Dizziness and Neck Tightness: Heart Health Insights

Dizziness and neck tightness?

Hello Doctor: My mother, 70 years old, experienced dizziness and tightness in her neck and back, which raised concerns about a stroke, prompting an emergency examination.
Abnormal findings included total cholesterol at 231, low-density lipoprotein cholesterol at 165, and arrhythmia.
She was then referred for outpatient cardiac ultrasound and 24-hour ECG, with the following results:
Cardiac Ultrasound Findings:
- Heart Rhythm: Sinus
- Clinical Diagnosis: Rule out valvular heart disease (VHD)
- Routine M-mode Data:
- Right Ventricular Diameter (RVD): 17 mm (normal range: 7-23)
- Interventricular Septum (IVS): 9 mm (normal range: 6-11)
- Left Ventricular Diameter (LVd): 49.2 mm (normal range: 36-52)
- Left Ventricular Posterior Wall (LVPW): 9 mm (normal range: 6-11)
- Left Ventricular Systolic Diameter (LVs): 27 mm (normal range: 20-36)
- Aortic Valve Opening (AV open): 18 mm (normal range: 15-26)
- Aortic Root (AO root): 36.6 mm (normal range: 20-37)
- Left Atrium (LA): 34 mm (normal range: 19-40)
- Ejection Fraction (LVEF): 76.3%
- Fractional Shortening (FS): 45.1%
- Global Longitudinal Strain (GLS): >18%
2-D Findings:
- Cardiac Chamber: Normal
- Wall Thickness: Normal
- Wall Motion: Normal
- Mitral Valve: Annulus calcification
- Aortic Valve: Sclerosing change
- IVC diameter: Normal
Color Doppler Findings:
- Mitral Stenosis (MS): None
- Mitral Valve Area (MVA): 4.4 cm²
- Mitral Valve Peak Gradient (PGmax): 1 mmHg
- Mitral Regurgitation (MR): Mild-Moderate
- Aortic Stenosis (AS): None
- Aortic Valve Area (AVA): Not specified
- Aortic Valve Peak Gradient (PGmax): 14 mmHg
- Aortic Regurgitation (AR): Mild-Moderate
- Tricuspid Regurgitation (TR): Moderate
- TR Peak Gradient (PGmax): 43 mmHg
- Mitral Flow E/A: Abnormal relaxation pattern
- Tissue Doppler E/e’: 9.4
- Pulmonary Regurgitation (PR): Mild
- PR Peak Gradient (PGmax): Not specified
- Pulmonary Stenosis (PS): None
Summary of Findings:
1.
Normal left ventricular systolic wall motion at rest with adequate left ventricular systolic function (EF = 76.3%).
2.
Normal cardiac chamber size.
3.
No left ventricular hypertrophy.
4.
Mild-Moderate MR, Moderate TR, Mild-Moderate AR, Mild PR.
5.
Abnormal mitral valve morphology (annulus calcification) and abnormal aortic valve morphology (sclerosing change).
6.
Left ventricular diastolic dysfunction: abnormal relaxation pattern.
7.
Moderate pulmonary hypertension (estimated pulmonary artery systolic pressure > 45 mmHg).
Diagnosis and Suggestions:
- Exam: M-2D + Color Doppler, 24-hour ECG
- Indication: Dizziness
- Medications: Comments: There were 0 ventricular beats, less than 1% were supraventricular beats.
1.
Sinus rhythm with a rate of 53-106/min and a mean of 74/min.
The maximum heart rate was 153 bpm at 6:33:41 AM due to nonsustained paroxysmal atrial tachycardia (PAT).
2.
No ventricular premature contractions (VPC).
3.
Moderate atrial premature contractions (APCs): Total 202 beats with pairs, repetitive APCs, and nonsustained PAT.
4.
No pauses.
5.
No ST segment changes.
6.
No events.
Since I am working away from home and unable to accompany my family for medical visits, I have difficulty understanding the medical terminology in the report.
I only know that there is mitral valve insufficiency, elevated pulmonary artery pressure, and arrhythmia, which are not likely causing the dizziness and neck/back tightness.
The doctor suggested that it might be due to poor blood circulation, hence prescribing Dipyridamole 25 mg/tablet, one in the morning and one in the evening.

