Presenting Complaints

• 11-year-old female presents with episodes of dizziness and lightheadedness.

History of Presenting Complaint

• Patient reports experiencing episodes of dizziness, lightheadedness, and feeling like she may faint for the past 2-3 months.
• Episodes typically occur when standing up quickly or during physical activity. They last for 30 seconds to 1 minute and then resolve on their own.
• Patient denies any chest pain, palpitations, shortness of breath, or loss of consciousness during these episodes.
• She reports feeling generally well otherwise, with no recent illnesses or changes in her health.

Significant Positives & Negatives For Differentials

Supraventricular Tachycardia (SVT)

Positives:

• Episodes of dizziness and lightheadedness triggered by standing up or physical activity
• No loss of consciousness
• No chest pain or palpitations

Negatives:

• No history of documented tachycardia episodes
• No family history of arrhythmias

Atrioventricular (AV) Nodal Reentrant Tachycardia

Positives:

• Episodes of dizziness and lightheadedness triggered by standing up or physical activity
• No loss of consciousness
• No chest pain or palpitations

Negatives:

• No history of documented tachycardia episodes
• No family history of arrhythmias

Wolff-Parkinson-White (WPW) Syndrome

Positives:

• Episodes of dizziness and lightheadedness triggered by standing up or physical activity
• No loss of consciousness
• No chest pain or palpitations

Negatives:

• No history of documented tachycardia episodes
• No family history of arrhythmias

Mitral Valve Prolapse

Positives:

• Episodes of dizziness and lightheadedness triggered by standing up or physical activity
• No loss of consciousness
• No chest pain or palpitations

Negatives:

• No murmur or other signs of structural heart disease on examination
• No family history of mitral valve prolapse

Vasovagal Syncope

Positives:

• Episodes of dizziness and lightheadedness triggered by standing up or physical activity
• No loss of consciousness
• No chest pain or palpitations

Negatives:

• Episodes do not resolve spontaneously within 1 minute
• No history of fainting or near-fainting episodes

Orthostatic Hypotension

Positives:

• Episodes of dizziness and lightheadedness triggered by standing up
• No loss of consciousness

Negatives:

• No significant drop in blood pressure with standing
• No other symptoms of autonomic dysfunction

Anemia

Positives:

• Episodes of dizziness and lightheadedness
• No other concerning symptoms

Negatives:

• No signs of chronic blood loss or nutritional deficiencies
• Normal hemoglobin and hematocrit levels

Dehydration

Positives:

• Episodes of dizziness and lightheadedness
• No other concerning symptoms

Negatives:

• No history of recent illness, vomiting, or diarrhea
• Normal vital signs and physical examination

Past Medical History

• No prior medical conditions
• No history of heart disease, arrhythmias, or other cardiac issues
• Up to date on all childhood vaccinations

Drug/Medication History

• No regular medications
• No over-the-counter supplements or herbal remedies

Social History

• Lives with both parents and younger sibling in a rural village in India
• Attends school regularly and participates in some physical activities
• No history of tobacco, alcohol, or drug use

Family History

• Father has hypertension, controlled with medication
• No family history of sudden cardiac death, arrhythmias, or other heart conditions

Systems Review

• Cardiovascular: No chest pain, palpitations, or syncope
• Respiratory: No shortness of breath, wheezing, or cough
• Gastrointestinal: No nausea, vomiting, or abdominal pain
• Neurological: No headaches, seizures, or focal neurological deficits

Ideas, Concerns & Expectations

• Patient and family are concerned about the episodes of dizziness and the possibility of an underlying heart condition.
• They are hoping for a thorough evaluation to determine the cause and appropriate treatment.

Case Presentation

Based on the patient's history and the significant positives and negatives for the various differential diagnoses, the most likely diagnosis is a cardiac arrhythmia or structural heart defect, such as supraventricular tachycardia (SVT), atrioventricular (AV) nodal reentrant tachycardia, or Wolff-Parkinson-White (WPW) syndrome. These conditions can cause episodes of dizziness and lightheadedness, especially with standing or physical activity, without other concerning symptoms like chest pain or loss of consciousness. Further evaluation with an electrocardiogram (ECG) and potentially other cardiac testing would be warranted to confirm the diagnosis and guide appropriate management.