Orthostatic Dysregulation Quiz
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Dizziness
Lightheadedness when I am standing
Dizzy when standing up
Fatigue is worse in the morning
Feeling faint
Off-balance like floating
Blacking out
Not seeing your symptoms? No worries!
What is Orthostatic Dysregulation?
Orthostatic dysregulation (OD) is a general term that describes abnormal blood pressure changes triggered by sitting up or standing, most commonly resulting in low (orthostatic hypotension) or, less commonly, high blood pressure (orthostatic hypertension). OD is most common in the elderly, and can be due to certain medications (e.g. anti-depressants and anti-hypertensives), certain diseases affecting the nervous system (e.g. diabetes, Parkinson disease, multiple sclerosis), and can be seen in certain sleep disorders.
Typical Symptoms of Orthostatic Dysregulation
- Fatigue or low energy that is worse in the morning
- Fainting
- Dizziness
- Feel unsteady or floating when I am standing
- Headache that gets worse in the morning
- Forehead pain
- Dizziness when standing or after prolonged standing
- Stressed over daily life
Diagnostic Questions for Orthostatic Dysregulation
Your doctor may ask these questions to check for this disease:
- Do you experience fatigue or low energy that is worse in the morning?
- Have you fainted recently?
- Do you feel dizzy?
- Do you feel dizzy or floaty when standing?
- Do your headaches get worse in the morning?
Treatment of Orthostatic Dysregulation
Treatment aims to restore normal blood pressure. The simplest method is to sit back down if symptoms occur and stand up slowly. For OD caused by specific diseases, treatment of those diseases can control symptoms. Other lifestyle changes like maintainin hydration, reducing alcohol intake can help.
Reviewed By:
Benjamin Kummer, MD (Neurology)
Dr Kummer is Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai (ISMMS), with joint appointment in Digital and Technology Partners (DTP) at the Mount Sinai Health System (MSHS) as Director of Clinical Informatics in Neurology. As a triple-board certified practicing stroke neurologist and informaticist, he has successfully improved clinical operations at the point of care by acting as a central liaison between clinical neurology faculty and DTP teams to implement targeted EHR configuration changes and workflows, as well as providing subject matter expertise on health information technology projects across MSHS. | Dr Kummer also has several years’ experience building and implementing several informatics tools, presenting scientific posters, and generating a body of peer-reviewed work in “clinical neuro-informatics” – i.e., the intersection of clinical neurology, digital health, and informatics – much of which is centered on digital/tele-health, artificial intelligence, and machine learning. He has spearheaded the Clinical Neuro-Informatics Center in the Department of Neurology at ISMMS, a new research institute that seeks to establish the field of clinical neuro-informatics and disseminate knowledge to the neurological community on the effects and benefits of clinical informatics tools at the point of care.
Yoshinori Abe, MD (Internal Medicine)
Dr. Abe graduated from The University of Tokyo School of Medicine in 2015. He completed his residency at the Tokyo Metropolitan Health and Longevity Medical Center. He co-founded Ubie, Inc. in May 2017, where he currently serves as CEO & product owner at Ubie. Since December 2019, he has been a member of the Special Committee for Activation of Research in Emergency AI of the Japanese Association for Acute Medicine. | | Dr. Abe has been elected in the 2020 Forbes 30 Under 30 Asia Healthcare & Science category.
Content updated on May 13, 2024
Following the Medical Content Editorial Policy
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- Feel anxiety suddenly
- Dizziness multiple times
- Felt nauseous then fainted
- Sweating followed by fainting
- Fainting followed by a headache
- Spinning feeling
- Fainting when walking
- Chest pain with fainting
- A sense of motion or spinning (vertigo)
- Feeling faint before losing consciousness
- Confused or drowsy for a while after recovering consciousness
- Fainting when tired
- Fainted but retained the ability to recall fainting
- Dizzy in the morning
- Feeling skin warmth or "hot flashes" before fainting
See full list
Symptoms Related to Orthostatic Dysregulation
Diseases Related to Orthostatic Dysregulation
FAQs
Q.
Body Misfiring? Why Your Autonomic Nervous System Is Failing & Medical Next Steps
A.