I would like to ask the doctor:
1.
What is the severity of my family member's mitral valve insufficiency and pulmonary hypertension? Is medication or surgery necessary?
2.
I understand that Dipyridamole is used to prevent thrombosis; why did the doctor say it is for poor blood circulation? Is it because my family member has had a stroke or is at risk of having one?
3.
Can elevated blood lipids cause dizziness and tightness in the neck and back? Although the dizziness is mild, it has persisted for several days without improvement, and the neck feels increasingly tight, raising concerns about a stroke.

I apologize for the lengthy and disorganized message.
Thank you for your assistance!

Xiao Lan, 70~79 year old female. Ask Date: 2024/03/08

Dr. Li Han reply Cardiology

Hello, your daughter sought medical attention due to dizziness and neck tightness.
However, these two symptoms are non-specific.
Based on the echocardiogram and 24-hour Holter monitor results, as previously mentioned by the physician, cardiac mechanical factors should be excluded, and no significant arrhythmias have been detected.
Regarding the connection to poor circulation, I do not understand and cannot comment.
However, as you mentioned, an LDL cholesterol level >160 does indeed increase the risk of atherosclerosis.
The management and target levels should be determined based on risk factors, and there are recommended guidelines to follow.
It may be advisable for you to discuss this with a trusted family physician or a neurologist.
The Changhua Hospital of the Ministry of Health and Welfare cares about you.

Reply Date: 2024/03/08

More Info

Understanding the health concerns related to dizziness and neck tightness, especially in the context of your mother's recent medical evaluations, is crucial for her overall well-being. Based on the information provided, your mother has been diagnosed with mild to moderate mitral regurgitation (MR), moderate tricuspid regurgitation (TR), and mild to moderate aortic regurgitation (AR), alongside some signs of pulmonary hypertension and arrhythmias. Let's break down the implications of these findings and address your questions.

1. Severity of Heart Valve Issues and Treatment Options
The presence of mild to moderate MR and TR indicates that the heart valves are not closing properly, which can lead to blood flowing backward in the heart. This can cause symptoms such as fatigue, shortness of breath, and potentially contribute to dizziness if the heart's efficiency is compromised. The aortic regurgitation is also mild to moderate, which means that while it may not be immediately life-threatening, it requires monitoring.

In terms of treatment, the decision to initiate medication or consider surgical intervention depends on several factors, including the severity of symptoms, the degree of valve dysfunction, and the overall heart function. Given that your mother's left ventricular ejection fraction (LVEF) is 76.3%, which is within normal limits, and her heart chambers are of normal size, it suggests that her heart is still functioning well despite the valve issues. However, regular follow-up with a cardiologist is essential to monitor any progression of these conditions.

2. Use of Dipyridamole and Circulation Concerns
Dipyridamole is primarily used as a vasodilator in stress testing and can also be prescribed to improve blood flow in certain conditions. In this context, it seems that the physician is considering it to enhance circulation, possibly due to the arrhythmias and the potential for reduced blood flow to the brain, which could contribute to dizziness. While it is not directly a treatment for valve issues, improving blood flow can help alleviate symptoms related to poor circulation.

Your concern about the risk of stroke is valid, especially given the arrhythmias noted in the 24-hour ECG monitoring. Atrial premature contractions (APCs) and nonsustained paroxysmal atrial tachycardia (PAT) can increase the risk of thrombus formation, which could lead to a stroke. Therefore, it is essential to manage these arrhythmias effectively, and your mother's physician may be monitoring her closely for any signs of increased risk.

3. Impact of Elevated Cholesterol on Symptoms
Elevated cholesterol levels, particularly low-density lipoprotein (LDL) cholesterol, can contribute to atherosclerosis, which narrows the arteries and can lead to reduced blood flow. This can manifest as dizziness, especially if the brain is not receiving adequate blood supply. However, the direct correlation between cholesterol levels and neck tightness is less clear. Neck tightness can often be attributed to muscular issues, stress, or tension rather than directly to cholesterol levels.

Given that your mother has been experiencing dizziness for several days, it is essential to ensure that she is adequately hydrated, managing stress, and addressing any potential muscular issues through gentle stretching or physical therapy. If her symptoms persist or worsen, further evaluation may be warranted.

Conclusion
In summary, your mother's heart valve issues and arrhythmias require careful monitoring and potentially medication to manage symptoms and prevent complications. The use of Dipyridamole may help improve circulation, and while elevated cholesterol can contribute to cardiovascular issues, it may not be the sole cause of her current symptoms. It is crucial to maintain open communication with her healthcare provider, ensuring that all concerns are addressed and that she receives appropriate follow-up care. Regular check-ups will help manage her conditions effectively and provide peace of mind regarding her health.

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