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

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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 ≥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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Acknowledgments

None.

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.

Author information

Authors and Affiliations

  1. Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    David E. Newman-Toker MD, PhD & David S. Zee MD

  2. The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Fei Jamie Dy MSc

  3. University of California, San Francisco, School of Medicine, San Francisco, CA, USA

    Victoria A. Stanton BA

  4. Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Hugh Calkins MD

  5. Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA

    Karen A. Robinson MSc

Authors
  1. David E. Newman-Toker MD, PhD
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  2. Fei Jamie Dy MSc
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  3. Victoria A. Stanton BA
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  4. David S. Zee MD
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  5. Hugh Calkins MD
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  6. Karen A. Robinson MSc
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Corresponding author

Correspondence to David E. Newman-Toker MD, PhD.

Appendix

Appendix

Appendix 1. Electronic search strategy

PubMed

((vertigo[mh] OR vertigo[tiab] OR dizziness[mh] OR dizziness[tiab]) AND (cardiovascular[tiab] OR myocardial[tiab] OR arrythmia[mh] OR arrhythmia[tiab] OR syncope[tiab] OR presyncope[tiab] OR orthostatic[tiab]) AND (diagnosis[tiab] OR symptom*[tiab] OR complaint[tiab])) AND eng[la] AND 1972:2007[dp]

EMBASE (accessed via EMBASE.COM)

  1. #1.

    vertigo:de OR dizziness:de OR vertigo:ti,ab OR dizziness:ti,ab

  2. #2.

    ‘heart arrhythmia’:de OR cardiovascular:ti,ab OR myocardial:ti,ab OR syncope:ti,ab OR presyncope:ti,ab OR arrhythmia:ti,ab OR orthostatic:ti,ab

  3. #3.

    symptom*:ti,ab OR diagnosis:ti,ab OR complaint:ti,ab

  4. #4.

    [english]/lim AND [1972–2007]/py

  5. #5.

    #1 AND #2 AND #3 AND #4

Appendix 2. Exclusion coding schema for abstract and full-length manuscript reviews

1

No data

Review paper, no original patient data

2

Not cv

Not a cardiovascular study (about schizophrenia, benign prostatic hypertrophy, urinary tract infection, gastroesophageal reflux, migraine, etc.)

3

Drug

Drug study with potential confounding exposure (cardiovascular, but drug administered that may have dizziness as a direct nervous system side effect, etc.)

4

Exp

Non-drug study with confounding exposure (spaceflight, anesthesia, multiple sclerosis, atrial fibrillation with possible transient ischemic attack, etc.)

5

No dx

No confirmed cardiovascular diagnosis (population study without individual diagnoses provided; no clear link between diagnosis and dizziness, etc.)

6

No sxs

No symptom data; no differentiation between types of dizziness; no reference to vertigo (or similar terms such as rotation, spinning, or motion), etc.

7

<5

Fewer than 5 subjects (total participants reported, including cases and controls)

8

Other

Any other reason abstract is not included

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Newman-Toker, D.E., Dy, F.J., Stanton, V.A. et al. How Often is Dizziness from Primary Cardiovascular Disease True Vertigo? A Systematic Review. J GEN INTERN MED 23, 2087–2094 (2008). https://doi.org/10.1007/s11606-008-0801-z

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  • DOI: https://doi.org/10.1007/s11606-008-0801-z

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