Skip to main content
Log in

The dizzy athlete

  • Published:
Current Sports Medicine Reports

Abstract

Dizziness is a common complaint both in athletes and their nonathletic counterparts. The diagnosis and treatment of dizziness is not significantly different between the two groups. The first step in evaluation involves defining dizziness as either presyncope, vertigo, disequilibrium, or nonspecific dizziness. Once the symptoms are better defined, the evaluation should then proceed with a careful history, physical examination, and appropriate diagnostic tests as indicated. Treatment strategies can be targeted at the underlying cause with the goal of diminishing or resolving the symptoms as well as preventing their recurrence. This article focuses on the diagnosis of dizziness and subsequent treatment regimens with particular attention paid to presyncope and vertigo.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Sloane PD, Coeytaux RR, Beck RS, et al.: Dizziness: state of the science. Ann Intern Med 2001, 134(9 Pt 2):823–832.

    PubMed  CAS  Google Scholar 

  2. Ovadia M: Head-upright tilt testing and syncope in athletes. In The Athlete and Heart Disease: Diagnosis, Evaluation, and Management. Edited by Williams RA. Philadelphia: Lippincott Williams & Wilkins; 1999:217–248.

    Google Scholar 

  3. Branch WT, Barton J: Approach to the patient with dizziness. UpToDate 2006. Available at http://www.uptodate.com. Accessed November 16, 2006.

  4. Oh JH, Hanusa BH, Kapoor WN: Do symptoms predict cardiac arrhythmias and mortality in patients with syncope? Arch Intern Med 1999, 159:375–380.

    Article  PubMed  CAS  Google Scholar 

  5. Mathias CJ, Deguchi K, Schatz I: Observations on recurrent syncope and presyncope in 641 patients. Lancet 2001, 357:348–353.

    Article  PubMed  CAS  Google Scholar 

  6. Kapoor WN: Syncope. N Engl J Med 2000, 343:1856–1862.

    Article  PubMed  CAS  Google Scholar 

  7. Wisten A, Messner T: Symptoms preceeding sudden cardiac death in the young are common but often misinterpreted. Scand Cardiovasc J 2005, 39:143–149.

    Article  PubMed  Google Scholar 

  8. Strickberger SA, Benson DW, Biaggioni I, et al.: AHA/ACCF Scientific Statement on the evaluation of syncope: from the American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research Interdisciplinary Working Group; and the American College of Cardiology Foundation: in collaboration with the Heart Rhythm Society: endorsed by the American Autonomic Society. Circulation 2006, 113:316–327.

    Article  PubMed  Google Scholar 

  9. Olshansky B. Evaluation of the patient with syncope. UpToDate 2006. Available at http://www.uptodate.com. Accessed November 16, 2006.

  10. Kinlay S, Leitch JW, Neil A, et al.: Cardiac event recorders yield more diagnoses and are more cost-effective than 48-hour Holter monitoring in patients with palpitations. A controlled clinical trial. Ann Intern Med 1996, 124(1 Pt 1):16–20.

    PubMed  CAS  Google Scholar 

  11. Sivakumaran S, Krahn AD, Klein GJ, et al.: A prospective randomized comparison of loop recorders versus Holter monitors in patients with syncope or presyncope. Am J Med 2003, 115:1–5.

    Article  PubMed  Google Scholar 

  12. Inamdar V, Mehta S, Juang G, et al.: The utility of implantable loop recorders for diagnosing unexplained syncope in 100 consecutive patients: five-year, single-center experience. J Invasive Cardiol 2006, 18:313–315.

    PubMed  Google Scholar 

  13. Dindar A, Cetin B, Ertugrul T, et al.: Sublingual isosorbide dinitrate-stimulated tilt test for diagnosis of vasovagal syncope in children and adolescents. Pediatr Cardiol 2003, 24:270–273.

    Article  PubMed  CAS  Google Scholar 

  14. Lewis DA, Zlotocha J, Henke L, et al.: Specificity of head-up tilt testing in adolescents: effect of various degrees of tilt challenge in normal control subjects. J Am Coll Cardiol 1997, 30:1057–1060.

    Article  PubMed  CAS  Google Scholar 

  15. Alehan D, Celiker A, Ozme S: Head-up tilt test: a highly sensitive, specific test for children with unexplained syncope. Pediatr Cardiol 1996, 17:86–90.

    Article  PubMed  CAS  Google Scholar 

  16. Kapoor WN: Using a tilt table to evaluate syncope. Am J Med Sci 1999, 317:110–116.

    Article  PubMed  CAS  Google Scholar 

  17. Salim MA, Di Sessa TG: Effectiveness of fludrocortisone and salt in preventing syncope recurrence in children: a double-blind, placebo-controlled, randomized trial. J Am Coll Cardiol 2005, 45:484–488.

