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Felt nausea and dizzy. Having panic attacks, anxiety and fatigue after having physical activity. What to do?

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Answered by

Practicing since : 1998
Answered : 1306 Questions
hi doctor,

I am writing with an act of desperation..

I have always been a sport addict boxing, gym, swimming...

About a year ago while training I felt nauseous dizzy an went pale. They took me to emergencies they did tests, ECG, tension, blood pressure.. nothing. It was clearly a normal issue.

The day after I started having panic attacks anxiety, fatigue, pale face.... Started to really worry so went to visit doctors. Had fatigue a anxiety red eyes mood swings issues sleeping morning fatigue, sometimes tinglings and muscles shaking for about 5months then things went better(took magnesium supplements) I remember. After that started going gym again training well sleeping well (was never perfect but better) then lately it came back... always worsen by physical activity any (running climbing stairs gym or even sex). Saw so many specialists : neuro, XXXXXXX medicine, sport doctor, endocryno, psychiatrist, heart doctors etc... each one of them doesn't find anything and says it may be stress. Well I know it is not, I live in dubai, lot of sun, nice job, nice environment, and if it was I would be in a bad shape all the time!! Well why is it most of the time triggered by physical activity?

I went to visit another endocrinologist who told me you have diabetes in your family (grand ma grandpa, dad) you must have bad genes!! Well I always eat healthy for 6 years now as I used to compete, proteins complexes carbs, fruits veggies... he said you have reactional hypoglycemia do a test : 4 blood test in the morning while fasting : 1 blood test result was 90 - 2nd after hyper sweet drink result 120 -then 3 test and hours after that result 70. He concluded I was reactional hypoglycemic. I am not a doctor but I am sorry this is not bad results they seem normal to me.

Nowadays i have learned a lot about all the deseases, my knowledge is quite good over a year (when it all started) - can sum the symptoms this way.

If no exercise : morning fatigue - irritability (times to times) - fatigue that starts with red eyes (after 15 20 min walk for example).

If exercise : anxiety, muscle movements, exercise intolerence, nausea, fatigue (need 3 or 4 days to recover).

I beg you if you can doctor help me cause I am desperate no sports no physical activities and above all living with something no one seems to understand.

TESTS DONE : XXXXXXX desease - Brain MRI, Blood test, Tyroids, Holter, ECG, Brain activity, magnesium and other vitamines, sugar levels and diabetes... all normal...

Many thanks.
Posted Sat, 22 Jun 2013 in Hypertension and Heart Disease
Answered by Dr. Sukhvinder Singh 9 hours later
Dear Sir,

I am a certified cardiologist in India and would like to explain your symptoms from cardiac point of view. Can you help me by providing following inputs:-

1.     If you have undergone a stress test (like TMT/Exercise ECG/ stress echo/ stress Thallium)? What were the results? I would be obliged if you can send me a copy of its report along with full graphs.
You have a feature to upload the reports/images by yourself on the right side of this query page. You may want to utilize it.

2.     What was your ECHO report? Please send a copy of it too.

3.     You have undergone Holter monitoring. Were the symptoms evoked on day of monitoring by exercise?

4.     Can you elaborate your symptoms further? What you feel? What others observe? How long it lasts. Say if you rapidly climb stairs or you had a session of "intercourse" What happens and how long it lasts?

5. What are the medicines you are currently taking?

5.     If your blood sugar level or ECG was done immediately after an episode? (Within next few minutes)?

Looking forward to your next mail.

Above answer was peer-reviewed by
Follow-up: Felt nausea and dizzy. Having panic attacks, anxiety and fatigue after having physical activity. What to do? 42 hours later
Hi doctor,

Thanms for your reply.

1) I have done stress test (200 while running) doctor had nothing to say except that my heart was solid.
Did also ecg there was nothing he said. Iam not sure what thallium and tmt is sorry.

2) I did ad24hrs holter and went exercising that day, didnt have much symptoms that night, I was 80% ok.

3) symptoms :
It first dependa if I exercise or not.

Let us start with no exercise : fatigue most of the day will go from nice to tired periods ie wake up in the morning automatically tired (80% of the time), will feel ok for hours then super tired for few others. If I take a walk 20 min more my eyes become red and wet I start yawning and I need to sit for few minutes. Then I fet a bit irritable and moody.

