Dizziness

Medically reviewed by A Ras, MD. Last updated on Aug  5, 2022.

What is dizziness?

Dizziness is one of the most common symptoms that prompt people to seek medical attention.

Dizziness can be difficult to define because it signifies different things to different people.

• It describes vertigo or the sensation of spinning as if the affected person had just gotten off a merry-go-round or feeling lightheaded as if the individual is weak and will pass out.
• Lightheadedness is frequently caused by a decrease in blood supply to the brain, but vertigo can be caused by disruptions in the inner ear and the brain’s balance centers.

It is critical that the doctor understands the person’s complaint, as this is the first step toward determining a diagnosis and commencing treatment.¶

Causes of dizziness?

Heart conditions that cause dizziness

Low blood pressure

Low blood pressure patients frequently complain of dizziness, lightheadedness, and the sensation of passing out. When blood pressure is too low, not enough oxygen-rich blood is supplied to the brain, and its function can suffer. If the blood supply to the brain is significantly reduced, the person may pass out (syncope).

Symptoms may intensify when shifting positions from lying down or sitting to standing up.

Along with dizziness, the following symptoms may occur:

• Sweating
• Weakness
• Nausea and vomiting
• Shortness of breath
• Chest pain

Low blood pressure could be from multiple causes that includes underlying illness, medications, or some normal physiological condition.

Some common causes of low blood pressure includes

• Bleeding
• Anemia, decreased red blood cell count due to decreased production or increased destruction of red blood cells
• Dehydration secondary to loss of water from the body secondary to diarrhea, fever excessive sweating
• Side effects from multiple medications for example
  • Beta-blockers, Metoprolol, atenolol, propranolol, Bystolic, these medication decrease in blood pressure secondary to decrease heart rate, bradycardia
  •  vaso dilator drugs, like sublingual nitroglycerin, isosorbide mononitrate.  These medication are used for blood pressure, and chest pain, angina
  • ACE inhibitors
  • Diuretics ,
  • Medications for erectile dysfunction (sildenafil , Viagra, Revatio, tadalafil, Cialis, and vardenafil Levitra, Staxyn ODT, avanafil ,Stendra) that can dilate blood vessels
• Pregnancy

Heart electrical issues

•  conduction abnormalities: Electrical conduction abnormalities can cause the heart to beat excessively fast (tachycardia) or too slowly (bradycardia), resulting in insufficient blood supply to the brain and dizziness or lightheadedness.

• Cardiomyopathy: Dizziness is also a symptom of cardiomyopathy, a heart muscle disorder that causes the muscle to not squeeze efficiently. The most prevalent cause of weakness is atherosclerotic heart disease or ischemic cardiomyopathy (ischemic=decreased blood supply), which occurs when the heart muscle itself does not receive enough blood flow to function correctly. Diabetes, alcoholism, and viral infections can all cause non-ischemic cardiomyopathies.

Postural hypotension cause of dizziness

Blood pressure readings in dehydrated or anemic persons may be acceptable when resting flat; nevertheless, the lack of fluid is shown when they rise up fast. Dizziness and lightheadedness may result from a shortage of blood in the brain. This sensation may pass in a matter of seconds as the body adjusts. However, if dehydration or drugs (such as beta-blockers) prevent the body from reacting by constricting blood vessels and boosting heart rate, the dizziness may last until the patient passes out (faints or experiences syncope).

Some disorders are linked to a failure to adapt to changes in body posture (autonomic dysfunction). When a person stands, blood vessels contract slightly to raise blood pressure, and the heart rate rises slightly to pump blood uphill to the brain against gravity. When a person with autonomic dysfunction moves from a sleeping posture to a sitting or standing position, they may feel dizzy. Diabetes, Addison’s disease, and Parkinson’s disease are examples of disorders associated with this syndrome.

