Dizziness while digging

SCENARIO

Julia, a 62-year-old woman, presented with a history of profound dizziness that came on suddenly while gardening on a very warm afternoon.

She had no chest discomfort or dyspnoea, but felt a sensation of rapid heart rate. The symptoms persisted, so she called her daughter and insisted she drive her to the nearest emergency department, 25 minutes away, despite her daughter’s strong encouragement to call an ambulance. She remained fully conscious and alert on the journey.

Julia had been a smoker for 15 years, but gave up over 20 years ago. She was on medication for hyperlipidaemia and hypertension. Upon arrival at the emergency department, she was pale and tachycardic. Her BP was 85/60.