By Marcello Cherchi, MD PhD
For patients
The phrase “cardiac arrhythmia” refers to an irregular heartbeat. Some types of cardiac arrhythmias result in inadequate blood flow to the brain, which in some cases can cause a sensation of lightheadedness, and in other cases can lead to fainting (loss of consciousness). It is very unusual for a cardiac arrhythmia to cause a spinning sensation. Practically, if disequilibrium is followed by loss of consciousness, then a cardiac arrhythmia may be suspected. In cases of disequilibrium that do not lead to loss of consciousness, a cardiac arrhythmia is less likely, though sometimes your doctor may still refer you to a cardiologist.
For clinicians
Overview
Cardiac arrhythmias can cause a transient decrease in cerebral perfusion. If this decrease is sufficiently severe and prolonged it can culminate in syncope. If not, it can manifest with presyncope, usually experienced as a lightheadedness (Susanto 2014).
However, given that patients may use terms with different intended meanings than what a clinician expects, they may describe a presyncopal sensation using words such as “dizziness” or “vertigo,” which serves as a reminder that it is unwise to diagnose the etiology of disequilibrium based only on a patient’s description (Newman-Toker and Camargo 2006).
However, while uncommon, some patients appear truly to experience a transient decrease in cerebral perfusion as a spinning sensation (Gordon 1978), and thus may offer terms such as “spinning” and “vertigo” in response to an interviewer’s queries about the quality of the sensation. This can easily lead a clinician to consider an otologic source of symptoms.
Practically, if a patient reports episodes of disequilibrium (of whatever quality) that culminate in syncope, cardiovascular causes should lead the differential diagnosis.
In cases that do not culminate in syncope, cardiovascular causes should be lower on the differential diagnosis, though should not be completely excluded. Reasons to consider a cardiac arrhythmia as the cause of disequilibrium include:
- A reasonable search for other etiologies, including otovestibular diseases, has been unrevealing.
- A patient experiences palpitations or shortness of breath preceding, or in association with, the disequilibrium.
- There is a known history, or grounds for suspecting, cardiovascular disease.
In such cases, cardiology referral is appropriate.
References
Gordon M (1978) Occult cardiac arrhythmias associated with falls and dizziness in the elderly: detection by Holter monitoring. J Am Geriatr Soc 26: 418-23. doi: 10.1111/j.1532-5415.1978.tb05390.x
Newman-Toker DE, Camargo CA, Jr. (2006) ‘Cardiogenic vertigo’–true vertigo as the presenting manifestation of primary cardiac disease. Nat Clin Pract Neurol 2: 167-72; quiz 173. doi: 10.1038/ncpneuro0125
Susanto M (2014) Dizziness: if not vertigo could it be cardiac disease? Aust Fam Physician 43: 264-9.