Autonomic nervous system dysfunction, or dysautonomia, can make your body feel like it is misfiring, causing dizziness on standing, heart rate or blood pressure swings, fainting, brain fog, and digestive changes, and it often arises from diabetes, autoimmune disease, post-viral syndromes including COVID-19, neurodegenerative disorders, medications, or deconditioning. There are several factors to consider, and the right next steps can differ by cause. See below for complete details on red flags that need urgent care, the key tests to request such as orthostatic vitals, tilt table, ECG or Holter, blood work, and sweat testing, how targeted lifestyle changes and medications help, and when to seek specialist referral.
References:
* Mukkamala SK, et al. Autonomic dysfunction: an overview of the clinical presentation and management. Auton Neurosci. 2023 Feb;245:103099. doi: 10.1016/j.autneu.2022.103099. Epub 2022 Nov 22. PMID: 36473041.
* Goldstein DS, et al. Dysautonomia: a comprehensive review for the clinician. Clin Auton Res. 2017 Aug;27(4):241-251. doi: 10.1007/s10286-017-0461-1. Epub 2017 Jul 18. PMID: 28721759.
* Darragh M, et al. Autonomic Neuropathy. Curr Treat Options Neurol. 2021 May 29;23(7):10. doi: 10.1007/s11940-021-00684-w. eCollection 2021. PMID: 34047814.
* Fedorowski A, et al. Postural orthostatic tachycardia syndrome: diagnosis, pathophysiology, and management. Lancet Neurol. 2021 Sep;20(9):767-778. doi: 10.1016/S1474-4422(21)00242-7. Epub 2021 Aug 17. PMID: 34418386.
* Palma JA, Goldstein DS. Pure autonomic failure: a comprehensive review. Handb Clin Neurol. 2023;193:17-45. doi: 10.1016/B978-0-323-99933-2.00002-8. PMID: 36934898.
Q.
POTS Disease? Why Your Heart is Racing & Medically Approved Next Steps
A.
A racing heart when you stand may be POTS, a disorder of the autonomic nervous system defined by a rise of at least 30 beats per minute within 10 minutes of standing without a major blood pressure drop, often with dizziness, brain fog, nausea, or fainting. Medically approved next steps include prompt medical evaluation to rule out dangerous causes, increasing fluids and electrolytes with salt if appropriate, graded recumbent exercise, compression garments, and medications when needed. There are several factors to consider. See below to understand more, including warning signs that need emergency care and how underlying conditions can change the best plan.
References:
* Rife B, Al-Hassani A, Zipes DP, Goldberger JJ. (2023). Postural orthostatic tachycardia syndrome: diagnosis, pathophysiology, and management. *Expert Rev Cardiovasc Ther*, 21(1), 15-28.
* Wells R, Tonkin A, Loader S, Mahajan R, Mahajan A. (2021). Current Diagnosis and Management of Postural Orthostatic Tachycardia Syndrome (POTS). *J Clin Med*, 10(9), 1869.
* Kanjwal K, Patel D, Kanjwal Y. (2020). Postural Orthostatic Tachycardia Syndrome: A Concise and Practical Review for Primary Care Physicians. *Mayo Clin Proc Innov Qual Outcomes*, 4(2), 207-220.
* Raj SR, Dudenbostel T, Ruzieh M, Kanjwal K. (2022). Clinical management of postural orthostatic tachycardia syndrome: Current updates. *J Arrhythm*, 38(4), 533-541.
* Blitshteyn S. (2022). Management of Postural Orthostatic Tachycardia Syndrome (POTS). *Clin Auton Res*, 32(1), 43-52.
Q.
What Is POTS? Why Your Heart Is Spiking & Medical Next Steps
A.
POTS is a disorder of the autonomic nervous system in which standing triggers a heart rate jump of 30 bpm or more without a major blood pressure drop, because blood pools in the lower body and the heart races to compensate, causing dizziness, palpitations, fatigue, and brain fog. Immediate next steps include tracking your lying vs standing heart rate, seeing a clinician for orthostatic vitals, tilt table testing and labs to rule out other causes, and beginning hydration, appropriate salt, compression, and gradual recumbent exercise, with urgent care for crushing chest pain, severe shortness of breath, or sudden fainting. There are several factors to consider that can change your plan; key causes, medication options, and red flags are explained below.
References:
* Sheldon RS, Grubb BP, Olshansky B, et al. Postural Orthostatic Tachycardia Syndrome: JACC Focus Seminar 2023. J Am Coll Cardiol. 2023 May 9;81(18):1811-1825. PMID: 37137691.
