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

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 >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.

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.