What is the cause of vertigo: The disease or the treatment?

by Hillary  Weston

 

More then 300 medications that are approved for treatment of various medical conditions, may cause vertigo, dizziness or both. An exacerbation in vertigo or dizziness can be another side effect of these drugs. The physician who prescribes the medication can not predict the effect on the vestibular system of his patient, if it is the first time that his patients takes this drug. Furthermore: a medication that was innocent in the past, may cause imbalance symptoms in advanced age.

 

When a cardiologist is injecting an IV medication as part of a life saving procedure, the possibility of vertigo as a side effect is not important. The physician must focus on the issue of saving life. The situation is different in elective treatments of which vertigo or dizziness are side effects.

Shemesh Zecharya (M.D.) from "Hadassah Ein Kerem" hospital in Jerusalem is presenting illustrative examples from the field of Cardio-vascular diseases.

 

What is the cause and what is the outcome of the treatment?

When the patient is experiencing a severe imbalance with vertigo or dizziness - this question may become the most important issue in the treatment. Based on the intensity it is possible to classify the diseases to two categories: Acute onset and Gradual onset. I did not use the term "Chronic onset" because the "Acute onset" may continue as "Chronic onset".
 

When the patient can tolerate the process of deep investigation of the precipitating factors of his vertigo or dizziness, the physician and the patient can isolate the relevant factors and regulate the medication that could cause it. In the next line we shall try to relate to more specific examples from the spectrum of treatments for Cardio-vascular diseases.

Hyperlipidemia is a diagnosis of elevated blood fats such as Total Cholesterol, HDL cholesterol, LDL Cholesterol or Triglycerides. Analysis of the blood picture of fats by an expert can assist in recognizing an increased risk of cardio-vascular diseases or weather there is no risk.

 The first step in treatment is a special diet. When there is no benefit from the dietary treatment, the physician offers a drug treatment, and the most common medications for decreasing the risk are classified as "Statins". 

This treatment can be applied slowly and gradually. In low doses of the statins, the treatment is tolerated very well. When there is need to increase the dose to high levels, some patients will suffer from side effects, Vertigo, Dizziness or Tinnitus (sensation of noise in the ears or the head) may occur.

Cardiac Arrhythmia may be accompanied by vertigo or dizziness. The Cardiologist will have to decide what is the underlying cause: the anti arrhythmic medication or the Cardiac Arrhythmia itself. When a patient is admitted to emergency room, part of the routine data exchange includes a brief convey of information using short professional terms between the medical staff, and as a result, nobody writes in the chart that there are problems of imbalance.

When there are co-dominant symptoms: vertigo and treated cardiac arrhythmia the cardiologist should differentiate between episodic abnormal cardiac activity and side effects of the anti arrhythmic medication. Drugs such as Lidocaine, Tocainide, Mexiletine, Moricizine or Dofetilide are in the list.

 

Another possible combination: vertigo due to side effects of medications that is limited to the episode of the cardiac arrhythmia.

 

A more complicated medical condition may happen when there is no vertigo, but there are attacks of nausea or vomiting. It may occur during treatment by Quinidine (nausea. May cause tinnitus), Procainamide, Propafenone, Amiodarone (nausea alone) and Ibutilide (nausea alone).

 

In emergency room, under conditions of stress it is possible that someone will write down in the medical chart of the patient: "vertigo, nausea and vomiting" instead of just "nausea and vomiting".

 

It is obvious that in a patient with Cardiac Arrhythmia the medical staff gives the highest priority to the investigation of the cardio-vascular parameters and (temporarily) neglect all other factors. The patient that wants a relief from his/her vertigo or dizziness may remain frustrated.

 

In the bottom line: even if the symptoms of a cardiac event are very mild, it is important to start the medical workup from a cardiologist, and only then go to a clinic for evaluation and treatment of vertigo and dizziness.

 

What treatments do you give your patients?

My patients come after failure of the physiotherapy, drug treatment such as betahistine or cinnarizine, given by otolaryngologists or insufficient effect of sedative medications that were prescribed by a psychiatrist. I offer my patients metabolic intervention. In most patients it is very effective.

 

For further Reading: http://www.tinnitus-vertigo-clinic.com

* This article can not come instead of examination and treatment by an expert.