Heart racing, heart rate variability, and high blood pressure. A cervical spine problem?
Ross Hauser, MD
In this article, we will discuss how chest pain, a racing heartbeat, panic attacks, and anxiety may be coming from a cervical spine and neck instability pressing on the vagus nerve. It is important to realize that this may only be one possible explanation as to why seemingly healthy individuals, having been checked out by their cardiologist, have cardiovascular type symptoms.
All of a sudden I had chest pain, chest heaviness, shortness of breath, and my heart was pounding
Someone will be in our office. They will tell us a story about a sudden, without cause, the onset of panic attacks. Such as this one:
I had an uncontrolled panic attack while driving to work. There was no new stress in my life, I was not even thinking “bad thoughts,” in fact I was not particularly thinking about anything. All of a sudden I had chest pain, chest heaviness, short of breath and my heart was pounding, I thought I was going to pass out. After I calmed down enough to drive again, I went home, laid down and waited for this to subside.
When searching for a possible cause to this event, this person revealed to us that she worked for a chiropractor and had a lot of cervical manipulation. When we did a digital motion x-ray (see below) it showed an incredible amount of upper cervical instability. This, we suggested, may be the cause of these and other symptoms she was suffering from including head pressure, history of migraine’s, sensitive to sound, intermittent blurry vision, off-balance sometimes, as well as brain fog.
A sudden recommendation for anti-anxiety medication – But I don’t think I have anxiety, but what else can it be?
We had a friend who was being recommended to start taking anti-anxiety medication. She wanted another opinion on this. That this friend was being recommended to anti-anxiety medication was somewhat surprising as we knew this person to be one of the calmest wonderful people we know. Great mother, great wife, nothing would suggest that she had anxiety. Not even to her.
Like the person above, she had new onset anxiety, no reason, just happened one day while she was dropping off the kids to school. When I asked her about her neck prior to the onset of the panic attacks, she gave me a long history of tension in her neck, various types of headaches, chiropractic care, cracking sounds up high on the neck, swishing in the ear and basically the rest of the signs and symptoms of upper cervical instability. I sent her to get a digital motion x-ray in her state which was significant for upper and mid cervical instability. We started treatments with Prolotherapy. (This is explained below).
I was not surprised that my blood pressure was elevated and that I had rapid heart rate. My doctor was.
I started having strange and unexplainable heart attack-like, panic attack-like symptoms. These included chest pains, a rapid heartbeat, and breathing difficulties. Of course, this frightened me, I am young, late 20’s, how could I have a heart condition? I did have the classic heart attack warning signs, pain in my chest, pain going down my left arm, breathing difficulties. One particularly bad day I went to Urgent Care because of chest pain and panic. I was assured that I was not having a heart attack but I should visit my primary care doctor as soon as I could. This visit to the doctor reassured me a little, but not a lot. I had an EKG which was fine. I was not surprised that my blood pressure was elevated and that I had a rapid heart rate. I could tell that on my own.
At my primary care doctor, these elevated cardio symptoms were attributed to panic attacks and “white coat syndrome,” the anxiety of being in the doctor’s office and my anxiety about taking the tests. I had had these symptoms before, I did not feel they were “strong” enough to see a doctor because I was convincing myself they were panic attacks. I was just not sure what caused them.
Since I also had pain in my chest when I sneezed or coughed or moved a certain way, my doctor suggested that this was an orthopedic problem and that I should see a specialist. There I learned about these “rare,” problems of “Slipping Rib Syndrome,” and “Costochondritis.” Basically, it was inflammation and a rib problem. I was sent off to physical therapy and told to come back 4 weeks later to see if cortisone would be needed.
The one thing that did stick out during this conversation with my doctor was that when she asked me, “how and when did this all start?” I said I did not know, but at the same time I was becoming aware of the chest pains, I also noticed a developing and significant neck pain. Not in the front of my neck, but in the back of my neck. Which I thought was odd. I would have thought I would have had pain in my throat and jaw area.
I went to therapy and I went back to discuss a cortisone injection because my symptoms were getting worse and increasing. I started feeling faint, I was having dizzy spells, I was feeling nauseous from all this. My doctor was perplexed and suggested that I see an ENT and/or perhaps a neurologist, a cardiologist, a rheumatologist, and a gastrointestinal specialist. I did not understand all this, my EKG was good, my blood tests were fine, the chest x-ray revealed nothing extraordinary. But now, more testing.
This is when I started doing research on my own. When I added up my symptoms and I started searching I came upon information on cervical spine and neck instability and the possible compression of my vagus nerve and my cervical arteries. Things started to make sense. I started researching Heart Rate Variability
Let’s stop here to explain some points. You may have already performed your own research as we find that people who suffer from symptoms like those above have done extensive reading on the internet. We will do a short summary.
