Vertigo or Dizziness: Is It the Heart?

Sensations described as vertigo or dizziness are among the most common reasons for medical consultation, both in primary care and in cardiology.

Although these symptoms are often attributed to the heart, this is not always the case. Many different medical conditions can be responsible.

The first step is to understand exactly what the person is experiencing. The nature of the symptoms often provides important clues that help guide the diagnosis.

Vertigo and Dizziness: They Are Not the Same

In everyday language, the words vertigo and dizziness are often used as if they meant the same thing.

In reality, they describe different sensations and usually have different causes.

True Vertigo

True vertigo creates the sensation that the room is spinning or that the person is spinning.

It may also be accompanied by a feeling of unsteadiness or loss of balance.

People experiencing true vertigo commonly report:

a spinning sensation;
nausea;
vomiting;
difficulty walking;
worsening of symptoms with head movements.

True vertigo is usually caused by a disorder of the inner ear or the balance system. It is rarely related to heart disease.

Dizziness

Dizziness is a different type of sensation.

People commonly describe:

feeling lightheaded;
weakness;
dimming or blurring of vision;
a sensation of floating;
the feeling that they might lose consciousness.

This type of symptom usually occurs when bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow to the brain is temporarily reduced.

Although cardiovascular disease may sometimes be responsible, many other conditions can also cause these symptoms.

A Symptom That Can Be Difficult to Describe

It is not always easy to put these sensations into words.

The word “dizziness” does not always mean the same thing. For some people, it refers to a spinning sensation. For others, it describes lightheadedness, loss of balance, sudden weakness, or the feeling of being about to faint.

Some people simply describe having “a spell” or “feeling unwell.” These expressions are very general and may refer to many different situations. The healthcare professional will therefore ask for a detailed description of what was experienced.

Why Does the Brain React This Way?

The brain is highly sensitive. To function normally, it requires a continuous supply of bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood.

When bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow to the brain decreases, even for only a few seconds, a variety of symptoms may occur.

These may include:

dizziness;
blurred or dimmed vision;
weakness;
sweating;
occasionally, loss of consciousness (syncope).

How Does a Healthcare Professional Approach This Symptom?

Rather than immediately searching for a specific disease, the healthcare professional first tries to determine the broad category to which the symptoms belong.

The answers to the questions asked, the way the symptoms present, and the circumstances in which they occur often provide valuable clues that guide the evaluation.

In general, the main causes can be grouped into three broad categories.

1. Disorders of the Inner Ear

When a person describes the sensation that the room is spinning or that they are spinning, the healthcare professional first considers a disorder of the inner ear or the balance system.

This type of vertigo is often accompanied by nausea, vomiting, and worsening of symptoms with head movements.

Inner ear disorders are among the most common causes of true vertigo.

2. Reduced Blood Flow to the Brain

When the person describes lightheadedness, dimming of vision, weakness, or the feeling of being about to lose consciousness, the healthcare professional first looks for a condition that may temporarily reduce bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow to the brain.

This reduction may result from:

low bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure;
a heart rate that is too slow (bradycardia);
a heart rate that is too fast (certain tachycardias);
significant heart valve disease;
severely reduced pumping function of the heart.

Depending on the underlying cause, these symptoms may sometimes progress to loss of consciousness (syncope).

Related article: Syncope (Fainting)

Why Do I Feel Dizzy When I Stand Up?

Dizziness that occurs upon standing is often caused by a temporary drop in bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure. This condition, known as orthostatic hypotension, occurs when the body does not adjust quickly enough to the change in position.

Symptoms usually resolve within a few seconds once bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow to the brain has returned to normal.

This condition is more common in older adults, people who are dehydrated, and those taking certain medications, particularly drugs used to treat high bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure or diuretics.

If symptoms occur frequently, worsen over time, or are accompanied by loss of consciousness, medical evaluation is recommended.

3. Other Possible Causes

When the symptoms do not fit either true vertigo or reduced bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow to the brain, the healthcare professional considers other possible conditions.

The most common include:

certain medications;
dehydration;
low bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood sugar (hypoglycemia);
anemia;
certain infections;
vestibular migraine;
certain neurological disorders;
anxiety or hyperventilation.

Depending on the clinical situation, the medical history, physical examination, and selected diagnostic tests will help determine the underlying cause.

Helping the Healthcare Professional

Episodes of dizziness are often brief and have resolved by the time medical evaluation takes place. Observations made by the patient can therefore provide valuable information that helps guide the assessment.

The goal is not to make your own diagnosis, but rather to gather information that will help the healthcare professional better understand what has occurred. In this way, the most accurate diagnosis can be made.

• Checking the Pulse

If the symptoms last long enough, taking a few seconds to check the pulseThe pulse is the sensation of beating that one feels by applying slight pressure on an artery, usually at the wrist or neck. It corresponds to the blood flow pulsated by the heart through the arteries with can be helpful.

It is useful to determine whether it is:

very slow;
very fast;
regular;
irregular.

