Orthostatic syncope is a term describing the loss of consciousness in association with orthostatic hypotension. After suddenly standing up and a sudden drop in blood pressure, patients report fainting episodes and lightheadedness. A detailed patient history and a physical examination, during which serial blood pressure measurements are made, are mandatory components of the diagnostic workup.
When the patient changes from supine to standing position, about 10-15% of all blood pools in the venous system of the lower extremities  . The sudden action of standing up might lead to an abnormal vasomotor response by causing sharp decreases in blood pressure and could result in hypoperfusion of tissues (particularly of the central nervous system)  . This phenomenon is known as initial orthostatic hypotension, characterized by a transient fall of systolic and diastolic pressures of > 40 mmHg and/or > 20 mmHg, respectively   . The inadequate perfusion of tissues seen when initial orthostatic hypotension ensues principally manifests as a transient loss of consciousness (syncope), which may be preceded by dizziness (pre-syncope)  . Orthostatic syncope develops approximately 5-10 seconds after suddenly standing up . Additional symptoms that have been described in the literature are lightheadedness, headaches, visual disturbances, dyspnea, muscle weakness, a transient cognitive decline, and shoulder discomfort  . This form of syncope is especially prevalent among the elderly, in whom baroreceptor activity and the mechanisms involved in blood pressure regulation are not optimally efficient .
Entire Body System
Targeted blood testing is reasonable including complete hematology, glycemic and metabolic profiles to rule out associated conditions such as anemia, metabolic or renal derangements. [ncbi.nlm.nih.gov]
100mg and ergotamine 100mg Differential Diagnosis Differential diagnosis includes other causes of loss of consciousness Seizures Hypoglycemia Concussion secondary to head trauma Drug or alcohol intoxication Metabolic conditions including hypothyroidism, hypoxemia [ncbi.nlm.nih.gov]
Melena, hematemesis, hematuria, menorrhagia or hematochezia point to blood loss. Elderly deconditioned patients, especially after prolonged hospitalization, may have reduced muscle tone. [ncbi.nlm.nih.gov]
- Eating Frequently
Eat frequent small meals (because eating lowers blood pressure). Avoid sudden standing after eating. Avoid straining at stool (because this may lower the blood pressure) Avoid hot showers or excessive heat. Use air conditioners. [dizziness-and-balance.com]
Additional mental loading could be a useful countermeasure to alleviate the orthostatic responses of persons, particularly in those with histories of dizziness on standing up, or to alleviate hypotension that frequently occurs during hemodialysis or on [ncbi.nlm.nih.gov]
All the general information concerning the mechanisms causing unconsciousness, the symptoms and the different types of syncope are presented under the heading: The syncope, a dizzying subject. [icardio.ca]
Usually the patient will complain of blackouts and dizzy turns, the result of impaired cerebral perfusion. Links: aetiology diagnosis and investigation management syncope [gpnotebook.co.uk]
[…] disease, there tends to be more rigidity than tremor, yet the rigidity lacks the typical “cogwheel” or “lead pipe” rigidity seen in Parkinson’s disease.24,25 Patients with parkinsonian-type MSA frequently display a loss of facial expression and limb akinesia [ahajournals.org]
[…] disease, there tends to be more rigidity than tremor, yet the rigidity lacks the typical “cogwheel” or “lead pipe” rigidity seen in Parkinson’s disease. 24,25 Patients with parkinsonian-type MSA frequently display a loss of facial expression and limb akinesia [circ.ahajournals.org]
- Truncal Ataxia
ataxia that may impede the person from standing without support. [ahajournals.org]
The diagnosis of orthostatic syncope rests on the ability of the physician to obtain a detailed patient history and conduct a meticulous physical examination. In fact, the role of a proper patient interview has shown to be pivotal in establishing the underlying cause of syncope . However, the diagnosis of orthostatic syncope can be confirmed by series of blood pressure measurements or continuous blood pressure monitoring   . Some authors recommend that blood pressure should be measured after 5 minutes of lying followed by few measurements after standing up (for 3-5 minutes). Physicians should note whether dizziness and light-headedness appear  . In rare cases, patients may not be able to stay in standing position throughout the entire examination , which is an important clue for the diagnosis of orthostatic syncope. The possibility of constant blood pressure measurement during this period significantly increases the chance of confirming the diagnosis   . Additionally, the head-up tilt test is described in the literature as a possible method to assess orthostatic hypotension . Furthermore, a complete cardiac exam, comprised of electrocardiography (ECG) and cardiac ultrasonography is recommended . The differential diagnosis of orthostatic syncope is quite broad, indicating that a more detailed evaluation (particularly of the central nervous system) might be necessary .
- Arthur W, Kaye GC. The pathophysiology of common causes of syncope. Postgrad Med J. 2000;76:750–753.
- Naschitz JE, Rosner I. Orthostatic hypotension: framework of the syndrome. Postgraduate Medical Journal. 2007;83(983):568-574.
- Brignole M, Alboni P, Benditt DG, Bergfeldt L, Blanc JJ, Bloch Thomsen PE. European Society of Cardiology. Guidelines on management (diagnosis and treatment) of syncope. Eur Heart J. 2001;22:1256–1306.
- Vaddadi G, Lambert E, Corcoran SJ, Esler MD. Postural syncope: mechanisms and management. Med J Aust. 2007;187(5):299-304.
- Wieling W, Krediet CT, van Dijk N, Linzer M, Tschakovsky ME. Initial orthostatic hypotension: review of a forgotten condition. Clin Sci (Lond). 2007;112(3):157-165.
- Low PA, Tomalia VA. Orthostatic Hypotension: Mechanisms, Causes, Management. J Clin Neurol. 2015;11(3):220-226.
- Nwazue VC, Raj SR. Confounders of Vasovagal Syncope: Orthostatic Hypotension. Cardiol Clin. 2013;31(1):89-100.
- Alboni P, Brignole M, Menozzi C, et al. Diagnostic value of history in patients with syncope with or without heart disease. J Am Coll Cardiol. 2001;37(7):1921-1928.