Differential Diagnosis for 70 y/o Female with 4 Days of Dizziness when Standing
- Single most likely diagnosis
- Orthostatic hypotension: This is the most likely diagnosis given the patient's symptoms of dizziness when standing, which is a classic presentation of orthostatic hypotension. This condition is common in the elderly due to age-related changes, dehydration, or medication side effects.
- Other Likely diagnoses
- Benign paroxysmal positional vertigo (BPPV): Although BPPV typically presents with vertigo triggered by specific head movements, some patients may experience dizziness when standing. The condition is common in the elderly and can be related to inner ear problems.
- Vestibular neuritis or labyrinthitis: These conditions can cause dizziness and vertigo, and while they might not be as directly related to standing, they could contribute to a sensation of dizziness when changing positions.
- Dehydration or volume depletion: Elderly individuals are prone to dehydration, which can lead to dizziness upon standing due to decreased blood volume and subsequent orthostatic hypotension.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cardiac causes (e.g., arrhythmias, heart block, cardiac tamponade): Although less common, cardiac issues can lead to dizziness when standing due to inadequate cardiac output or abnormal heart rhythms. Missing these diagnoses could be fatal.
- Severe aortic stenosis: This condition can cause dizziness or syncope upon standing due to fixed cardiac output and inability to increase blood pressure appropriately.
- Subclavian steal syndrome: A rare condition where there's a significant stenosis or occlusion of the subclavian artery, leading to reversal of blood flow in the vertebral artery, which can cause dizziness or syncope when exercising the affected arm or standing.
- Rare diagnoses
- Autonomic dysfunction (e.g., pure autonomic failure, multiple system atrophy): These conditions affect the autonomic nervous system, leading to orthostatic hypotension and other symptoms. They are less common but should be considered in the differential diagnosis of persistent or severe orthostatic hypotension.
- Adrenal insufficiency: A rare condition where the adrenal glands do not produce adequate amounts of hormones, including those that help regulate blood pressure, leading to orthostatic hypotension.