How Often is Dizziness from Primary Cardiovascular Disease True Vertigo? A Systematic Review
- 314 Downloads
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.
Systematic review of observational studies was made: Search—electronic (MEDLINE, EMBASE) and manual (references of eligible articles) search for English-language studies (1972–2007).
Inclusions Studies of ≥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.
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.
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.
KEY WORDScardiovascular diseases vertigo syncope medical history taking diagnosis meta-analysis
Sources of funding and support; an explanation of the role of sponsor(s)
The preparation of this manuscript was supported principally by the National Institutes of Health—National Center for Research Resources (NCRR) K23 RR17324–01, “Building a New Model for Diagnosis of ED Dizzy Patients.” The NIH was uninvolved in design of the study; the collection, analysis, and interpretation of the data; and the decision to approve publication of the finished manuscript.
Conflict of Interest
Potential Conflict of Interest Disclosure
Karen Robinson has worked as a consultant for GfK V2 in the past 3 years and has received honoraria from MedPro Communications, Inc., in the past 3 years.
- 5.Newman-Toker DE. Diagnosing Dizziness in the Emergency Department—Why “What do you mean by ‘dizzy’?” Should Not Be the First Question You Ask [Doctoral Dissertation, Clinical Investigation, Bloomberg School of Public Health]. Baltimore, MD: The Johns Hopkins University; 2007. In: ProQuest Digital Dissertations [database on Internet, http://www.proquest.com/]; publication number: AAT 3267879. Available at: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:3267879. Accessed September 2, 2008.
- 6.Daroff RB. Dizziness and vertigo. In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al., editors. Harrison’s Online, 17th ed. [online]. Available at: http://www.accessmedicine.com/content.aspx?aid=2886671. Accessed September 2, 2008.
- 13.Elixhauser A, Steiner C, Palmer L. Clinical Classifications Software (CCS), 2006. US Agency for Healthcare Research and Quality. Available at: http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp. Accessed September 2, 2008.
- 14.Levels of Evidence and Grades of Recommendation. 2001. Oxford Centre for Evidence Based Medicine. Available at: http://www.cebm.net/levels_of_evidence.asp#levels. Accessed September 2, 2008.
- 28.Halmagyi GM. History II. Patient with vertigo. In: Baloh RW, Halmagyi GM, eds. Disorders of the Vestibular System. 1New York: Oxford University Press; 1996:171–7.Google Scholar
- 32.Shore WB. Observations from practice with Filipino patients [eLetter]. Ann Fam Med 2003;1:113–18. Annals of Family Medicine. Available at: http://www.annfammed.org/cgi/eletters/1/2/113. Accessed September 2, 2008.