Dizziness and Heart Palpitations: Differential Diagnosis and Urgency

Concurrent dizziness and palpitations suggest cardiovascular, metabolic, or neurologic pathology requiring prompt evaluation.

Major Etiologic Categories

Category	Key Causes	Typical Features
Arrhythmias	AFib, SVT, VT, bradyarrhythmias	Irregular pulse, syncope risk, exertional trigger
Hemodynamic	Orthostatic hypotension, anemia, dehydration, PE	Postural worsening, tachycardia compensates
Metabolic/Endocrine	Hypoglycemia, hyperthyroidism, electrolyte imbalance	Diaphoresis, tremor, weight change, heat intolerance
Medication Effects	Stimulants, thyroid meds, QT-prolonging drugs, diuretics	Temporal relation to dosing
Neuro/Vestibular	Vestibular migraine, BPPV, autonomic dysfunction	Positional trigger, nausea, visual vertigo

Immediate Actions

• Call 911 if: chest pain, syncope, dyspnea, focal neuro signs, palpitations >10 min
• Sit/lie down; avoid driving
• Hydrate if tolerated
• Bring medication list to evaluation

Diagnostic Workup

ECG → rhythm strip → labs (CBC, BMP, TSH, troponin if indicated) → ambulatory monitoring (Holter, event recorder, ILR) → echo if structural concern → EP study if arrhythmia confirmed.