Submitted by Dr T on August 25, 2013 – 4:59pm
The ECG reading explains nothing about your symptoms. While vertigo may be associated with a cardiac problem, this EKG doesn’t prove anything. You need a doctor’s consultation to evaluate your heart, your ears and possibly your brain as well as other causes.
An assessment for any serious underlying disorder requiring urgent treatment such as coronary artery disease, cerebrovascular disease.
Identifying the nature of the presenting symptom in terms of true vertigo, syncope (fainting), presyncope or any other form of dizziness. Dizziness can usually be categorised into one of four main groups:
- Vertigo is defined as an abnormal sensation of movement, either of the surroundings or the person. Descriptions of vertigo include spinning, tilting, and moving sideways.
- Most cases seen in primary care are due to peripheral vestibular disorders such as benign paroxysmal positional vertigo, acute vestibular neuronitis and Ménière’s disease, but causes also include central nervous system disorders such as vascular incidents or multiple sclerosis.
- A feeling of lightheadedness, muscular weakness and feeling faint. Features may suggest a specific diagnosis.
- A sensation of unsteadiness, not localised to the head, that occurs when walking and is relieved with rest.
- The most common cause of disequilibrium is ‘multiple sensory deficits’ in elderly patients, who may have deficits with all three balancepreserving senses, ie vestibular, visual and proprioceptive.
- Nonspecific dizziness:
- Many patients with dizziness do not have specific features of vertigo, disequilibrium or presyncope. The history is vague beyond a complaint of dizziness and there are no features that would point to causes in one of the other categories.
A careful examination is required in order to assess a possible underlying cause; for example:
Cardiovascular: Blood pressure: sitting position, and also supine and standing, to assess any significant drop in blood pressure. Also the heart needs to be checked for a heart murmur, and the arteries to the brain need be checked for a noise called carotid bruit, suggesting decreased blood flow.
Eyes: visual impairment, nystagmus
Features of cerebrovascular disease, peripheral neuropathy or Parkinsonism. Check heel to toe walking if abnormal, test reflexes and tone in the lower extremities, and test plantar responses. Put the opposite heel on the knee and to run the foot down and up the shin (assuming the patient is physically able to do this).
As you can see a lot needs to be done before a diagnosis can be made.
Hope this helps,