Autonomic nervous system (ANS) regulation and Heart Rate Variability – Is this the answer for some?
If the C1 vertebra is unstable and causes problems of “nerve pinching” this is how upper cervical instability can affect heart rate variable.
There is a difference between Heart Rate and Heart Rate Variability.
- Heart Rate measures the number of heartbeats per minute.
- Heart Rate Variability measures the time between individual heartbeats.
To understand what may be happening in these people we need to understand the autonomic nervous system. The autonomic nervous system operates automatically. That is why it is called the autonomic nervous system. By itself, without conscious instruction, the autonomic nervous system keeps your heart pumping, your blood flowing through your blood vessels, your lungs breathing, and a myriad of other activities that occur in your body all the time, every day of your life. Part of that myriad of duties includes the operation of the sympathetic nervous system and parasympathetic nervous system.
The sympathetic nervous system is part of the autonomic nervous system. It helps make adaptations to your current situation. For instance, if you are witness to a crime or an accident or something bad, your body shifts into “fight-or-flight mode.” Your heart rate, blood pressure, and breathing rate dramatically increase. The blood vessels shift blood away from the intestines into the muscles, enabling you to run or fight depending on the situation. This also happens automatically.
The parasympathetic nervous system is an energy management center. When you are done being in “fight or flight mode,” or are using techniques to end a panic attack or to catch your breath, or to calm yourself down. The parasympathetic nervous system helps automatically reduce heart rate and blood pressure. As opposed to “fight or flight,” the parasympathetic nervous system is often described as “rest and digest,” as it signals to send blood back into the gut and digestive system.
So here we have the autonomic nervous system and its components, the sympathetic nervous system and parasympathetic nervous system, that among its duties regulate your heart rate. Its main highway of communication is the vagus nerve of which there are two running down each side of the neck. The vagus nerve has great impact on heart function, as the cardiovascular afferents (afferents – simply the nerve fibers that send message to the brain as opposed to efferents, nerve fibers which send the response back) make up the greatest extent (compared to other organs) of the 85-90% of sensory fibers which make up the vagus nerve.
In other words, the majority of work the vagus nerve does is getting messages back and forth from brain to heart These afferents (messages in) go through the nodose ganglion (nerve bundle) which sits in front of the atlas (C1 vertebra). If the C1 vertebra is unstable and causes problems of “nerve pinching” this is how upper cervical instability can affect heart rate variable.
I had bulging discs up and down my neck. But it is not significant enough to operate on. For now, I would just have to manage along with my neck pain, shoulder pain, and if my heart raced, I should find a quiet place to rest and avoid caffeine and sugary food.
Heart Rate Variability has become a new and popular subject for longevity experts and advanced sports science. Simply if your heart is always racing, doesn’t “rest,” if it does not have slow beats with consistent heart rate variable, you are at higher risk for disease and premature death from cardiovascular events. This is not the subject of this article. This article deals with your “mysterious symptoms,” like those explained above. Dizziness, balance issues, panic attacks, loss of consciousness, possible problems with digestion, breathing, headaches and other possible problems caused by cervical spine instability pressing on the vagus and cervical nerves.
I have been having neck and shoulder pain going on for one year now. I am young, 25, athletic, do a lot of working out in the gym. I woke up one morning, my arm left arm was numb and I had significant shoulder pain. I thought I slept on it wrong, but the numbness persisted, the pain came and went. After a few weeks, I went to the doctor, had an MRI. The doctor said, “nothing wrong here,” and that I should come back if things did not get better on their own.
Things did not get better. A started having significant muscle spasms, a lot of pain. One day when the muscle spasms hit, I started having difficulty breathing, my heart started to race. I do not know if I was having a panic attack or a heart attack but I had a friend get me to the emergency room. I had the x-ray, the chest scans, all the tests, and nothing came up except that I was prone to heart palpitations. Probably nothing to worry about but I should definitely get myself to a cardiologist.
At the cardiologist, they found the same thing, heart palpitations, and rapid heartbeat. Everyone was confused. Maybe I had hyperthyroid, I should see an endocrinologist.
I explained that I did not know if it was my thyroid or panic attacks, all I knew is that I had a problem breathing, spasms in my chest, and chest pain. I was given blood pressure medication, pills to reduce my heart rate, a referral to a thyroid doctor to get a blood work order to have my thyroid checked and a referral to a cervical spine specialist. In all this, I barely mentioned to the doctor that I was developing not only significant shoulder pain but neck pain as well.
