controlled with medication
• No history of heart disease, stroke, or other cardiovascular conditions

Drug/Medication History

• Lisinopril 10 mg daily for hypertension
• No other regular medications

Social History

• Works as an office administrator, mostly sedentary job
• Married with 2 young children
• Denies smoking, alcohol, or recreational drug use

Family History

• Father had a heart attack at age 60
• No family history of sudden cardiac death or inherited arrhythmias

Systems Review

• Cardiovascular: Palpitations, chest discomfort
• Neurological: Dizziness, lightheadedness, unsteadiness
• All other systems review normal

Ideas, Concerns & Expectations

• Patient is concerned that the dizziness may be a sign of a more serious underlying condition, possibly related to her hypertension or family history of heart disease.
• She hopes the doctor can determine the cause of her symptoms and provide appropriate treatment.

Case Presentation

Based on the patient's presentation, the most likely diagnosis is some form of cardiac arrhythmia. The key features supporting this include the intermittent dizziness/lightheadedness, associated cardiovascular symptoms like palpitations and chest discomfort, and the patient's risk factors such as hypertension and family history of heart disease. While other diagnoses like BPPV or migraine cannot be completely ruled out, the predominance of cardiac symptoms and signs make a cardiac etiology the most plausible explanation for this patient's presentation.