Concluded Case

Vertigo with chest pain

A 55 year old men C/0 spinning sensation with perspiration since 3 days H/O-chest pain with vomiting 3 day ago RBS-182., BP-130/100, ECG-see below was treated with antiemetic, antacid, and tab stemetil but still vertigo is present and recurrent chest pain what can be the cause of vertigo and what treatment is needed No H/O-DM or HTN

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its a case of Bppv, pt was treated with vestibular sedative and PPI now no complaints, his lipid profile,CBC were done which are WNL
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ECG shows Left axis deviation, LAHB , incomplete RBBB, bifascicular block Needs cardiac workup Present case is probably is due to diabetic vestibulopathy , / BPPV , with gastritis Suggest tab betahistin 16 mg TDS , domperidone + PPI , absolute rest . Audiogram, MRI brain needed . Good control of BP and DM
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Hypertension to be treated( blood for lipid profile ur Cr ). Rule out Anaemia. Blood for FBG PPBG Hba1c for confirmation of Diabetes Mellitus. ( There may be Hypoglycemic episodes). USG of Whole abdomen ( r/o- Cholelithiasis). Treatment accordingly.
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Complaints are suggestive of likely episode of 1 CVA 2 ACS hospitalise the pt for further evaluation and management
Sir there is no fnd and pt is conscious & oriented. And ECG taken after episode of chest pain with perspiration shows rbbb
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? BPPV.. ? LABRYNTHITIS.. ? MENIERES DISEASE..
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DM HTN ( DIASTOLIC HTN ) BERTIHO ECG= SINUS RATE AROUND 60 ,/ MT BIFASCULAR BLOCK ( LAHB + RBBB ) HIS SYMPTOMS ARE DUE TO VERTIGO CAUSE TO BE DETERMINED LOOK FOR NYSTAGMUS HORIZONTAL / VERTICAL ? SITE PLANTERS FINGER NOSE TEST DYSDIADOCOKINESIA ? ROMBERGERS SIGN NUSTAGMOGRAM CALORIC TEST HALLPIKE MANUAVRE OPTOKINETIC TEST VESTIBULAR SEDATIVE DRUGS MAY BE GIVEN FOR SHORTPERIOD LONG TERM USE CONRTAINDICATED CONTROL BLOOD SUGAR & BLOOD PRESSURE SALT RESTRICTION IN DIET TO TRY FIRST IN HTN MEDITATION YOGA WALKING AFTER VERTIGO IS NOT THERE LOW GLYCEMIC DIET WEIGHT REDUCTION IF OBESE METFORMIN 500 OD PC
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ECG shows LAD and RSR' pattern in v1 If vertigo is a/w positional changes then rule out BPPV... Do a complete neurological exam and see if there is presence of any nystsgmus.. BPPV causes mixed vertical torsional nystagmus whereas unilateral ear lesion causes unidirectional nystagmus... Chest pain can be due to Reflux and a course of PPI can be tried... if still not found, echo can be done
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It looks like BPPV(benign paroxysmal positional vertigo).ecg is normal. He is a diabetic & hypertensive.both have to be evaluated and managed as per the lab reports. Needs 2d echo.can be managed with. Tab vertin & sturgeon forte.pl refer to a neurologist for head tilting test & his opinion
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Ecg -TWNL except sinus bradycardia. Advse-1-ENT check up. 2-neurological checkup. 3-cect head. 4-xray neck lateral view. 5-Diabetic profile -plasma glucose fasting and pp after 2hrs. Meanwhile vestibular sedatives gemvert md 1tds tab domperidon 10mg 1tds bed rest. Then as per reports.
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its a case of Bppv, pt was treated with vestibular sedative and PPI now no complaints, his lipid profile,CBC were done which are WNL
ECG - RBBB D/D- BPPV Labrynthitis Investigation :- 2D echo Add tab.stugeron forte 1 OD Neurophysician opinion
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