At the neck specialist, it was determined by MRI that I had bulging discs up and down my neck. But it is not significant enough to operate on. For now, I would just have to manage along with my neck pain, shoulder pain, and if my heart raced, I should find a quiet place to rest and avoid caffeine and sugary food. This was not enough for me. I needed to find out what was going on and get this fixed. If this is coming from my neck, I want it fixed.
The idea that upper cervical spine instability impacts heart rate variability and this may be a culprit of your symptoms, is not a new idea.
The idea that upper cervical spine instability impacts heart rate variability and this may be a culprit of your symptoms, is not a new idea. In our 27 years of helping patients with problems related to the cervical spine, we have seen these symptoms many times. Yet medical research is not yet that abundant. In our own peer-reviewed published studies we have been able to document cervical neck ligament damage as a possible cause of low HRV as to when cervical neck ligaments are damaged or weakened by wear and tear damage or injury, they allow the upper cervical instability that can impinge on the cervical nerves. We will be citing this research below. First, we will explore some independent research.
In the first two studies, the first being from neurosurgeons, the second from chiropractors, both discuss the benefit of treatment, surgery or chiropractic care.
In April 2011, in the medical journal Spine, (1) Doctors at the Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences in India examined patients with suspected autonomic nervous system (ANS) and cervical compressive myelopathy. The researchers noted, “there are no studies on compressive myelopathies.”
So what does nerve compression do?
- The researchers evaluated 29 adult patients with cervical compressive myelopathy.
- Conventional autonomic function tests and Heart Rate Variability HRV were studied in these patients.
- The same tests were done on 29 age- and sex-matched healthy controls.
Study learning points:
- Patients with cervical compressive myelopathy as compared with controls showed a significant difference in the following parameters;
- Deep breathing,
- Valsalva ratio
- Explanation note: Valsalva Ratio is the outcome of the Valsalva Maneuver. In the Valsalva Maneuver, similar to trying to get water out of your ears, you exhale forcefully with a closed mouth and pinched nose to create “internal pressure.” It is a test that can help determine cardiac function and autonomic nervous control of the heart. Among other things, it measures the “R-R interval” the specific changes in time (or variability) between successive heartbeats.
The researchers found: “Patients with cervical compressive myelopathy have definite Autonomic nervous system dysfunction as compared to healthy age- and sex-matched controls. There is significant improvement in the Valsalva ratio after (decompression) surgery.”
For some people, surgery can be an answer. This is not our answer. We will discuss our non-surgical treatments below.
Measurements in Heart Rate Variability as a means to show a treatment is working
Chiropractors in Sweden and Denmark are collaborating on a study (2) in which they can use Heart Rate Variability as a measure to detect if spinal manipulation, by reducing a patient’s pain, is impacting itself on the Autonomic nervous system.
The posterior-cervical sympathetic nervous system signals the sympathetic part of the autonomic nervous system that controls the head, neck, and face area. In cervical spine neck instability or cervicocranial syndrome, the posterior cervical sympathetic system is underactive because the vertebrae in the neck are pinching the sympathetic nerves.
Let’s let the researchers explain:
“The pain-reducing effects of (spinal manipulation therapy) on certain spinal pain conditions are well established, as are the normal reactions to such treatment. However, the mechanisms behind these effects are not well understood, although it is hypothesized that the pain-reducing effects could be mediated through the Autonomic nervous system”
In other words, spinal manipulation helps people by alleviating pain. But how does the manipulation do it? That is “not well understood.” So what the researchers hypothesized is that it must have something to do with the function of the Autonomic nervous system and that they may be able to show this by measuring Heart Rate Variability.
“Therefore, the study of Heart Rate Variability responses to Spinal Manipulation Therapy as part of a short treatment plan and its relation to pain sensitivity and normal reactions to treatment will advance knowledge regarding the mechanisms involved in the specific effects of Spinal Manipulation Therapy.”
So here there is speculation that short-term pain relief achieved with chiropractic care can be shown by restoring normal heart rate variability.
We also measure Heart Rate Variability to determine the progression of treatment
Caring Medical measures both the time- and frequency-domain indices of HRV. Once baseline measurements are taken, they can be compared with those taken when with the patient under various stressors. As health improves, the changes in HRV from baseline lessen.
Many Caring Medical patients, especially those with systemic illnesses and/or cervical instability find monitoring and improving their HRV important to regaining their health. Typically, a finger probe is used which can measure the EKG and this is synced to a cell phone app. Each morning it is checked, and trends noted. A person then tests HRV doing various activities and to determine which ones lower and which ones raise their HRV. Just because you like a certain type of music, for instance, does not mean that your nervous system does. On a day when the HRV is low, it is helpful then to do something to raise it, like take a cold shower, meditate, pray or better yet, pray before you take that freezing cold shower! Obviously slowing down the breathing rate and increasing the depth of breaths always has a great effect on HRV. Mostly obtaining a high HRV involves getting adequate sleep and having an attitude of gratefulness.
