Brief Answer:
A comprehensive differential diagnosis is necessary.

Detailed Answer:
Hello!

Thank you for asking on HCM!

I passed carefully through your mother's medical history, and I would like to explain (regarding your question) that her persistent dizziness may be influenced by several factors.

First of all it is important to exclude a possible implication of frequent hypotension to her dizziness symptomatology. A review of close and very frequent BP monitored values is necessary.

It is necessary to investigate the role of a low cardiac performance and consequently abnormal low cardiac output on hypotension and hence on dizziness. Was your mother's heart attack associated with an extensive myocardial damage?

Please, could you upload her cardiac ultrasound reports for a review of her heart attack consequences and cardiac performance (LV EF, etc).

I would like to explain also that possible cerebral vascular lesions may be present (logically as coronary vessels are affected [confirmed actually by her previous heart attack], and by the fact that atherosclerosis is usually a generalized diffuse process). As such, dizziness may be a consequence of insufficient vascular cerebral blood supply.

A comprehensive actual neurological status evaluation by a specialist (neurologist) is necessary.

From the other hand, her actual dementia (vascular or Alzheimer?) therapy: Exelon and Namenda may both exert several important side effects including dizziness. So, it is necessary to discuss with her prescribing doctor about such effects and find alternative solutions.

So, at the end, I would say that understanding her dizziness etiology (and thus also the right medical solution to the problem), requires a comprehensive differential diagnosis, considering several medical issues, such as cardiac, cerebral-vascular disorders, and possible drugs side effects, etc.

You need to discuss with her attending doctor about the above mentioned issues.

Hope to have been helpful to you!

Feel free to ask me whenever you need! Greetings! Dr. Iliri

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Brief Answer:
I strongly recommend you to follow the above advices.

Detailed Answer:

Hi again!

Seems that both vascular dementia and hypotension have some implications in her dizziness. At that advanced age, usually exists some degree of orthostatic intolerance, manifested wit horthostatic hypotension (that is a symptomatic occurrence of a relative hypotension with standing up).

But from the other part even possible adverse drugs effects should be excluded.

So, I recommend to consult her cardiologist for the above recommended topics and also neurologist to clarify those neurological issues (primary disorder and therapy implications).

These diagnostic steps should be undertaken one by one.

Best regards,

Dr. Iliri

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