Thanks to the contributor who mentioned the spirograph - I remembered seeing images like this as a kid when I saw the opening credit sequence of "Vertigo" & found the images fascinating. Now I remember my own experience of that little machine. Even so, the opening sequence, both visually and musically - and also together - set a tone of something stressful for the action to come.
Moving beyond the opening sequence, "Vertigo" is a movie of "high anxiety" - literally. This is where Hitchcock moves beyond the outward experience of the cliffhanger to the inward one. I haven't yet found when he first used the motif of someone hanging from a great height, but it ends with death in "Saboteur" (1942) There's one in "Rear Window" (1954) where the character falls and is injured. Yet another in "To Catch a Thief" (1955) when again, the evil-doer hangs from a roof. How many other of Hitchcock's movies have such a cliffhanger? What was their chronological sequence? Just another fascinating fact to research about H!
"Vertigo" of 1958 takes a huge step beyond the external experience of the cliffhanger to the internal experience of it - moving into the effect on the psyche of the individual who was hanging over the "cliff." The movie starts with the cliffhanger instead of ending with it and deals several times with the most likely effect of such a predicament - i.e. death. Interestingly, the protagonist in "Vertigo" is not only experiencing the damaging effect on his psyche of having hung off a "cliff," but also seeing the experience from the outside as well, several times. Also interestingly, in "North By Northwest" (1959) H. returns to the concluding cliffhanger, but makes a very positive transition from the horror to happiness. A delightful resolution - but as in "Vertigo," leaving unanswered the question: how did the character get out of the predicament s/he was in? Of course, it's a film, a story; and in effect it doesn't matter because film moves on fast and the director ensures his focus is the audience's focus, at least for the first viewing. However, in "Vertigo," an interesting unanswered question is how Scottie got himself out of his own predicament at the start of the movie! It leaves a lot for the imagination to come up with after the movie ends.
My further reading tells me that an alternative ending was made for this movie - see https://en.wikipedia.org/wiki/Vertigo_(film) - which reflected the concerns of the censors of the time - they didn't want viewers to come away thinking that someone could get away with murder.