Q. Why did I have a four-second arrhythmia when I stood up?

Answered by
Dr. Muhammad Zohaib Siddiq
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Mar 12, 2021 and last reviewed on: Apr 15, 2021

Hello doctor,

I am a 17-year-old male. About a month ago, I passed out after watching a movie first responders came and said I was fine until they asked me to stand up, and that is when a four-second arrhythmia occurred. I was rushed to the emergency room and was told I needed a pacemaker, and there was no reason for me to pass out as my blood work was fine. The following day I had an appointment with a doctor, and he said it was just a vasovagal syncope. However, after reviewing my blood work personally I noticed my fibrinogen and platelet count were low, and I had slight hemolysis and mild positive D-dimer. Could this be from COVID because these levels are all COVID-like but I do not feel incapacitated at all? I have been a little out of balance lately, but could COVID be the reason? At first, I thought it was dysautonomia due to all the symptoms, but I do not believe that is the case anymore.



Welcome to

Thanks for the query.

The transient loss of consciousness with loss of postural tone but with spontaneous and complete recovery is called syncope. The most common in the general population is vasovagal syncope. Please answer some questions so that I may rule out the causes of syncope.

This occurred while you were in a standing position for a long time, or you just stood up from a sitting position?

What did you feel a minute to seconds before passing out?

Was there a tongue bite, urine voiding during the episode?

The regaining of consciousness was immediate and spontaneous or otherwise?

Were you totally aware of the surroundings and peoples around you or not after regaining consciousness?

Any such event in the past?

Do you suffer from any known cardiac issues?

Are you taking any medicine for hypertension?

Are you suffering from dehydration?

Any addiction to illicit or street drugs?

Anyone with first-degree relatives has such episodes or suffer from the known cardiac disease?

Any sudden death in the family, especially first-degree relatives?

Platelets, fibrinogen, d-dimers have no direct link with passing out.

Please have some tests done:

ECG (electrocardiogram).

TSH (thyroid-stimulating hormone).


Hi doctor,

I got tested for COVID, and it turns out I have COVID and influenza at the same time, and that has been causing all of my symptoms. They recommended Aspirin because of the high risk of clots. Can I take it although I am under 18?



Welcome back to

Thanks for the query

There is data that Aspirin has a protective role. In a study, it was shown that those admitted in the ICU for COVID-19 and who are on treatment of COVID-19, Aspirin, were associated with the decreased need for mechanical ventilation compared to those who were not receiving Aspirin. This is just a small retrospective trial, and further data is needed. This shows protection only in case the patient is admitted to ICU. Regarding those patients who are on home treatment, there is still no evidence available regarding the role of Aspirin. As you said, you have a low platelet count, but you did not mention absolute numbers, be cautious in taking Aspirin as Aspirin inhibits platelets and may cause more tendency to bleed.


Hello doctor,

Thank you for the reply.

My MPV (mean platelet volume) is 7.80 on my latest test but at first it was 9.3.

My RDW (red cell distribution width) is 11.

My WBC is 9.600.

My platelets are 199.

Basophil absolute 0.06.

NRBC absolute.



Welcome back to

Thanks for the follow-up.

MPV 7.5 to 12 fL is the normal range. You are within the range.

Your platelet count is also within the range.

If you are taking low-dose Aspirin, continue it.

Hello doctor,

And D-dimer is 0.75 PTT. Is it high?



Welcome back to

D-dimer 0.75 is slightly increased and it is increased in COVID-19.

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