His symptoms are due to worsening of his heart condition until proven otherwise. Therefore, he needs to see his cardiology or be seen at a heart hospital immediately. He should have an ultrasound of this heart, routine blood work screening, EKG, and medication reconciliation. If those are unremarkable, then he needs a stress test. It is important to distinguish between vertigo, presyncope (patient feels like they are going to black out; vision and hearing may become obscured), disequilibrium (off balance), and light-headedness (vague, inconsistent symptoms, no rotational component). Vertigo is the sensation of movement ( room spinning ) when no movement is actually occurring; results from peripheral or central causes or may be induced by medications/anxiety disorders.