Dizziness: Insights from Neurology and Cardiology

Regarding dizziness, please ask again?

Hello Dr.
Jiang, the link above contains your explanation from April 5th.
I would like to add a few additional questions for your clarification.

1.
During episodes of dizziness, I experience slight body warmth and an increased heart rate.
If possible, lowering my head helps alleviate the symptoms.
When the condition occurs, my blood pressure can rise to 160/110, with a pulse rate around 80-100.
I initially thought this was due to emotional and physiological responses related to the episodes.

2.
After the symptoms subside, my blood pressure sometimes drops to 100-110/60-70, with a pulse rate of 50-60 (these are the readings while taking Concor 1.25 mg).

3.
During my first visit to the neurologist, I was advised to consult a cardiologist for medication adjustment.
Currently, I am taking half of the Concor 1.25 mg once in the morning.
Over the past three weeks, my blood pressure has mostly remained around 130/90 with a pulse rate of about 70, although I have experienced a few mild episodes of dizziness.

4.
The two neurologists I consulted at the same hospital both said that no further tests were necessary, but they did not provide any possible causes or diagnoses, insisting instead that I should have my medication adjusted by the cardiologist.

5.
I initially consulted the cardiologist because my heart rate would sometimes become rapid and heavy.
Over a year ago, I stopped taking Concor 5 mg and switched to Concor 1.25 mg and Kady's extended-release tablets.
I have undergone all the necessary tests twice, and aside from a blood test six months ago showing total cholesterol and fasting blood sugar nearing the upper limit, which led to resuming the use of Rosuvastatin, the doctor does not believe there are any cardiovascular issues.

6.
I was treated for Meniere's disease at the same hospital over a decade ago, which lasted for about five years before resolving on its own.
I occasionally experience positional dizziness, usually triggered by busyness or lack of sleep, especially during times of high work-related stress.

7.
I have been under cardiology treatment for two and a half years due to a choking sensation (crying).

8.
My cardiologist is very patient and seems to imply that I may be overthinking things, but the current dizziness does exist and is indeed causing me more anxiety.

9.
Aside from needing to confirm the dizziness issue, all cardiology tests have come back normal.
I can only tell myself not to overthink and to avoid joining the panic disorder club.

Mr. Zhang, 50~59 year old female. Ask Date: 2016/04/05

Dr. Jiang Junyi reply Neurology

Hello, based on your description, I believe that the relevant specialists have provided effective pharmacological treatment.
However, I'm unsure about your lifestyle and exercise habits.
How is your autonomic nervous system functioning? I recommend consulting a rehabilitation physician or a physical therapist for a fitness plan.
Wishing you good health, peace, and joy.
Dr.
Tao cares about you.

Reply Date: 2016/04/05

More Info

Understanding dizziness can be complex, as it often involves both neurological and cardiovascular factors. Based on your detailed description, it appears that your dizziness is accompanied by symptoms such as increased heart rate, elevated blood pressure, and a sensation of warmth. These symptoms can be indicative of various underlying conditions, and it’s essential to consider both the neurological and cardiovascular aspects in your evaluation.

1. Physiological Response: The symptoms you describe, including increased heart rate and elevated blood pressure during episodes of dizziness, may be a physiological response to stress or anxiety. When the body perceives a threat or experiences discomfort, it can trigger the "fight or flight" response, leading to increased heart rate and blood pressure. This response can be exacerbated by emotional factors, such as anxiety or panic, especially if you have a history of stress or high-pressure situations.

2. Postural Changes: You mentioned that lowering your head can alleviate the dizziness. This suggests that your dizziness may have a positional component, which could be related to changes in blood flow or pressure in the brain. Postural hypotension, where blood pressure drops significantly upon standing or changing positions, can lead to dizziness and is worth considering, especially given your history of medication adjustments.

3. Medication Effects: You are currently taking medications that can influence heart rate and blood pressure. It’s crucial to monitor how these medications affect your symptoms. For instance, the adjustment from a higher dose of Concor (bisoprolol) to a lower dose may have contributed to fluctuations in your heart rate and blood pressure. It’s essential to work closely with your cardiologist to find the right balance in your medication regimen.

4. Neurological Considerations: Given your history of Meniere's disease and occasional positional dizziness, it’s important to consider vestibular causes of dizziness. Meniere's disease can cause episodes of vertigo, tinnitus, and hearing loss, and it can sometimes recur. If your dizziness feels like spinning or is accompanied by ear symptoms, it may warrant further evaluation by a neurologist or an ear, nose, and throat (ENT) specialist.

5. Anxiety and Dizziness: Your concern about the dizziness leading to panic or anxiety is valid. Anxiety can manifest physically, causing symptoms such as palpitations, dizziness, and a sense of impending doom. Cognitive-behavioral strategies or relaxation techniques may help manage anxiety and its physical manifestations.

6. Monitoring and Follow-Up: Since your cardiologist has conducted thorough evaluations and found no significant cardiovascular issues, it may be beneficial to focus on managing your anxiety and monitoring your symptoms. Keeping a symptom diary can help identify triggers and patterns, which can be useful for your healthcare providers in tailoring your treatment plan.

7. Further Evaluation: If your dizziness persists or worsens, or if you develop new symptoms, it may be necessary to revisit your healthcare providers for further evaluation. This could include additional tests or referrals to specialists who can provide a more comprehensive assessment of your symptoms.

In conclusion, while your dizziness may not be directly related to a cardiovascular issue, it is essential to consider the interplay between your neurological and cardiovascular health. Collaborating with your healthcare team, including both your cardiologist and neurologist, will be crucial in addressing your symptoms and ensuring your overall well-being. Remember to communicate openly with your doctors about your concerns and any changes in your symptoms, as this will help them provide the best care possible.

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