A 70 year-old male with a history of gout, hypertension, chronic renal insufficiency, and hypercholesterolemia presented to his primary care physician complaining of intermittent dizziness. He had approximately three episodes per week, each lasting ten minutes, and resolving spontaneously. He described feeling``lightheaded'' during each episode, and denied a positional component, vertigo, visual disturbances, tinnitus, history of seizures, aura, post-ictal state, loss of consciousness, palpitations, chest pain, and shortness of breath. An EKG shortly after the first episode showed no rhythm abnormalities, ischemia, or infarction. His chronic medications were simvastatin, allopurinol, and lisinopril. Physical examination revealed a blood pressure of 156/84mmHg, pulse 66, and respiratory rate 16. He did not have orthostatic hypotension. Cardiac exam revealed a non-displaced PMI, regular rate and rhythm, normal S1 and S2 with no murmurs, gallops, or rubs. Holter monitor testing revealed multiple episodes of multifocal ventricular ectopy including short runs of ventricular bigeminy, trigeminy, and quadrigeminy with a heart rate of 80 beats per minute. He was diagnosed with non-sustained ventricular tachycardia (NSVT). A review of the patient's log revealed that each tachyarrhythmic event correlated with an episode of dizziness. He underwent echocardiography, which showed a structurally normal heart and an ejection fraction of 55%. He was prescribed metoprolol 12.5mg po qam, and at a one-month follow-up visit reported improvement in his symptoms. IMPLICATIONS/DISCUSSION: Dizziness is a common complaint heard by primary care physicians, yet only a small percentage of patients receive a firm diagnosis and an effective treatment. In this patient, the discrete nature of these episodes hinted at the possibility of a cardiac arrhythmia. Clinical suspicion for a cardiac problem prompted an evaluation by Holter testing. The results showed a temporal relationship between NSVT and dizziness, and provided evidence for a firm diagnosis. Patients with NSVT and a structurally normal heart are not at risk for sudden death, and may be treated with daytime oral beta-blocker therapy to decrease symptoms. Conversely, large studies have shown that the combination of NSVT and a structurally abnormal heart is a risk factor for sudden death. Treatment of NSVT with a structurally abnormal heart requires the use of an Automatic Implantable Cardioverter-Defibrillator (AICD). Beyond cardiac arrhythmias, dizziness has many causes. A proper history of the dizzy patient should include questions about syncope, hyperventilation, anxiety, visual disturbances due to incorrect eyeglasses or diplopia, and concussion. Physical examination should evaluate orthostatic hypotension, hypertension, and peripheral neuropathy. Anemia and hypoxia should be evaluated by laboratory studies.