Q. I get on and off bout of dizziness. Is this related to heart problem?

Answered by
Dr. Isaac Gana
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Oct 08, 2020

Hello doctor,

I have been getting bouts of dizziness on and off for the last one and a half years. It comes while at rest and out of the blue over this period. I have had done treadmill tests, echo, stress echo tests (twice), 24-hour tapes, 36-hour tapes, plac2 test, thyroid test, cholesterol tests, which have all come back normal other than ectopic beats which I have had for seven years and are confirmed benign. I had a dizzy spell last night for about three hours, I went to lay in bed but I still was dizzy. I checked my heart rate and it was at 60-65 bpm.

My questions are, could this dizziness be heart related? What does heart related dizziness feel like? What causes it and what would be the heart rate? After all these tests could I say that my heart is healthy? Are heart attacks common in people of my age 38? (my mother and father have not had any heart disease before 50 and 65). How do I know if I have a healthy heart? What can I do to increase my heart health?



Welcome to

I understand exactly what you are going through at the moment. Please do not worry you will be fine.

1. This dizziness is most likely not heart related.

2. Heart related dizziness is just like other forms of dizziness and often is caused by reduced red blood cells or congenital heart defects in which deoxygenated blood and oxygenated blood mix together therefore reducing oxygen concentration. Bradycardia could also lead to dizziness when the heart rate is lower than 40 bpm.

3. These days it is not totally uncommon to have a heart attack at 38 years of age, it depends on a combination of factors like family history, lifestyle, etc.

4. You can know if you have a healthy heart by running tests once a while to check your cardiovascular health. Examples are ECG (electrocardiography), echo, lipid profile test, stress tests, BMI (body mass index), etc.

5. In your case firstly it is essential to loose some weight. At 103 kg you are overweight and this increases your chance of heart diseases.

Cut down on high cholesterol foods. Avoid smoking and reduce alcohol intake if you do. Check your blood pressure to see if elevated and start treatment if high in more than three occasions above 140/90 mmHg.

Low pack cell volume can cause dizziness, hypoglycemia, medications such as antidepressants, etc., can all cause dizziness. What treatment have you done in regards to vestibular problem? This is a very common cause of dizziness and is the number one suspect in your situation.

Thank you doctor,

After having all these tests, could I say that my heart is healthy? Thyroid test, cholesterol test, treadmill test, echo, 24-hour tapes (except for benign ectopics), echo, stress test, 36-hour Holter, cholesterol, thyroid, MRI all tests are clear except for benign ectopics.MRI with contrast shows a vestibular problem. My mom and dad have not had a heart attack before 50 or 65 years of age. I quit smoking eight years ago.

Regarding AF, what are the symptoms, and would you think that would be causing my dizziness? Is my dizziness not cardiac-related?



Welcome back to

Obviously, there is no indication to suggest any heart disease, so your heart is healthy. I am happy you quit smoking. This will significantly reduce your chance of heart disease. Atrial fibrillation often does not come with symptoms. When they do, they often present with palpitations, shortness of breath, especially at night while asleep, low blood pressure, etc. All these are not specific, although. If you had AF echo, ECG and stress test would have presented with abnormalities. Dizziness alone can be an indicator of AF when all necessary tests are normal.

Cardiac related dizziness will present with abnormal lab results and other symptoms like shortness of breath, swelling of feet, etc. The test you reported to have done video nystagmography (vgn) reported vestibular problem which is the cause of your dizziness. What treatment have you received in regards to this?

Thank you, doctor,

So far, I am waiting for a vestibular rehabilitation session. I opted for taking medications. According to you, can AF can or cannot present with just dizziness, and the test I have done would have picked it up?



Welcome back to

But why did you refuse medications and choose rehab sessions? Has the dizziness not been worsening? Yes, AF would certainly present with other symptoms like shortness of breath, chest pain, etc. And the ECG would have been abnormal. Perhaps you do not have any condition like high blood pressure, coronary heart disease, thyroid disease, etc., that can predispose you to AF.

Thank you doctor,

I felt I wanted to try without medication. Can you have cardiac dizziness while sitting, standing but with a heart rate of 68 bpm? Could heart dizziness last for one or two seconds with a heart rate again being 62-70 bpm?



Welcome back to

When there is reduced oxygen circulation it does not make any difference either on sitting or standing. Yes, it is possible although often once the dizziness begins it progresses except if treatment is commenced.

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