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. 2008 Dec;23(12):2087-94.
doi: 10.1007/s11606-008-0801-z. Epub 2008 Oct 9.

How often is dizziness from primary cardiovascular disease true vertigo? A systematic review

David E Newman-Toker  1 , Fei Jamie Dy, Victoria A Stanton, David S Zee, Hugh Calkins, Karen A Robinson
Affiliations

How often is dizziness from primary cardiovascular disease true vertigo? A systematic review

David E Newman-Toker et al. J Gen Intern Med. 2008 Dec.

Abstract

Objectives: To assess how frequently cardiovascular dizziness is vertigo. Recent studies suggest providers do not consider cardiovascular causes when a patient reports true vertigo (spinning/motion) as opposed to presyncope (impending faint). It is known that cardiovascular disease causes dizziness, but unknown how often such dizziness is vertiginous, as opposed to presyncopal.

Data sources: Systematic review of observational studies was made: Search--electronic (MEDLINE, EMBASE) and manual (references of eligible articles) search for English-language studies (1972-2007).

Review methods: Inclusions Studies of >or=5 patients with confirmed cardiovascular causes for dizziness and reporting a proportion with vertigo were included. Two independent reviewers selected studies for inclusion, with differences adjudicated by a third. Study characteristics and dizziness-type proportions were abstracted. Studies were rated on methodology and quality of dizziness definitions. Differences were resolved by consensus.

Results: We identified 1,506 citations, examined 125 full manuscripts, and included 5 studies. Principal reasons for exclusion were: abstracts--lack of original data, no cardiovascular diagnosis, or confounding exposure/disease (74%); manuscripts--failure to distinguish vertigo from other dizziness types (78%). In the three studies not using vertigo as an entry criterion (representing 1,659 patients with myocardial infarction, orthostatic hypotension, or syncope), vertigo was present in 63% (95% CI 57-69%) of cardiovascular patients with dizziness and the only dizziness type in 37% (95% CI 31-43%). Limitations include modest study quality and non-uniform definitions for vertigo.

Conclusions: Published data suggest that dizziness from primary cardiovascular disease may often be vertigo. Future research should assess prospectively whether dizziness type is a meaningful predictor for or against a cardiovascular diagnosis.

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Figures

Fig. 1
Fig. 1
Citation search and selection. 1 MEDLINE was accessed via PubMed; EMBASE–the Excerpta Medica database, 2 abstracts coded as “yes” or “maybe” by at least one reviewer, 3 adjudication conducted by discussion with third reviewer.
See this image and copyright information in PMC

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