Cardiovascular Disease and Vertigo: Is there a Link?
People with underlying cardiovascular disease may experience symptoms of dizziness while sitting still and/or with activity.
Often times we find that there is a link between cardiovascular disease and vertigo.
This article contains more medical terminology than I typically include in my articles. If this content seems too complex…
You can simply consult a Cardiologist for assessment of any underlying causes of cardiovascular disease and vertigo.
Then you don’t need to read on.
How can Cardiovascular Disease Contribute to Vertigo?
The aging heart can develop rhythm disturbances, pumping insufficiency, or narrowing of the vessels within the heart.
Carotid occlusion, carotid sinus hypersensitivity, arrhythmias, cardiac syncope, moderate to severe atherosclerosis, heart failure, vertebra-basilar artery insufficiency, and small vessel ischemia are a few common examples of cardiovascular diagnoses that may contribute to dizziness in older adults.
Arrhythmias that contribute to dizziness include tachyarrhythmias, such as atrial fibrillation, as well as bradyarrhythmias.
These cardiovascular conditions are usually experienced as lightheadedness, which we would refer to as “dizziness.”
It is possible that we could see a link between cardiovascular disease and vertigo, which may be overlooked. Reduced blood flow to the inner ear vestibular system is the link between cardiovascular disease and vertigo.
This link may occur if the cardiac or vascular problem is affecting blood flow to the inner ear vestibular system.
Any reduction in blood flow to the inner ear can precede BPPV or the development of a vestibular hypofunction.
What about Lightheadedness with Standing?
People who are experiencing dizziness or lightheadedness upon standing should be tested for orthostatic hypotension (OH), which is one type of dysautonomia.
For more information about orthostatic hypotension, click here.
If orthostatic hypotension has been ruled out, these patients should also be screened for a possible carotid occlusion or another form of dysautonomia. This is because a carotid occlusion and other types of dysautonomia can cause dizziness with standing as well.
To learn what to do about dizziness upon standing, click here.
Electrolyte Imbalances can Contribute to Dizziness
Electrolyte imbalances, such as potassium levels that are too high (hyperkalemia) or too low (hypokalemia), can cause cardiac arrhythmias and may be a side effect of certain commonly prescribed medications.
Sodium, calcium and magnesium levels also affect cardiac contractility and relaxation.
Intervention by a healthcare provider is necessary to return electrolytes to acceptable levels and properly monitor prescribed medications that may cause electrolyte imbalances.
Healthcare providers can also further investigate a new onset of cardiac arrhythmia, positive carotid bruit, or signs of heart failure exacerbation.
Medical management may be necessary to reduce dizziness or vertigo related to these conditions.
Heart Palpitations
Another link found between cardiovascular disease and dizzy spells is that some people may have an occasional change in heart rhythm that they may experience as “palpitations.”
Heart palpitations may correlate directly with sporadic episodes of dizziness. This dizziness may be associated with a fluttering feeling in the chest.
An extra heart sound, called S4, is considered a normal part of aging.
Talk to your Doctor
If you are experiencing any dizziness or vertigo, your doctor may recommend a full work-up by a Cardiologist.
This may be an important step for you, due to the link between cardiovascular disease and vertigo.
Disclaimer
This blog is provided for informational and educational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.
my husband is suffering from continuous dizziness for over 50 days…only the degree of dizziness changes…it seems to be worse in the early morning hours…the ENT insists on continuing vestibular therapy…this does not seem right…I don’t know what to pursue for him…
Hi Gay,
Dizziness that is worse in the morning is common symptom of BPPV. Here is a link to an article on that topic, where I mention that common complaint.
Research is clear that vestibular PT is the best place to start for people with dizziness.
It is good that the ENT is even familiar with vestibular therapy as an option. Many doctors are not.
I hope you are able to find a local vestibular PT who is experienced to help.
You can use this article to search for local vestibular physical therapist.
Best wishes!
6 days after heart attack I have developed lightheadednes when in motion and palpitation when sitting or lying
Hi Joseph,
I’m sorry to hear this! I’m glad you survived the heart attack.
Of course, you should follow up with your primary doctor and cardiologist after the heart attack. They may be able to help.
You may also want to seek evaluation with a vertigo doctor, which you can search for using this article.
You can document your symptoms using the questions I ask in this article, to share with all your doctors.
I struggle with dizziness alot and thought it was neurological. Thinking now I may be wrong. Could it heart problems also be a reason for becoming winded easily? Or a heaviness on the chest that makes you want to sleep really bad?
Have recurrent attack of vertigo since a couple months now. They are short lived (10-15 seconds), untriggers (around 1 maybe 2 times a day). After the main vertigo, I find it difficult to walk (like am drunk, very dis-balanced) for a couple minutes (usually up to 20-25) then all is fine..until the next attack! Dix and roll tests are negative (do not produce vertigo). Had an ECG which is normal as well as an MRI (also normal). Pretty confusing.
We’re of same symptoms and I don’t know what my disease is… I’m thinking of undergoing ECG or 2d echo
I have very intense episodes of dizziness that last less 5 seconds. I do have pvcs but no heart disease. My doctor doesn’t seem worried but I sure am. It makes me feel like I am
Going to fall down when it happens. Thoughts?
Hi Kate,
If you have not already seen an Otoneurologist, that might be helpful.
Fear of falling is important to address because research shows it can alter how you walk and increase your risk of falls.
You can also ask for a referral to vestibular PT.
Hopefully you already had a cardiologist consult based on what you shared about the pvc’s, but if not that may be appropriate also.