    Article  PubMed  CAS  Google Scholar 

  18. Kaufmann H, Saadia D, Voustianiouk A: Midodrine in neurally mediated syncope: a double-blind, randomized, crossover study. Ann Neurol 2002, 52:342–345.

    Article  PubMed  CAS  Google Scholar 

  19. Mahanonda N, Bhuripanyo K, Kangkagate C, et al.: Randomized double-blind, placebo-controlled trial of oral atenolol in patients with unexplained syncope and positive upright tilt table test results. Am Heart J 1995, 130:1250–1253.

    Article  PubMed  CAS  Google Scholar 

  20. Sheldon R, Connolly S, Rose S, et al.: Prevention of Syncope Trial (POST): a randomized, placebo-controlled study of metoprolol in the prevention of vasovagal syncope. Circulation 2006, 113:1164–1170.

    Article  PubMed  Google Scholar 

  21. Theodorakis GN, Leftheriotis D, Livanis EG, et al.: Fluoxetine vs. propranolol in the treatment of vasovagal syncope: a prospective, randomized, placebo-controlled study. Europace 2006, 8:193–198.

    Article  PubMed  Google Scholar 

  22. Di Girolamo E, Di Iorio C, Sabatini P, et al.: Effects of paroxetine hydrochloride, a selective serotonin reuptake inhibitor, on refractory vasovagal syncope: a randomized, double-blind, placebo-controlled study. J Am Coll Cardiol 1999, 33:1227–1230.

    Article  PubMed  Google Scholar 

  23. Connolly SJ, Sheldon R, Roberts RS, et al.: The North American Vasovagal Pacemaker Study (VPS): a randomized trial of permanent cardiac pacing for the Prevention of vasovagal syncope. J Am Coll Cardiol 1999, 33:16–20.

    Article  PubMed  CAS  Google Scholar 

  24. Raviele A, Giada F, Menozzi C, et al.: A randomized, double-blind, placebo-controlled study of permanent cardiac pacing for the treatment of recurrent tilt-induced vasovagal syncope. The vasovagal syncope and pacing trial (SYNPACE). Eur Heart J 2004, 25:1741–1748.

    Article  PubMed  Google Scholar 

  25. Gajek J, Zysko D, Mazurek W: Efficacy of tilt training in patients with vasovagal syncope. Kardiol Pol 2006, 64:602–608.

    PubMed  Google Scholar 

  26. Foglia-Manzillo G, Giada F, Gaggioli G, et al.: Efficacy of tilt training in the treatment of neurally mediated syncope. A randomized study. Europace 2004, 6:199–204.

    Article  PubMed  Google Scholar 

  27. Lu CC, Diedrich A, Tung CS, et al.: Water ingestion as prophylaxis against syncope. Circulation 2003, 108:2660–2665.

    Article  PubMed  Google Scholar 

  28. Barton J, Branch W: Approach to the patient with vertigo. UpToDate 2006. Available at http://www.uptodate.com. Accessed November 16, 2006.

  29. Labuguen RH. Initial evaluation of vertigo. Am Fam Physician 2006, 73:244–251.

    PubMed  Google Scholar 

  30. Baloh RW: Differentiating between peripheral and central causes of vertigo. Otolaryngol Head Neck Surg 1998, 119:55–59.

    Article  PubMed  CAS  Google Scholar 

  31. Hanley K, O’Dowd T: Symptoms of vertigo in general practice: a prospective study of diagnosis. Br J Gen Pract 2002, 52:809–812.

    PubMed  CAS  Google Scholar 

  32. Swartz R, Longwell P: Treatment of vertigo. Am Fam Physician 2005, 71:1115–1122.

    PubMed  Google Scholar 

  33. Steenerson RL, Cronin GW, Marbach PM: Effectiveness of treatment techniques in 923 cases of benign paroxysmal positional vertigo. Laryngoscope 2005, 115:226–231.

    Article  PubMed  Google Scholar 

  34. Kroenke K, Lucas CA, Rosenberg ML, et al.: Causes of persistent dizziness: a prospective study of 100 patients in ambulatory care. Ann Intern Med 1992, 117:898–904.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Chris A. Klenck MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Klenck, C.A. The dizzy athlete. Curr Sports Med Rep 6, 25–31 (2007). https://doi.org/10.1007/s11932-007-0008-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11932-007-0008-9

Keywords

Navigation