Extreme dizziness after AVR

[Dinesh__0]

  Dear Doctors,
  A friend of mine, 68 years old,  underwent AVR operation 3 months back.
  After about 2 months he felt dizziness but nothing of a major nature.
  2 weeks earlier he found that he could not get up from bed as extreme dizziness
  overtook him. However, after some help form other he was able to get to
  the hospital where condition of heart was found normal. He was discharged
  the next day but re-admitted 5 days later due to same complaint. At this
  time a brain scan was carried out but it was found normal. After 3 days of
  medication he was discharged.
  He still feels dizziness when he tries to lie down and this feeling
  persists throughout the night till he is on his feet in
   the morning.
  The doctor says there is nothing wrong other than postural hypertension.
  He is worried about this extreme dizziness. Any info or insight highly
  appreciated. Thanks so much.

[CCF Cardio MD - MTR]

_
Dear Dinesh, thank you for your question.  Dizziness is not a common post-
operative problem in patients who have had valve replacements, so this
problem may be unrelated to the valve surgery.  It will be difficult to
determine what the real cause of the dizziness is.  Dizziness is caused
by disorders of the vestibular system, cerebral ischemia, depression, and
diabetes.  The vestibular system is located in the inner ear and regulates
balance and positional sense.  Dizziness can result when the vestibular system
is damaged by infections of the inner ear, trauma, toxins (drugs or alcohol),
or a tumor.  Usually, a sensation called vertigo is experienced.  When
someone suffers from vertigo, they have periodic episodes of feeling that
the whole room is spinning around them.  A specific disease called
Meniere's disease can cause dizziness by affecting the vestibular system.
Cerebral ischemia occurs when the carotid and vertebral arteries which supply
blood to the brain and spinal cord are blocked by atherosclerotic plaques.
During open heart surgery, the heart is stopped and a bypass machine provides
continuous blood flow to the brain.  While this form of blood flow is less
forceful than normal pulsatile blood flow, it usually suffices to provide
sufficient blood flow to the brain when the arteries to the brain are not
blocked.  If your friend has blockages in these arteries, cerebral ischemia
could have caused the dizziness to occur but I would expect him to have
other symptoms like a poor memory, confusion, and weakness. Depression is
commoly seen in patients who have undergone open heart surgery which is
more situational than permanent.  Depression usually responds well to anti-
depressant medications.  Diabetes can cause multiple neurologic symptoms when
the blood sugar is either too high or too low.  Thus, your friend may
benefit from a visit to a neurologist for a thorough evaluation.  From what
you mention, I'm unable to determine the cause of his dizziness.  I hope
you find this information useful.
Information provided in the heart forum is for general purposes only.  
Specific diagnoses and therapies can only be provided by your physician.