A very slow pulseThe pulse is the sensation of beating that one feels by applying slight pressure on an artery, usually at the wrist or neck. It corresponds to the blood flow pulsated by the heart through the arteries with may suggest bradycardia. Conversely, a very fast pulseThe pulse is the sensation of beating that one feels by applying slight pressure on an artery, usually at the wrist or neck. It corresponds to the blood flow pulsated by the heart through the arteries with may suggest tachycardia. A completely irregular pulseThe pulse is the sensation of beating that one feels by applying slight pressure on an artery, usually at the wrist or neck. It corresponds to the blood flow pulsated by the heart through the arteries with may raise the possibility of atrial fibrillation.

• Measuring Blood Pressure

If a bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure monitor is available at home, a measurement obtained during the symptoms or immediately afterward can provide valuable information.

Low bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure may explain dizziness, particularly when symptoms occur after standing up, after remaining upright for a prolonged period, or in the presence of dehydration.

Conversely, normal bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure makes orthostatic hypotension much less likely and often directs the evaluation toward other possible causes. However, it does not completely exclude heart disease.

Today, many smartwatches and other connected devices can also provide useful information. Some can detect an abnormally slow or fast heart rate, while others may identify an irregular rhythm compatible with atrial fibrillation. Although these devices do not replace medical evaluation, the information they provide can help guide the diagnostic process.

• A Precise Description of the Symptoms

Rather than simply saying, “I’m dizzy,” a more precise description of the sensation is much more helpful, for example:

“The room is spinning.”
“I feel like I’m about to lose consciousness.”
“My vision goes dark for a few seconds.”
“I feel unsteady.”
“I suddenly feel very weak.”

A detailed description of the symptoms is often more helpful than simply using the word “dizziness.”

• The Circumstances in Which Symptoms Occur

The circumstances surrounding the symptoms are often just as important as the symptoms themselves.

It is helpful to determine whether the symptoms occur:

upon standing;
after remaining upright for a prolonged period;
during physical exertion;
after a meal;
during intense emotional stress;
after a coughing spell;
while urinating;
during rapid head movements or while turning over in bed.

The answers to these questions often provide important clues that help guide the diagnosis.

• The Duration of the Symptoms

The duration of the symptoms is also an important clue. Episodes lasting a few seconds, a few minutes, or several hours may suggest different causes.

When episodes recur, recording their frequency, duration, and the circumstances in which they occur can provide valuable information during the medical evaluation.

Putting the Pieces Together

In many cases, the information provided by the patient, combined with the medical history and physical examination, is enough to strongly guide the diagnosis.

When the pulseThe pulse is the sensation of beating that one feels by applying slight pressure on an artery, usually at the wrist or neck. It corresponds to the blood flow pulsated by the heart through the arteries with is normal, bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure remains appropriate during the episode, and the cardiac examination reveals neither a significant heart murmur nor signs of heart failure, a cardiac cause becomes much less likely.

The healthcare professional will then focus the evaluation on other possible conditions, sometimes in collaboration with another specialist.

It is important to understand that referral to a cardiologist does not necessarily mean that the heart is responsible for the symptoms. An important part of the evaluation is determining whether the heart can reasonably be excluded as the cause of the dizziness.

This step is just as important because it helps direct the patient to the most appropriate specialty or assists the primary care physician in pursuing other diagnostic avenues while avoiding unnecessary cardiac testing.

What Tests May Be Needed?

Depending on the symptoms, the circumstances in which they occur, and the findings of the physical examination, one or more of the following tests may be recommended:

an electrocardiogram (ECG);
bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure measurements while lying down and again after standing for several minutes;
bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood tests;
cardiac monitoring (Holter monitor or extended ambulatory monitoring);
an echocardiogram;
an exercise stress test.

The choice of tests depends on the medical history and the diagnostic possibilities identified during the evaluation. Therefore, not every test is necessary for every individual.

When Is Prompt Medical Evaluation Needed?

Prompt medical evaluation is recommended when the symptoms are accompanied by:

loss of consciousness;
chest pain;
significant shortness of breath;
prolonged palpitations“Palpitation” is a symptom related to an abnormality in heartbeats. There are several types of arrhythmias. This term is like a surname that encompasses several first names.;
weakness affecting an arm or a leg;
difficulty speaking;
double vision;
symptoms occurring during physical exertion;
injury following a fall.

Key Points

Vertigo and dizziness are common symptoms with many possible causes. Approximately 20% to 30% of adults experience at least one episode of true vertigo during their lifetime.

True vertigo is usually caused by a disorder of the inner ear, whereas dizziness is more often related to a temporary reduction in bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow to the brain or to other medical conditions.

A precise description of the symptoms, their duration, the circumstances in which they occur, and simple observations such as checking the pulse or measuring bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure often provide valuable clues that help guide the diagnosis.

The goal is not to make your own diagnosis, but rather to gather information that will help the healthcare professional better understand what has occurred. In this way, the most accurate diagnosis can be made.