John W. Watford, MD
Unsteady Standing Up?
A careful discussion and a few basic tests usually reveal the cause
shutterstock | Andrey Popov
Have you ever become unsteady standing from a lying or seated position? Has it happened more than once? An abnormal decrease in blood pressure while rising, or orthostatic hypotension, may be the cause.
When we stand up, particularly if we have been lying down, the pressure under which our blood is flowing in our brains can be significantly lower than the blood pressure at our feet or near our hearts. To compensate, the speed and force of our heartbeat may temporarily increase. The arteries in the periphery of our bodies may constrict to redirect more blood to our brains. If the pressure drops enough over a short period of time, we feel dizzy or may even faint and fall.
Pinpointing the cause of orthostatic hypotension can be challenging. Usually, more than one issue is present. If you are 60 years or older and have felt faint or lost consciousness, you should see your doctor or seek attention at an emergency department if symptoms are severe and persistent. Your doctor will ask you to retell the circumstances of your dizziness or fainting in some detail to help discern the most likely cause. He or she will also measure your blood pressure and heart rate when you are lying flat, seated, and standing. Orthostatic hypotension is present if your systolic blood pressure drops 20mmHg (millimeters of mercury) with a concomitant drop of at least 10mmHg in diastolic blood pressure between lying and standing when measured over a few minutes. Usually, the heart rate increases.
Your doctor will consider your age and details about your personal and family history to recommend some simple initial changes to your activity, fluid intake, and/or medications. Your doctor may order an electrocardiogram, ultrasound of your heart, and basic blood tests if warranted. A home heart rhythm monitoring device may be suggested. Finally, further investigation of your nervous system and reflexes, particularly if you are diabetic or have peripheral neuropathy, might be needed.
People with orthostatic hypotension can still have high blood pressure. Though challenging, your doctor can recommend adjustments to your diet as well as the type, dosing, and timing of medicine to mitigate the orthostatic pressure while still avoiding the negative effects of chronic high blood pressure.
Talk to your doctor about it. He or she can help to solve the problem.
Dr. John W. Watford is certified by the American Board of Internal Medicine and has been practicing medicine since 2003. His concierge internal medicine and primary care practice is open and welcoming new patients at 4085 Tamiami Trail N, Suite B103, Naples FL, 34103. Reach Dr. Watford at 239.544.7440 or firstname.lastname@example.org.