Research on cervical instability and Prolotherapy treatments. A possible solution to the problems and challenges created by cervical spine instability and pressure on the vagus nerve on heart rate
Caring Medical Regenerative Medicine Clinics has published dozens of papers on Prolotherapy injections as a treatment in difficult to treat musculoskeletal disorders. We are going to refer to two of these studies as they relate to cervical instability and a myriad of related symptoms including the problem of a racing heartbeat, heart rate variability and high blood pressure.
In our 2014 study (3) we published a comprehensive review of the problems related to weakened damaged cervical neck ligaments.
This is what we wrote:
“There are a number of treatment modalities for the management of chronic neck pain and cervical instability, including injection therapy, nerve blocks, mobilization, manipulation, alternative medicine, behavioral therapy, fusion, and pharmacologic agents such as NSAIDs and opiates. However, these treatments do not address stabilizing the cervical spine or healing ligament injuries, and thus, do not offer long-term curative options.
To date, there is no consensus on the diagnosis of cervical spine instability or on traditional treatments that relieve chronic neck instability issues like those mentioned above. In such cases, patients often seek out alternative treatments for pain and symptom relief. Prolotherapy is one such treatment that is intended for acute and chronic musculoskeletal injuries, including those causing chronic neck pain related to underlying joint instability and ligament laxity. While these symptom classifications should be obvious signs of a patient in distress, the cause of the problems are not so obvious. Further and unfortunately, there is often no correlation between the hypermobility or subluxation of the vertebrae, clinical signs or symptoms, or neurological signs or symptoms. Sometimes there are no symptoms at all which further broadens the already very wide spectrum of possible diagnoses for cervical instability.”
What we demonstrated in this study is that the cervical neck ligaments are the main stabilizing structures of the cervical facet joints in the cervical spine and have been implicated as a major source of chronic neck pain and in the case of racing heartbeat, heart rate variability and high blood pressure, cervical instability.
Prolotherapy is an injection of simple dextrose into the unstable cervical spine. The concept is that these injections will strengthen the cervical ligaments thereby providing a stronger or more stable connection between the cervical vertebrae.
In our practice, we continue to see a large number of patients with a myriad of symptoms, like those described above, related to cervical neck instability. These people are often confused, many times frightened by recommendations to complicated cervical neck surgeries they don’t understand.
Many of these people have been told that their problem is a problem of degenerative cervical disc disease. After years of prolonged pain and conservative care options such as chiropractic, massage, physical therapy, anti-inflammatories, pain medications, cortisone injections, and cervical epidurals that eventually fail, the only recourse, these people are told, is neck surgery.
Surgical recommendations are described in a way that seemingly makes sense as the only solution to degenerative disc disease.
- The surgery will help, the patient is told, because it will cut away the cervical vertebrae bone that is pressing on the nerves
- The surgery will fuse the cervical vertebrae in place so the vertebrae do not shift out of place and press on the nerves again.
- Sometimes the cervical disc that has been flattened or herniated is also be replaced with an artificial implant.
Surgical treatments for Cervical Instability may chase the wrong problem
In medicine, there are universally accepted equations. When pain cannot be controlled using conservative treatments including physical therapy, chiropractic, and pain medications, there has to be a surgical recommendation.
In neck and spine surgery, doctors focus on degenerative disc disease and its treatment, anterior cervical discectomy and fusion and cervical decompression surgery to remove whole or part of the cervical vertebrae to allow space on compressed nerves and to fix the instability by fusing vertebral segments together. In the case of C1-C2 instability, these two vertebrae are fused posteriorly (behind) to limit their amount of movement. The goal is to limit pressure on the nerves. To be clear again, for some people surgery is the only way. For many others, surgery can be realistically avoided.
If this article has helped you understand your symptoms and you would like to explore Prolotherapy as a possible remedy, ask for help and information from our specialists
1 Srihari G, Shukla D, Devi BI, Sathyaprabha TN. Subclinical autonomic nervous system dysfunction in compressive cervical myelopathy. Spine. 2011 Apr 15;36(8):654-9. [Google Scholar]
2 Bakken AG, Axén I, Eklund A, O’Neill S. The effect of spinal manipulative therapy on heart rate variability and pain in patients with chronic neck pain: a randomized controlled trial. Trials. 2019 Dec;20(1):1-0. [Google Scholar]
3 Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. Open Orthopaedics Journal. 2014;8:326. [Google Scholar]