TY - JOUR
T1 - How often is dizziness from primary cardiovascular disease true vertigo? A systematic review
AU - Newman-Toker, David E.
AU - Dy, Fei Jamie
AU - Stanton, Victoria A.
AU - Zee, David S.
AU - Calkins, Hugh
AU - Robinson, Karen A.
N1 - Funding Information:
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.
PY - 2008/12
Y1 - 2008/12
N2 - 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.
AB - 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.
KW - Cardiovascular diseases
KW - Diagnosis
KW - Medical history taking
KW - Meta-analysis
KW - Syncope
KW - Vertigo
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U2 - 10.1007/s11606-008-0801-z
DO - 10.1007/s11606-008-0801-z
M3 - Article
C2 - 18843523
AN - SCOPUS:57249094274
SN - 0884-8734
VL - 23
SP - 2087
EP - 2094
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 12
ER -