[58F] With persistent nausea, dizziness, and pain post-heart attack
Question
It doesn't really tell me what could be wrong is it the medication or something else like a heart attack again
Patient Description
A 58-year-old female has been experiencing constant nausea for about four weeks, which does not improve with Zofran and worsens with any activity, even sitting still. She also reports vomiting multiple times a day, dizziness that includes both spinning and lightheadedness, and difficulty standing and walking. The dizziness has been present for a couple of weeks and can be quite severe at times. Additionally, she has pain in her shoulder and neck, which is dull, achy, and makes it painful to move. She also mentions having a poor appetite and a diastolic blood pressure reading consistently over 90. She recently had a heart attack about four weeks ago and is currently on medications including Levaquin, Metoprolol, Januvia, Spironolactone, and Gabapentin. She has a history of diabetes, high blood pressure, deep vein thrombosis (DVT), and previous renal cancer. She also uses marijuana daily to help with nausea and appetite. She has not experienced any chest pain, headaches, changes in vision, or swelling and redness in her muscles or joints. She has not traveled recently or been exposed to new environments that might contribute to her symptoms.
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Arora's Assessment
What might be happening
Based on the symptoms and history you've provided, here are some possible explanations:
1. Post-Heart Attack Complications
- Dizziness and Nausea: These could be related to your recent heart attack. Post-heart attack, some patients experience dizziness and nausea due to changes in blood flow or side effects of medications like Metoprolol and Spironolactone.
- High Diastolic Blood Pressure: This could be a sign that your blood pressure is not fully controlled, which can contribute to dizziness and other symptoms.
2. Medication Side Effects
- Levaquin: This antibiotic can cause side effects like nausea, vomiting, and dizziness. Given that your symptoms worsened after starting Levaquin, it could be contributing to your current condition.
- Metoprolol and Spironolactone: These medications can also cause dizziness and nausea as side effects.
3. Diabetes-Related Issues
- Nausea and Vomiting: These could be related to gastroparesis, a condition where the stomach doesn't empty properly, which is more common in people with diabetes.
- Dizziness: This could be due to fluctuations in blood sugar levels.
4. Chronic Pain and Muscle Issues
- Shoulder and Neck Pain: This could be due to musculoskeletal issues like cervical radiculopathy or muscle strain, which can cause pain and weakness in the limbs.
What you can do
Dizziness and Nausea
- Consult Your Doctor: Given the severity and persistence of your symptoms, it's crucial to consult your healthcare provider. They may need to adjust your medications or investigate further.
- Stay Hydrated: Drink plenty of fluids to stay hydrated, which can help alleviate dizziness.
- Small, Frequent Meals: Eating small, frequent meals can help manage nausea.
- Avoid Triggers: Try to identify and avoid any triggers that worsen your symptoms.
Shoulder and Neck Pain
- Physical Therapy: Consult a physical therapist for exercises that can help alleviate pain and improve mobility.
- Pain Management: Over-the-counter pain relievers like ibuprofen can help manage pain. However, consult your doctor before taking any new medications.
- Heat and Cold Therapy: Applying heat or cold packs to the affected area can help reduce pain and inflammation.
High Diastolic Blood Pressure
- Monitor Blood Pressure: Regularly monitor your blood pressure and keep a log to share with your healthcare provider.
- Lifestyle Changes: Adopt a heart-healthy diet, reduce salt intake, and engage in regular physical activity as recommended by your doctor.
- Medication Review: Discuss with your doctor whether your current medications need adjustment.
General Tips
- Symptom Journal: Use MDandMe to journal your symptoms, track progress, and get insights. This can be very helpful for your healthcare provider to understand your condition better.
- Follow-Up Appointments: Ensure you keep all follow-up appointments with your healthcare provider to monitor your condition and make necessary adjustments to your treatment plan.
What you should look out for
Given the complexity and severity of your symptoms, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:
- Severe or worsening dizziness
- Persistent vomiting
- Chest pain or discomfort
- Shortness of breath
- Fainting or severe weakness
Remember, while I can provide information and suggestions, it's essential to consult with a healthcare professional for a formal diagnosis and appropriate treatment. If you have any more questions or need further assistance, feel free to continue the conversation.
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7 mo ago