Dizzy spells could mean ear crystals have moved: Ask the GP DR MARTIN SCURR

Is there any treatment for vertigo? My consultant discharged me from the balance clinic earlier this year after an MRI and other tests found nothing wrong. But since then I have had three more attacks (the vertigo started 18 months ago). I was prescribed cinnarizine but the pills do not relieve the vertigo.

Joan Jones, Shepperton, Surrey.

The term ‘vertigo’ in medicine refers to the unpleasant sensation that everything around you is spinning. It is not, as many people believe, a fear of heights.

The tests you have undergone will have ruled out a sinister cause (such as a stroke or tumor); This type of vertigo related to an illness or injury is known as central vertigo.

But I’m wondering if you might have peripheral vertigo, where the symptoms of dizziness and nausea are due to a problem in the inner ear mechanism that controls balance and are triggered by movement, especially of the head.

Although much less worrying, this type of vertigo can be very unpleasant. It is often caused by benign paroxysmal positional vertigo (BPPV), a common inner ear condition that occurs when calcium crystals naturally found there break off and end up in the wrong part of the inner ear, disrupting signals to the brain. . It’s not clear why they break off, but they move toward one of the semicircular canals that form the balancing structure of the inner ear. This will not show up on a scan or other investigations, so the diagnosis depends on the history of your problems.

Sometimes BPPV gets better without treatment, although it can take months. Clearly this has not been your case. And since BPPV is a mechanical disorder, anti-nausea medications, such as cinnarizine, will not stop the dizziness.

It’s important to seek treatment because BPPV also puts you at risk for falls. One method involves exercises performed by a specialist or physical therapist to remove dislodged crystals from the ear canals.

The most commonly used procedure is the Epley maneuver, which lasts a few minutes. An alternative, often prescribed as a follow-up, are Cawthorne-Cooksey exercises, movements to improve the functioning of the balance mechanism.

I suggest you discuss the matter once again with your GP to devise a treatment plan.

I am an 80 year old man who had a triple bypass in 2004. Since then I have seen a cardiologist and been prescribed several medications, but none of them stop my shortness of breath. Now he wants me to do a stress echocardiogram. What will it show?

Keith Bell, Bradford.

The surgery he underwent 19 years ago was to allow an adequate supply of oxygenated blood to reach his heart after his vital coronary arteries became narrowed or blocked as a result of cholesterol deposits.

The operation reroutes blood flow around blocked arteries using veins taken from other places. The term triple bypass means that there were three places where this procedure was necessary.

Shortness of breath means the heart muscle is not working efficiently: reduced blood flow means less oxygen available to the lungs, writes Dr Martin Scurr (File Image)

Since surgery, I hope you have taken cholesterol-lowering statins to minimize the risk of further blockages and medications to control other risks to your heart health, such as high blood pressure.

Shortness of breath implies that the heart muscle is not working efficiently: reduced blood flow means less oxygen available to the lungs. A stress echocardiogram will show how your heart muscles and valves are working. This involves an ultrasound of the heart at rest and then the same scan while walking on a treadmill.

It measures blood flow in the heart and allows for an accurate measurement of how well the heart valves and muscles are working.

In an adult man, a healthy heart pumps about 140 ml of blood with each beat, at rest. It increases greatly when you exercise. If the heart muscle is damaged, not as much blood will be pumped. Walking on a treadmill requires greater effort, so more blood is pumped.

If it is low, it is likely related to the original condition that caused the bypass.

Your cardiologist may describe what’s happening as heart failure, which sounds alarming; but it actually means that the heart has become less efficient and there are treatments that can help.

Write to Dr. Scurr

Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email drmartin@dailymail.co.uk. Dr. Scurr cannot correspond personally. Answers should be taken in a general context. Consult your family doctor if you have any health problem.