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Dr. Andrew Rynne

Family Physician

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Feeling dizzy, vomiting, have high BP and fast heart rate. Any advice?

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Dr. Anil Grover

Cardiologist

Practicing since :1981

Answered : 922 Questions

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Posted on Wed, 12 Dec 2012 in Hypertension and Heart Disease
Question: Hello, my father is 72 and he has just experienced the following sudden symptoms:
- his body suddenly became very stiff and eyes rolled up and could not responding for a couple of minutes.
- sudden dizziness was noted prior to this occurrence
- vomitted on and off for 5 minutes during the occurrence
- diareah during the occurrence
- took his blood pressure at home in his right arm and it was 140 over 112
- the heart rate was 92
- no complaint of chess pains or shortness of breath so far
- feels better when lying down (right now)

Note: this is the second time this has happened in one week...he is a very heavy smoker...And refuses to go to emergency room.

I need some urgent advise on how I should proceed forward...

My email is YYYY@YYYY

Thank you,
XXXXXXX


doctor
Answered by Dr. Anil Grover 5 hours later
Hello XXXXXXX
Thanks for writing in.
I am a qualified and certified cardiologist.pu
I read details of medicines he had been taking, his present symptoms and your suspicion.
You can be right then he should be in emergency room. However diagnosis of heart attack according to World Health Organization is based on presence of 2 out 3 criteria being present.
1. Prsence of typical central pain he does not have pain. That is possible
2. Raised cardiac enzymes like serum myoglobin, creatine phospho kinase myocardial fraction CPK-MB. Serum troponin I or T levels no information available
3. ECG changes typical of hyperacute or acute myocardial infarction not avaiable.
That makes difficult to make a definitive diagnosis of heart attack. It is possible in emergency room. That brings me to second possibility based on background illness one can make out from the medicines he had been on is cerebrovascular accident. Which also can be diagnosed by him being seen by a doctor. I hope in the interim you had taken him to ER and some headway in the diagnosis and treatment been made please write that so that I can be of some help. If you have any question for me. Please do write I shall be happy to answer. Best of Luck.

Regards
With Best Wishes:
Dr Anil Grover
MBBS, MD (Medicine) DM(Cardiology)
Cardiologist and Internist
http:/ WWW.WWWW.WW


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Anil Grover 7 hours later
Dear Dr XXXXXXX

Could this have been related to a stroke? If you look at sever various articles I was researching last night prior to your response and after the occurrence occurred it states that a seizure can be caused by a stroke, see below articles:

1) First epileptic seizures in old age suggest high risk of subsequent stroke
Reference: WWW.WWWW.WW
2) Management of seizures following a stroke: what ... [Drugs Aging. 2012] - PubMed - NCBI
Reference: WWW.WWWW.WW
3) What Is the Connection Between Strokes and Seizures?
Reference: WWW.WWWW.WW
4) Seizure Disorders in the Elderly - January 15, 2003 - American Family Physician
Reference: WWW.WWWW.WW
Most importantly please note the below from article 4:

"A five-year study of 151 patients with a first seizure after 60 years of age found that 32 percent of the seizures were caused by strokes and 14 percent by brain tumors, including meningiomas, malignant gliomas, and brain metastases; 25 percent had no identifiable cause. A community cohort study of 675 patients with a first stroke found that the risk of having a seizure was 2 percent at stroke onset and 11 percent in the first five years after the stroke. Seizure recurrence after a stroke can be immediate, or it may not happen for several years. Recurrences are more common after hemorraghic or severe ischemic strokes with cortical (particularly occipital) involvement and late onset of the first seizure".

I am assuming that his symptoms could be a seizure and I would like your expert opinion as we noted the following:

- his body went stiff and eyes rolled up for two minutes
- he was unresponsive for two minutes
- all his muscles got very tight in his body
- he was spitting up a little and his face started to shake left and right
- he began to vomit slowly
- he had trouble breathing for that short period during the event

Importantly to note, cerebrovascular accident never occurred, he is taking topamax for essential tremors, my father refused completely to go to the ER and he then started to lie down yesterday and relax. My mother woke him a few hours later and he was responsive to some extent but very exhausted. Note he has been now sleeping for 12 hours and woke about 5 hour ago and complained of sever dizziness and then went back to bed and is still sleeping till now.

When my father woke he had full use of his limbs and was speaking normally. No verbal disability noted.

My main concer here based on the above articles that I read, and not I am not a doctor, so I am not the expert, was this a stroke?? In my opinion this would be very serious and would need us immediately to take him to the hospital.

For the blood enzyme test is there a time limit window to take the test after the occurrence as it has been exactly 12 hours since the occurrence took place.

Right now he is having the best sleep he ever had and is sleeping straight though the night. This is the first time he has had a contusions sleep straight through the night in years as he he used to wake every few hours in the past during the night and used to stay awake very often Witt being able to go back to sleep.

Please respond ASAP as my father is still at home and has not been to the ER and refuses to go.

All the best, XXXXXXX
doctor
Answered by Dr. Anil Grover 1 hour later
Thanks for your writing back.
I shall be very brief and to the point.
Yes, it can be stroke.
No some cardiac enzymes are useful in diagnosis of heart attack up to 2 weeks in any case EKG will show evidence literally for rest for his life.
You are wsting your time, I am sorry to say by reading articles and not attending an uncooperative person. Use all persuasive powers or call help, he should be in ER asap even if it is stroke many a things which result in bad sequelae are treatable at this stage. Good Luck
With Best Wishes

Dr Anil Grover
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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