Best wishes!
I am a 62 year old male with long-term Type 1 diabetes (over 42 years) with some mild neuropathy but also significant myalgia, especially shoulders and neck and with some evidence of early spine degeneration. I also have hypertension and medial arterial stenosis. I have experienced about half a dozen intermittent episodes of light-headedness over a period of months which is not due to hypo- or hyperglycaemia or hypo- or hypertension. A trigger seems to be loud noise, bright light and/or busy environments. This requires me to steady myself to avoid falling over. These are also not due to postural changes. On two additional occasions, one while lying down and one while seated, my visual field has either dramatically rotated anticlockwise or moved horizontally right to left repeatedly for about twenty seconds. In the latter case, my eyes did not appear to be moving so the problem seemed to be one of perception. I wear an Apple watch and can pinpoint the exact time when this second event occurred as it coincided exactly with a phone call I made. The watch starts to automatically record continuously when a ‘workout’ is detected and it did so during this incident. My HR increased from around 60bpm to 73bpm but then fell dramatically by 10bpm, no doubt in response to, rather than a cause of, the vertigo. I also did an ECG using the watch at the time of the incident and it showed significantly elevated T-waves. The ECG later showed a normal rhythm.
I’ve been dizzy for 2 months and my legs sometimes shake when I’m standing it’s because I have atrial fibrillation
Hi, thanks for the post above. I have been having dizzy spells on and off but never for a period of more than 2 months. I have tried the Brandt-Daroff Exercise for almost a week but the dizzy spells do not seem to get any better and have complete the dosage of medication prescribed by a family doctor but is not helping at all, which seriously affecting my daily lifestyle and work as well. I hope that there is someone out there who could tell me what I should do??
Vertigo for 19 months daily for 9 months. It is constant. Just different degrees. Controlled slightly with 750mg of acetazolamide daily Valium as a rescue med and 2 different migraine meds. I am always sedated. Neuro says end organ damage in the left but the ENT says no inner ear problems detected.
Ruled out MS already
No one will help me now.
Additional symptoms include: Migraines Daily severe GERD, tinnitus, mild hearing loss in the left, unable to manage altitudes at all, fatigue, depression(life is not good anymore) weight loss (vomiting) Ear pain sore throat.
All of this started at the same time.
My husband has been suffering from the same symptoms. Hearing loss started during covid. Dizziness started about 6 months later but severe vertigo is constant since April. Each episode brings high blood pressure and fatigue. Been to several Drs. Neurology and ENT have not found anything. We are wondering if it could be from covid he had 2 years ago
Hi Kim,
Long COVID can certainly cause dizziness and other neurological symptoms. I am definitely seeing this pattern in the last three years.
In fact, right now I am working on a blog draft on COVID related dizziness that I will publish later this fall.
I refer to my local otoneurologist for a full neurological work up to rule out other possible causes.
I also refer to these two companies if I suspect long COVID related dizziness:
The Wellness Company
Bruce Patterson, MD at Long Haul COVID clinic
I hope your husband feels better soon!
Best wishes
I have experienced chronic vertigo for over a year now. I am on blood pressure medication. MS has been ruled out. I’ve seen a vestibular doctor. Have repeatedly and currently am doing physical therapy. Valium and other medications do not affect the symptoms. I’ve experienced multiple episodes of feeling as if my power has suddenly been turned way down. I have not passed out but feel as if I’m shutting down and then recover. I can’t get any physician to consider that it could possibly be heart related. Everyone is convinced that it is inner ear. My mother had an extensive history of heart disease. I am 54 and female. Should I insist on seeing a cardiologist?
Hi Michelle,
A cardiology work up is a fairly typical step for patients with unexplained symptoms of dizziness. You can discuss that option with your primary care doctor and seek individual medical advice from someone who knows you.
You can use this article to write up a case summary.
If you have been diagnosed with an inner ear condition, it may be taking longer than expected to recover with your vertigo treatment plan.
You can have more than one issue at the same time.
For example, I had a new patient last week with dysautonomia, BPPV, and upper cervical dizziness.
You add on top of that some anxiety and stress, and you have a perfect storm!
I suggest you follow up with your primary care doctor to express your concerns and seek medical advice for next steps.
Best wishes
I have had vertigo attacks for 3 years now. Every time I have an attack my blood pressure is very high. No exceptions, every time.
For the vertigo attacks I have seen a neurologist, vestibular ent and an endocrinologist & hypertension specialist at Vanderbilt. I see a cardiologist regularly since 2009 when I had a stent put in for a blocked artery.
Vertigo attacks stopped for unknown reason for 6 months and returned 5 days ago and have been daily since then. Sometimes moderate attacks, sometimes severe with vomiting, sweating, shaking, extreme dizziness etc.
Nothing I have tried for the last 3 years has stopped this. I’ve had no changes in medications or health conditions or diet.
My blood pressure is very high when vertigo attacks happen, again every time, typically 160 -175 systolic, though they have been as high as 190s and once it was 211/105.
Nothing seems to help.
I had a heart attack 5 months ago and am in my early 30’s. Shortly after started getting vertigo daily. I don’t think coincidently that depression, personality swings, anxiety, fatigue and weight loss has come with it.
I have had one cardiologist appointment after the heart attack, when I brought it up he took me off blood pressure medication but didn’t seem to give it much thought. Blood pressure shot back up and felt bad for other reasons as well as vertigo.
I just want an answer if it’s a permanent issue or what can I do. I have tried everything I can at home and is getting worse.