Diabetic Causes of Dizziness

Dizziness is a common complaint in any person who is diabetes mellitus.  This could be related to low blood sugar, high blood sugar, autonomic dysfunction, heart issues, and multiple other factors

• Hypoglycemia, also known as low blood sugar, defines an insufficient amount of glucose in the blood. Hypoglycemia can occur as a result of a decrease in food intake or from taking too much medicine (insulin or oral pills), resulting in low blood sugar levels. In this case, the person feels dizzy or lightheaded because the brain does not have enough glucose to function correctly. Individuals with diabetes and their relatives must be aware of the signs of hypoglycemia, which include dizziness, sweating, confusion, and, in severe cases, coma. Immediate therapy is required. If the person is awake, give sugar-containing items by mouth, or a glucagon injection may save the patient’s life.
• Hyperglycemia can also produce dizziness as a result of dehydration. High blood sugar levels develop when there is insufficient insulin to allow cells to utilize glucose for energy consumption. (Ironically, brain cells do not require insulin to use glucose.) High blood sugar levels trigger a number of metabolic reactions in the body, including dehydration, anaerobic metabolism, and alterations in the acid-base balance. This can lead to potentially fatal conditions such as diabetic ketoacidosis and nonketotic diabetic acidosis.

Endocrine diseases causing dizziness

• Diabetes 
• Thyroid disorders
  •  hyperthyroidism, that make us tachycardia, fast heart rate and that may produce lightheadedness
  • Hypothyroidism may cause low blood pressure because of the low heart rate that may produce lightheadedness and weakness
• Addison’s disease develops when the adrenal glands fail to produce enough cortisol to meet the body’s needs. Cortisol is a naturally occurring steroid that the body produces as part of the stress response (often termed the “fight or flight” response). Low cortisol levels can cause weakness, weariness, lightheadedness, low blood sugar, and low blood pressure.

Hyperventilation causing dizziness

While hyperventilation or rapid breathing may be used by the body to help with acid-base balance, it may also occur as a response to an emotionally distressing circumstance. Rapid breathing eliminates some of the body’s carbon dioxide, causing tingling sensations in the hands and feet, as well as around the mouth, in hyperventilation syndrome. Dizziness and lightheadedness are symptoms that go hand in hand. The symptoms may heighten the perception of emotional stress and lead to even more hyperventilation. Carbon dioxide levels fall low enough in extreme hyperventilation to elicit carpopedal spasm, in which the hands and feet become claw-like and difficult to move. When the breathing rate returns to normal, the symptoms of hyperventilation resolve quite rapidly.

Hyperventilation is not usually the result of an emotional response. People with asthma, COPD exacerbations, congestive heart failure, and pneumonia may also breathe fast to assist maintain blood oxygen levels. When the body gets acidotic (for example, diabetic ketoacidosis), hyperventilation occurs; fast breathing is one corrective strategy that the body attempts to manage its acid-base balance.

Vertigo and Dizziness

Vertigo is frequently described as feeling dizzy or spinning. A person may expressly state that the room appears to be whirling around them. Sometimes the complaint is about a lack of balance or equilibrium. This is frequently caused by discomfort in the inner ear (the part of the ear that involves balance, not hearing).

The semicircular canals and the vestibule are two elements of the inner ear that assist the body identify its position in space relative to gravity.

Three semicircular canals are at right angles to one another. These canals are filled with fluid and lined by a nerve-rich, crystal-encrusted membrane that sends data to the cerebellum (the part of the brain that controls balance and coordination). Every time one portion of the body moves, the cerebellum collects information from the eyes (visual stimuli) and nerve endings in muscles related with proprioception (the perception of movement) to assist the brain in determining where the body is in relation to gravity.

When the head moves, the fluid in the semicircular canals shifts, and this information is transmitted to the brain. When the head stops moving, the fluid also stops, and this information is conveyed to the brain.

