A 72-year-old man came with intermittent dizziness for two days. He used the word “vertigo,” and a peripheral vestibular problem was initially considered.
He had no obvious nystagmus, no vomiting and no focal neurological deficit.
The bedside clue
Before moving further into a neurological work-up, his pulse was checked carefully.
Pulse: 34 beats per minute. Regular.
An ECG showed complete heart block.
The diagnostic twist
Patients use “dizziness” to describe vertigo, presyncope, imbalance, weakness and many other sensations. The word itself should never determine the diagnostic pathway.
Clinical pearls
- Clarify what “dizziness” means to the patient.
- Always check pulse, blood pressure and orthostatic symptoms.
- Bradyarrhythmia can present with vague weakness, near-syncope or recurrent falls.
- A normal neurological examination does not exclude a cardiovascular cause.
Take-home message
Before ordering a scan for dizziness, do not forget the pulse.
Educational note: This is a fictionalized/composite teaching case created for clinical reasoning. It is not a record of an identifiable patient and is not a substitute for local protocols, specialist advice or patient-specific clinical judgement.