* Raj SR, Bourne KM, Sheldon RS, et al. Postural Orthostatic Tachycardia Syndrome: The American Autonomic Society Statement on Diagnosis and Management. Auton Neurosci. 2023 May;250:103164. PMID: 36764507.
* Vernino S, Bourne KM, Raj SR. Postural orthostatic tachycardia syndrome (POTS): current knowledge and future challenges. Eur Heart J. 2021 Dec 21;42(48):4927-4935. PMID: 34520556.
* Chandar N, Maalouf B, Maalouf J. Postural Orthostatic Tachycardia Syndrome (POTS): A Concise Review of Diagnosis and Management. Front Physiol. 2021 Jul 15;12:688642. PMID: 34335345.
* Fu Q, Vanegas-Arroyave N, Sheldon RS. Current Approach to the Diagnosis and Management of Postural Orthostatic Tachycardia Syndrome. Cardiol Clin. 2020 Aug;38(3):365-375. PMID: 32622438.
Q.
Heart Racing After Standing? POTS Symptoms & Medically Approved Next Steps
A.
A racing heart after standing, especially with dizziness, fatigue, or brain fog, may be POTS, where heart rate rises by 30 bpm or more within 10 minutes without a major blood pressure drop; it is usually not life-threatening but should be medically evaluated. Medically approved next steps include seeing a doctor, tracking seated and standing vitals, increasing fluids, using salt only under guidance, wearing compression, starting graded recumbent exercise, and considering medications if needed; seek urgent care for chest pain, fainting, severe shortness of breath, confusion, or a very high resting heart rate. There are several factors to consider; see below for diagnosis details, triggers to avoid, specialist referrals, and what recovery can look like.
References:
* Sheldon, R. S., et al. "2023 ACC Expert Consensus Decision Pathway for Postural Orthostatic Tachycardia Syndrome (POTS): A Report of the American College of Cardiology Solution Set Oversight Committee." Journal of the American College of Cardiology, vol. 82, no. 18, 2023, pp. 1735–1782.
* Raj, S. R., et al. "Treatment of Postural Orthostatic Tachycardia Syndrome (POTS): JACC State-of-the-Art Review." Journal of the American College of Cardiology, vol. 82, no. 18, 2023, pp. 1783–1808.
* Bryarly, M., et al. "Postural Orthostatic Tachycardia Syndrome: JACC Focus Seminar." Journal of the American College of Cardiology, vol. 78, no. 9, 2021, pp. 943–961.
* Vernino, S., et al. "Postural Tachycardia Syndrome: An Overview of Diagnosis and Management." Current Opinion in Neurology, vol. 34, no. 1, 2021, pp. 121–127.
* Fu, Q., & Vittinghoff, E. "Postural Orthostatic Tachycardia Syndrome: The Latest Evidence-Based Treatments." American Journal of Physiology-Heart and Circulatory Physiology, vol. 319, no. 6, 2020, pp. H1225–H1232.
Q.
Heart Racing? Why POTS Syndrome Happens & Medically Approved Next Steps
A.
Heart racing when you stand can be due to POTS, a recognized autonomic disorder where standing triggers a rise in heart rate of at least 30 beats per minute, often with dizziness and brain fog, commonly linked to blood pooling, low blood volume, and post viral or autonomic regulation issues. There are several factors to consider; medically approved next steps include hydration, doctor guided salt intake, compression garments, gradual recumbent to upright exercise, and individualized medications, plus medical evaluation to rule out other causes and know when to seek urgent care. See below for complete details that can shape the next steps in your healthcare journey.
References:
* Sheldon RS, Grubb BP, Olshansky B, Shen WK, Calkins H, Brignole M, Sutton R, Wieling W. 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Orthostatic Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope. Heart Rhythm. 2015 Jun;12(6):e41-e63. doi: 10.1016/j.hrthm.2015.03.003. Epub 2015 Mar 24. PMID: 25732150.
* Raj SR, Guzman JC. Postural Tachycardia Syndrome (POTS): Pathophysiology, Diagnosis, and Management. Curr Cardiol Rep. 2021 Mar 27;23(5):37. doi: 10.1007/s11886-021-01479-7. PMID: 33772290; PMCID: PMC8003102.