If i exercise : 10 to 30 min after i start i feel tired and my heartbeat increases and takes long to slow down.
Then anxiety kicks in get focused on myself nervous scared of any desease that I might have, stressed irritable, very sensitive to loud noise, when people speak to long I get issues focusing, concentration issues, some short term very mild memory losses, amd forget names sometimes, have the image on my mind but cant recall the name. Headaches ( very mild and short termed), issues sleeping with adrenaline rushes when falling asleep. Weight loss ( muscle cause I stop training), muscles that move alone (due to weighlifting when you stop according to some doctors).

See how weird this is.. i am lost and not sure where to go anymore.

Thanks a lot doctor, very hard for a competitive sport person like me to do nothing all of a sudden..

Answered by Dr. Sukhvinder Singh 4 hours later
Dear Sir
Thanks for the details.
1. If you underwent a stress test (running) with heart beat reaching 200 bpm and you did not get any symptoms during stress, then it indicates that a heart issue is unlikely. I wish to emphasize that had it been a cardiac issue you should have got symptoms while running too. TMT (treadmill test) is a way of giving exercise to patient while his ECG is continuously being monitored. In some part of world "cycle ergometry" is used in place of treadmill. Stress Thallium is a radio-nucleides based stress test.
2. A Normal holter report with ~20% of symptoms (as you mentioned that you were 80% fine) again speaks against cardiac issue.
3. Most of your symptoms seems to be neurological /psychological in nature, although an endocrinological (hormonal) cause will be ruled out by an expert endocrinologist only. I would request you to consult a neurologist/ psychologist for further guidance. A blood sugar level just when you are symptomatic will help in ruling out rare glucose metabolism disorders.
4. You did not mention anything about your cardiac ultrasound (ECHO)..
Hope this helps. Feel free to write if there is anything else.
Above answer was peer-reviewed by
Follow-up: Felt nausea and dizzy. Having panic attacks, anxiety and fatigue after having physical activity. What to do? 11 hours later
Hello Doctor,

Also had an echo that was normal.

I had a full EMG today with a neurologist everything seemed to be normal...

Can it be anything related to NMH? Neurally mediated hypotension?

What do you think?

Many thanks.
Answered by Dr. Sukhvinder Singh 26 minutes later
Dear Sir
I would not keep this possibility high up in the table because basic fact is that along with signs of hypotension (some of them you have), there should be slower heart rate , at least initially. Moreover, classically it causes sudden drop in BP after prolonged standing or after standing suddenly from lying down posture. Fall is so abrupt that you fell down or you have a blackout. The symptoms usually have a strong relation to posture. They may be recurring in certain peculiar situations also, like coughing, urinating, swallowing. Usually this problem starts in adolescence and incidence decreases thereafter.
Since some people with NMH may have chronic fatigue, inability to concentrate, headaches and confusion, it can not be entirely ruled out. A simple check for postural hypotension in clinic followed by HUTT (head up tilt table) test is usually required in work-up. A prescription for HUTT requires a clearance from your physician.
Hope this helps
Sukhvinder XXXXXXX
Above answer was peer-reviewed by
Follow-up: Felt nausea and dizzy. Having panic attacks, anxiety and fatigue after having physical activity. What to do? 5 hours later
Thanks a lot Doctor.

I actually do get dizzy tired anxious when I do groceries or walk for more than 10 20 min. I dont get it when getting up after standin (tried it), but if I get symptomatic after walking a lot standing in queue, visiting museum... I feel better when I sit for a little while.

I will give it a try as I have nothing to lose trying. But not cardiac issue so far doctor right?

Many thanks for your help.
Answered by Dr. Sukhvinder Singh 5 hours later
Dear Sir
Historically and going by your normal stress test, ECG, ECHO and Holter monitoring, possibility of a cardiac issue is less likely.
Even if you really have NMH (by any chance), a neurologist would be most appropriate person to deal with it (if required, in consultation with a cardiologist).
Sukhvinder XXXXXXX
Above answer was peer-reviewed by
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