How Often is Dizziness from Primary Cardiovascular Disease True Vertigo? A Systematic Review

  • David E. Newman-TokerEmail author
  • Fei Jamie Dy
  • Victoria A. Stanton
  • David S. Zee
  • Hugh Calkins
  • Karen A. Robinson
Original Article



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 ≥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.


cardiovascular 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

None disclosed.

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.


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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • David E. Newman-Toker
    • 1
    Email author
  • Fei Jamie Dy
    • 2
  • Victoria A. Stanton
    • 3
  • David S. Zee
    • 1
  • Hugh Calkins
    • 4
  • Karen A. Robinson
    • 5
  1. 1.Department of NeurologyThe Johns Hopkins University School of MedicineBaltimoreUSA
  2. 2.The Johns Hopkins University School of MedicineBaltimoreUSA
  3. 3.University of California, San Francisco, School of MedicineSan FranciscoUSA
  4. 4.Division of CardiologyThe Johns Hopkins University School of MedicineBaltimoreUSA
  5. 5.Department of MedicineThe Johns Hopkins University School of MedicineBaltimoreUSA

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