Cardiogenic vertigo: a comprehensive review

Cardiogenic vertigo (CV) is an episodic form of true vertigo arising from primary cardiac dysfunction, most commonly due to arrhythmias, structural heart disease, or other hemodynamic disturbances that result in transient cerebral hypoperfusion. Although spinning vertigo is typically regarded as a hallmark of vestibular disorders, emerging evidence indicates that similar symptoms can originate from cardiovascular abnormalities that intermittently disrupt cerebral perfusion of the inner ear, vestibular nuclei, or cerebellum. Prompt recognition of CV is crucial, as delayed identification may lead to serious consequences, including embolic stroke, syncope-related trauma, or sudden cardiac death. Understanding CV requires the integration of cardiovascular physiology with vestibular neuroanatomy, clarifying how transient reductions in cardiac output or rhythm disturbances provoke vertiginous sensations. Differential diagnosis from central and peripheral vestibular disorders, as well as psychogenic dizziness, necessitates careful evaluation through echocardiography, extended cardiac monitoring, and vestibular testing. An evidence-based diagnostic approach that combines cardiological and neuro-otological perspectives can improve diagnostic precision and treatment outcomes. Incorporating recently proposed diagnostic criteria may further enhance the accurate recognition of CV and reduce the risk of potentially life-threatening complications.