Heart-Related Symptoms: Dizziness, Chest Pain, and More

Dizziness, headache, chest tightness, chest pain, and occasional constipation?

Hello Doctor, my mother is 73 years old and has been taking medication for chronic heart disease for a long time.
About ten years ago, she underwent a CT scan which revealed a tumor near her heart, but since there has been no indication of growth, the doctor recommended monitoring it.
Recently, my mother has been experiencing dizziness, headaches, chest tightness, chest pain, occasional constipation, and poor sleep quality.
She has been to the hospital and clinics numerous times, even visiting the emergency room.
These symptoms often appear intermittently and in rotation.
She has seen specialists in otolaryngology (due to symptoms of inner ear imbalance), pulmonology, cardiology (where an ECG showed signs of hypoxia), and gastroenterology (with some inflammatory symptoms).
She has been prescribed various medications for her symptoms, but there has only been slight improvement.
Currently, she is still taking medications for her heart condition and inner ear imbalance, but the aforementioned symptoms continue to appear sporadically.
We feel lost and somewhat desperate in seeking help.
Could you please provide some suggestions for us to consider? Thank you!

Xiao Bi, 40~49 year old female. Ask Date: 2013/08/26

Dr. He Dongjin reply Cardiology

Hello, is there anything happening at home recently? It seems that your mother is experiencing symptoms of autonomic nervous system dysfunction.
I have attached a symptom checklist for your reference.
It is advisable to seek medical attention from a psychosomatic medicine or psychiatry specialist.
Changhua Hospital cares about you.

Reply Date: 2013/08/26

More Info

Understanding heart-related symptoms, especially in older adults, can be quite complex due to the interplay of various health issues. Your mother’s situation, characterized by dizziness, headaches, chest discomfort, and gastrointestinal symptoms, is indeed concerning and warrants careful evaluation.

Firstly, it’s important to recognize that the symptoms your mother is experiencing can stem from multiple sources. Given her age (73 years) and history of chronic heart disease, it is crucial to consider both cardiac and non-cardiac causes for her symptoms.
1. Cardiac Considerations:
- Ischemic Heart Disease: Given her history of heart disease and the reported "hypoxia" on her ECG, there is a possibility that she may be experiencing angina or other forms of ischemic heart disease. This can manifest as chest pain or discomfort, especially during exertion or stress.

- Heart Failure: Symptoms like dizziness and fatigue can also be indicative of heart failure, where the heart is unable to pump effectively, leading to inadequate blood flow to the brain and other organs.

- Arrhythmias: Irregular heartbeats can lead to dizziness and palpitations, which may explain some of her symptoms. An ambulatory Holter monitor could be beneficial to capture any transient arrhythmias that may not be evident during a standard ECG.

2. Neurological Factors:
- Vestibular Disorders: The mention of inner ear imbalance suggests that her dizziness could be related to vestibular dysfunction. This can cause vertigo and may also contribute to her headaches.

- Cerebrovascular Issues: Given her age, it’s also prudent to rule out transient ischemic attacks (TIAs) or strokes, which can present with dizziness and headaches.

3. Gastrointestinal Issues:
- Constipation and Abdominal Pain: These symptoms can sometimes lead to discomfort that mimics cardiac pain. Additionally, medications for heart conditions can sometimes cause gastrointestinal side effects, which may exacerbate her symptoms.

4. Psychosocial Factors:
- Anxiety and Depression: Chronic illness can lead to psychological stress, which can manifest as physical symptoms, including chest pain and headaches. It’s essential to consider her mental health and whether she might benefit from counseling or therapy.

5. Medication Review:
- A thorough review of her current medications is essential. Some medications can have side effects that contribute to dizziness, headaches, or gastrointestinal issues. Adjustments or changes in her medication regimen may be necessary.

Given the complexity of her symptoms and the various potential causes, a multidisciplinary approach is recommended. Here are some steps you can take:
- Comprehensive Evaluation: Consider seeking a comprehensive evaluation from a geriatrician or a cardiologist who specializes in older adults. They can provide a holistic assessment of her health status.

- Diagnostic Testing: Further testing, such as echocardiograms, stress tests, or even advanced imaging like MRI or CT scans, may be warranted to evaluate her heart and brain more thoroughly.

- Symptom Diary: Keeping a detailed diary of her symptoms, including when they occur, their duration, and any associated activities or stressors, can help healthcare providers identify patterns and potential triggers.

- Lifestyle Modifications: Encourage her to maintain a healthy diet, engage in light physical activity as tolerated, and ensure she has a regular sleep schedule to improve her overall well-being.

In conclusion, while your mother’s symptoms are multifaceted and may arise from various underlying conditions, a coordinated approach involving thorough evaluation and management of her cardiac and non-cardiac symptoms is essential. It’s crucial to work closely with her healthcare providers to ensure she receives the appropriate care and support.

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