* Blitshteyn S, Raj SR. Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders: Pathophysiology and Clinical Management. Neurotherapeutics. 2023 Jul;20(4):947-959. doi: 10.1007/s13311-023-01362-7. Epub 2023 May 10. PMID: 37166545; PMCID: PMC10359876.
* Kritsi K, Dimopoulou P, Tsioufis K. The current state of knowledge regarding postural orthostatic tachycardia syndrome. J Clin Hypertens (Greenwich). 2023 Nov;25(11):980-987. doi: 10.1111/jch.14725. Epub 2023 Aug 11. PMID: 37566191; PMCID: PMC10657922.
* Raj SR. Postural Tachycardia Syndrome (POTS). Circulation. 2013 Aug 13;128(9):1034-42. doi: 10.1161/CIRCULATIONAHA.112.144019. PMID: 23940139; PMCID: PMC3931441.
Q.
POTS Syndrome in Women 65+: Why Your Symptoms Aren’t Just Age
A.
POTS in women 65+ is real and often mistaken for normal aging; standing causes an abnormal jump in heart rate with dizziness, fatigue, brain fog, and sometimes palpitations that often ease when you lie down. There are several factors to consider. See the complete guidance below for how it is evaluated with orthostatic vitals and sometimes tilt testing, why it can increase fall risk, and practical treatments like fluids, doctor approved salt, compression, gradual recumbent exercise, and carefully chosen medicines, plus urgent red flags and self advocacy steps.
References:
* Fu, Q., & Vongpatanasin, W. (2021). Postural orthostatic tachycardia syndrome in older adults: An underrecognized entity?. *Journal of geriatric cardiology : JGC*, *18*(10), 833–840. https://pubmed.ncbi.nlm.nih.gov/35070007/
* Vongpatanasin, W., & Fu, Q. (2023). Aging and Autonomic Dysfunction: Insights from Postural Orthostatic Tachycardia Syndrome. *Circulation research*, *133*(5), 458–471. https://pubmed.ncbi.nlm.nih.gov/37624637/
* Arnold, A. C., & Vongpatanasin, W. (2022). Evaluation and Management of Postural Orthostatic Tachycardia Syndrome in the Older Adult. *Current cardiovascular risk reports*, *16*(10), 185–193. https://pubmed.ncbi.nlm.nih.gov/36048154/
* Muto, M. Y., Kudo, Y., Fukasawa, T., Ohsawa, M., Sato, Y., & Muto, T. (2021). Differential Diagnosis of Orthostatic Intolerance in the Elderly. *Geriatric Medicine Research*, *3*(2), 1-8. https://pubmed.ncbi.nlm.nih.gov/34296245/
* Chen, B., Wang, N., Wei, J., Wu, X., & Xu, Z. (2022). Impact of Age on Clinical Characteristics and Prognosis in Patients with Postural Orthostatic Tachycardia Syndrome. *Clinical interventions in aging*, *17*, 305–315. https://pubmed.ncbi.nlm.nih.gov/35345719/
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https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1References
Kawai M, Miyai N, Arita M. The prevalence of orthostatic dysregulation among newly graduated female nurses after employment and its associations with autonomic nervous function, stress, and depressive symptoms. SAGE Open Med. 2021 Apr 29;9:20503121211012180. doi: 10.1177/20503121211012180. PMID: 33996079; PMCID: PMC8107664.
https://journals.sagepub.com/doi/10.1177/20503121211012180Roca F, Rougette K, Zmuda L, Noel G, Larose S, Bordage M, Chassagne P. Association between orthostatic blood pressure dysregulation and geriatric syndromes: a cross-sectional study. BMC Geriatr. 2022 Feb 26;22(1):157. doi: 10.1186/s12877-022-02844-8. PMID: 35219308; PMCID: PMC8881862.
https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-022-02844-8Tsuchiya A, Kitajima T, Tomita S, Esaki Y, Hirose M, Iwata N. High Prevalence of Orthostatic Dysregulation among Circadian Rhythm Disorder Patients. J Clin Sleep Med. 2016 Nov 15;12(11):1471-1476. doi: 10.5664/jcsm.6268. PMID: 27568888; PMCID: PMC5078701.
https://jcsm.aasm.org/doi/10.5664/jcsm.6268