There may be a little delay in the delivery of this information to the brain in some circumstances. When a person rides a merry-go-round or spins quickly in circles, the fluid in the canals gains speed, and even when the body stops spinning, the fluid in the semicircular canals may continue to move. This generates vertigo, or a spinning sensation, and may cause the individual to fall or stumble. It may also be linked to vomiting.

• Inflammation of the fluid or irritation of the crystals on the membrane that lines the walls of the semicircular canals: In patients with vertigo, inflammation of the fluid or irritation of the crystals on the membrane that lines the walls of the semicircular canals may cause the spinning sensation even without much head movement. When only one canal is damaged, the patient may experience no symptoms if they do not move.
• BPPV (benign paroxysmal positional vertigo) occurs when crystals in the inner ear become dislodged and irritate the semicircular canals. The reason is frequently unknown, but there may be a relationship with odd head placement or movement. Moving the head up and down while working on a computer is one example, as is dusting anything above the level of the head. It is commonly seen in adults over the age of 60.
  Labyrinthitis (labyrinth=inner ear + itis=inflammation) can occur after a viral infection that produces inflammation in the middle ear.
• Meniere’s disease is a disturbance of the movement of fluids in the inner ear. Vertigo, hearing loss, and tinnitus are the three symptoms encountered combined (ringing in the ears).
• Acoustic neuroma is a benign tumor of the ear that can cause vertigo.
• Neurologic: Vertigo can sometimes be caused by a problem with the brain. Vertigo can be caused by a stroke, tumors, seizures, or multiple sclerosis.

What signs and symptoms may happen with dizziness?

• A feeling that your surroundings are moving even though you are standing still
• Ringing in your ears or hearing loss
• Feeling faint or lightheaded
• Weakness or unsteadiness
• Double vision or eye movements you cannot control
• Nausea or vomiting
• Confusion

How is the cause of dizziness diagnosed?

The diagnosis of dizziness starts with the health care practitioner determining whether the complaint is lightheadedness or vertigo. Once this differentiation is made, further diagnosis can begin.

A detailed history and physical examination are essential in the diagnosis of dizziness. Listening to the patient’s story often leads to a diagnosis. The health care provider may inquire about the factors that cause and treat dizzy symptoms.

• The onset of symptoms whether these are quick or slow
• Duration of symptoms
• Symptoms associated with a change in position
• Other associated symptoms like nausea vomiting chest pain
• Symptoms associated with hearing or balance issues

A system review is a set of questions that go over the patient’s body functions. The doctor may inquire about symptoms such as fever, vomiting, diarrhea, chest pain, shortness of breath, palpitations, or unusual bleeding.

The doctor may go through the patient’s medical history, including the medications he or she is now taking.

• Take the patient’s blood pressure and pulse rate when laying down and standing (called orthostatic or postural vital signs) to determine the fluid condition of the body. When individuals who are dehydrated or bleeding change positions, their blood pressure and pulse rate may drop. Patients on beta-blockers, on the other hand, will not experience an increase in pulse rate.
• Physical examinations are frequently adapted to the patient based on the information provided in the patient’s medical history. A lady with a heavy menstrual cycle, for example, may require a pelvic examination, while a patient with a cough and shortness of breath may require a detailed examination of the heart and lungs. The cerebellum, the region of the brain responsible for balance and coordination, will be examined more closely in a patient suspected of having vertigo.
• Imaging studies and/or blood tests: The requirement for imaging studies and/or blood testing is determined by the health care professional’s and patient’s concerns about the source of the dizziness.
• common tests
  • Complete blood count
  • Electrolyte level
  • Blood sugar level
  • Kidney function
  • Liver function text
  • Thyroid function test
  • Chest x-ray
  • CT scan
  • EKG
  • MRIs

How is dizziness treated?

Treatment will depend on the cause of your dizziness. Your healthcare provider may give you oxygen or medicines to decrease your dizziness and nausea. He may also refer you to a specialist. You may need to be admitted to the hospital for treatment.

For additional information, always call your health care provider