Dizziness is a sensation of spatial disorientation that often leads to feeling faint, unsteady or lightheaded. Many people describe dizziness as feeling “like the room is spinning,” Some people may become dizzy from simple actions, such as  going on an amusement park ride or not having enough to eat.  However, frequent or lengthy episodes of dizziness may signal a more serious underlying cause, such as heart disease.

Most episodes of dizziness are not related to serious conditions and often quickly resolve without treatment. However, people are encouraged to see their physician if they have any unexplained dizziness, especially if is accompanied by other symptoms.

The most serious cardiovascular conditions that can lead to dizziness include a severe drop in blood pressure, abnormal heart rhythm (arrhythmia) heart attack and stroke. In many of these cases, there may be additional signs or symptoms, such as chest pain or heart palpitations.

Dizziness is a sensation of spatial disorientation that often leads to a loss of balance and/or a feeling that “the room is spinning.” People use the term to describe any number of sensations, including feeling lightheaded, unsteady and woozy.

Dizziness is usually caused by lack of blood flow to the brain. However, in some cases, dizzy feelings can be the result of certain brain conditions.

Dizziness also may be accompanied by the any of the following symptoms:

Dizziness usually occurs while standing up or walking  and the feeling may be lessened by lying or sitting down. Dizziness is one of the most common reasons for physician visits among older adults. This may be because aging increases the risk of developing conditions that cause dizziness.

In general, physicians recognize four disorders that are often categorized under the term dizziness. They include:

• Vertigo. The illusion of motion, as if the patient or the room is moving or spinning.
  
  
• Nonspecific dizziness. Giddiness, lightheadedness or faint dizziness.
  
  
• Disequilibrium. A sense of imbalance that occurs while walking.
  
  
• Presyncope. Near-fainting, often described by patients as almost blacking out or almost fainting.

Each of these disorders may be the result of a different underlying condition, ranging from inner ear problems to psychiatric disorders to cardiovascular causes. Cardiovascular causes may include:

• Cardiovascular disease (e.g., coronary artery disease or valvular heart disease).
  
  
• Abnormal heart rhythm (arrhythmia). This may involve problems in the communication between the upper and lower chambers of the heart such as heart block or disorders in the heart’s electrical system (Brugada syndrome).
  
  
• Heart attack. Dizziness, shortness of breath and abdominal pain, for example, may be possible signs of a heart attack, even if classical chest pain is not present.
  
  
• Pulmonary hypertension.
  
  
• High blood pressure (hypertension).
  
  
• Low blood pressure (hypotension) or rapid fall in blood pressure.
  
  
• Stroke or transient ischemic attack (called a TIA or mini-stroke). Dizziness is more commonly a symptom of stroke in men than in women.
  
  
• Cardiomyopathy (a type of heart disease in which the heart muscle is abnormally enlarged, thickened and/or stiffened).

However, not all serious causes of dizziness are related to the heart. Non-cardiovascular causes may include:

• Inner ear (vestibular) disorders
  
  
• Anxiety disorders
  
  
• Heat stroke
  
  
• Hyperventilation
  
  
• Hypoglycemia, low blood sugar levels (which, in diabetes, can also be a sign of poor glucose control)
  
  
• Panic attacks
  
  
• Mental illness
  
  
• Brain disease (e.g., a brain tumor)
  
  
• Metabolic disorder
  
  
• Multiple sensory deficits such as failing vision and nerve damage (often seen in older people)
  
  
• Anxiety disorders
  

It is important to note that a brief, isolated dizzy spell may not have significant clinical meaning. These brief spells may be due to standing up too quickly, the use of certain stimulants (e.g., caffeine, nicotine or certain recreational drugs), certain prescription medications (e.g., antihypertensives, vasodilators, birth control pills, hormone replacement therapy) or new prescription eyeglasses. High protein/low carbohydrate diets can cause dizziness due to a quick loss of body fluids.

Dizziness is a rather vague symptom and so, to diagnose the cause, the physician will attempt to understand the exact nature of the condition.. It is important that patients be specific when describing their symptoms. The physician may wish to know if the dizziness:

• Occurs with different positions or activities (e.g. walking, standing up quickly)
  
  
• Worsens at different times of the day
  
  
• Develops after the use of any medications
  
  
• Is accompanied by other symptoms, such as nausea or sensitivity to light
  
  
• Has caused any fainting episodes
  
  
• Has become more severe over time

The physician will ask about the patient’s medical history and review any current medications and psychiatric history. The physician will then give the patient a physical examination. As part of this exam, the physician will examine the ears, eyes and reflexes. Vital statistics, including pulse rate, blood pressure and temperature may also be taken. Based on the results of these tests, the physician may order additional tests that could include:

If any of these tests come back abnormal, the physician may wish to do an electrophysiology study to get a more precise measurement of the heart’s electrical activity and pathways. The physician may also order a magnetic resonance imaging (MRI) scan.

If the physician rules out cardiovascular causes, other tests may be conducted to discover the cause of the dizziness. These may include a CAT scan of the brain and eye or ear tests. To help diagnosis possible causes, the patient may be referred to medical specialists, such as an otolaryngologist (ear nose and throat doctor) or neurologist.

Once the underlying cause is diagnosed, treatment for that condition or disease may begin. Treatment may include taking or discontinuing certain medications, lifestyle modifications and/or a medical procedure or surgery. Management and treatment is entirely dependent on the cause of the dizziness.

When individuals experience dizziness, certain steps may help reduce the symptoms and prevent possible injury. These can include:

• Sit down or grab hold of a stationary object when dizziness first occurs
  
  
• Avoid actions that may cause dizziness, such as rising too quickly.
  
  
• Keep track of any medications that appear to increase dizziness. Report them to a physician for a possible change in the drug.
  
  
• Avoid excessive use of caffeine or alcohol, which can increase the symptoms.

It is important to follow all of the physician’s recommendations for treating dizziness, including proper use of medications and lifestyle changes. Controlling the underlying condition will, in most cases, prevent or reduce the occurrence of future dizzy spells.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to dizziness:

1. When should I report dizziness to a doctor?
   
   
2. What is the likely cause of my dizziness?
   
   
3. How can I determine if it is related to a serious health condition?
   
   
4. What tests can help diagnose the cause of my dizziness?
   
   
5. Should I see any specialists for my dizziness?
   
   
6. Could any of my medications be contributing to my dizziness?
   
   
7. Is dizziness a common symptom of my heart condition?
   
   
8. What are my treatment options?
   
   
9. When can I expect to obtain relief from the treatment?
   
   
10. What are the risks associated with these treatments?
    
    
11. What can be done if the treatments don’t work?
    
    
12. What symptoms indicate a medical emergency?