90 year old feeling dizzy, disoriented with high blood pressure. What should I do?
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There are several causes of dizziness – brain, ear and so on. Brain may not the prime suspect here - in the absence of numbness or tingling. So is ear, in the absence of tinnitus. Of course, they can not be excluded, but low in priority.
In this situation, the priority is cardiovascular. Sudden turning movement precipitating this may point to blood vessels of the neck. A Doppler study or MRA of carotid and vertebral arteries for possible narrowing is in order. Cervical spondylosis (neck bone degeneration) commonly contributes.
Shooting of BLOOD PRESSURE at that time could be reactive. It has to be checked again – and again – before modifying the medication. Blood pressure may need to be monitored for 24 hours (There are ambulatory monitors)
Slow HEART RATE at that time could be the cause or consequence. When the pressure is high, the rate may be slow. Metoprolol can reduce the rate – but a few days are enough to clear it from the body. 24 to 48 hour ambulatory monitoring (Holter) is generally done to analyse hear rate. It will shed light on the role of heart rate and help in management. Sick Sinus Syndrome is a common cause for a low heart rate at this age.
Avalide has a diuretic – we should check his electrolytes, especially POTASSIUM.
The first thing to do in a situation like this is to make him LIE DOWN flat (Sitting is not enough). A flat posture increases blood supply to the brain. Steps should be taken to avoid injury.
The next and most important step is to see his doctor – as soon as possible. He may need a battery of investigations – the aim is to prevent future episodes. Control of pressure and management of heart rate are in need.
In the absence of associated morbidity, the prognosis looks good
Wishing him speedy recovery
God bless him
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