Acute circulatory problems

Acute circulatory problems in Berlin, the central question

Syncope (transient loss of consciousness from reduced cerebral perfusion) and its milder precursors (pre-syncope, vision blacking on standing, dizziness on rising) are common reasons for our visits. In Berlin we see the full spectrum: young adults with vasovagal syncope at the sight of blood, older patients with orthostatic dysregulation on new medication, patients with arrhythmia signs. The central clinical question is: is this a harmless vasovagal episode, or a cardiac event needing further work-up?

The distinction is not trivial. Certain features (syncope without prodrome, syncope on exertion, syncope with injury, prior cardiac disease, ECG abnormalities) demand prompt cardiology assessment. On the house call we record a 12-lead ECG and decide with you whether outpatient work-up suffices or whether cardiology hospital admission is the better path.

What happens during the house call

We ask about onset, trigger, prodrome, injuries, accompanying symptoms and medication. We measure blood pressure supine and after rapid standing (Schellong test), check heart rate, oxygen saturation, auscultate heart and lungs and run a basic neurological exam. A 12-lead ECG captures arrhythmia, bundle branch block, QT prolongation or ischaemic signs. For classical vasovagal syncope without cardiac signs we explain behavioural strategies (slow standing, adequate hydration, trigger avoidance). For orthostatic dysregulation we review medications that lower blood pressure and adjust therapy. With cardiac signs we organise prompt cardiology work-up or hospital admission.

Acute vertigo, peripheral or central

With acute rotatory vertigo the most important question is: peripheral (inner ear, vestibular nerve) or central (brainstem, cerebellum)? Benign paroxysmal positional vertigo (BPPV) is the most common cause, second-long, position-triggered attacks on turning in bed or bending; the treatment of choice is the Epley manoeuvre, which we perform directly on site at a success rate above 80 percent. Vestibular neuritis causes continuous rotatory vertigo over days without hearing loss and is treated with antiemetics and a short steroid course. To rule out a central cause we use the Dix-Hallpike test and the HINTS triad (Head Impulse, Nystagmus, Test of Skew); with red flags we direct you straight to a stroke unit. For any syncope with unclear cause, cardiac history or ECG abnormalities we additionally issue a referral for cardiology work-up with echocardiography and Holter monitoring.

How the house call works

On first contact we screen for red flags of cardiac or neurological cause. With clear emergency signs we direct you to 112 or hospital. Otherwise we dispatch the next available physician, typically a 60- to 90-minute arrival.

On site we perform the structured exam with Schellong test and ECG, discuss findings and next steps. You receive medication adjustments where relevant, a cardiology referral and written escalation criteria.

Billing and insurance

We bill according to the German private medical fee schedule (GOÄ) via our Privatärztliche Verrechnungsstelle. House call, internal medicine exam, Schellong test, ECG and administered medication are itemised separately. German private health insurance and Beihilfe schemes typically reimburse these positions in full.

We can issue an English invoice on request and remain reachable by phone for billing questions after the visit.