How to interview a patient with dizziness or fainting

"Dizzy" means different things to different patients. First find out which kind it is; for fainting, the story from before, during and after the event is the key.

Step by step

1. Introduce yourself and keep the patient safe

   Have them sit or lie down while you talk. Confirm identity and get consent. [1]

2. What does dizzy mean?

   The room spinning (vertigo), feeling faint or lightheaded, or feeling off balance. Each points to a different cause. [2]

3. Before the event

   Position (standing up, lying, exercising), warning signs (sweating, nausea, tunnel vision), palpitations or chest pain, and triggers such as pain, heat or standing long. [2]

4. During the event

   Did they lose consciousness, and for how long? Ask a witness about jerking, color, tongue biting and incontinence. [2]

5. After the event

   Quick recovery or a long confusion? Injuries from the fall? [2]

6. Heart red flags

   Fainting during exercise or lying down, palpitations, known heart disease, and a family history of sudden death at a young age. [3]

7. Medications and falls

   Blood pressure drugs, diuretics, sedatives and new medicines. Ask about other falls this year and fear of falling. [4]

8. Summarize and plan

   Name the most likely type, say if a heart red flag is present and plan orthostatic vital signs and an ECG. [1]

Common errors

• Treating all dizziness as the same.
• Not asking a witness.
• Missing exercise-related fainting (heart cause).

Sources

1. AAMC Core Entrustable Professional Activities (Core EPAs)
2. NBOME COMLEX-USA clinical presentations
3. NCCPA PANCE Content Blueprint
4. CDC STEADI (falls in older adults)

Facts and steps follow NBOME COMLEX-USA clinical presentations; CDC STEADI (falls in older adults). VMS is not affiliated with these organizations. Updated: 2026-10-11.