Symptoms of OI
• Symptoms Before the Faint and With Continued Standing
• Delayed Symptoms & Autonomic Symptoms
Delayed & Autonomic Symptoms
Not all of the symptoms start right away. It is these other symptoms that can interfere the most with daily life.
• Delayed symptoms - The third set of symptoms comes after standing up and getting the first round of OI symptoms. A person can continue with other symptoms that last for days or weeks.
• Other symptoms - There are also symptoms that can develop that are associated with failure of the autonomic nervous system.
- Delayed Symptoms
- Other Symptoms - Autonomic Nervous System Dysfunction
Afterward standing for longer periods, the person may have a different type of symptoms. The delayed symptoms can last for hours and even days. The challenge in understanding the delayed symptoms is the fact that if a person's not on medication or stable with other management, every time a person stands up, they are releasing Epi/Norepinephrine and stressing the body. This starts a new set of delayed symptoms or makes them worse.
- Fatigue - This could be mild to 'tired to the bone' fatigue. It can last hours or days.
- Mental fog - This might be confusion, problem with finding words, word-letter substitution,doing simple math, & memory.
- Exercise Intolerance - This usually means the person cannot exercise like before getting sick. There is usually more fatigue after exercising. There might be orthostatic symptoms with exercising such as headache/neck pain, shortness of breath (hard to breath), or just feel "yucky". Just going up a flight of steps can bring symptoms.
- Post-Exertional Malaise (PEM) - This is the fatigue and other symptoms including a general "yucky" feeling that comes after doing too much. It could come after climbing stairs, doing exercise, being in the heat for a long time or doing mental activities like reading, concentrating on paperwork, focusing on a computer screen. This relationship is especially obvious in people who have both POTS and CFS.16
- Sleep disturbance
- Migraine headaches
Trying to do things standing up when the orthostatic problem has not been corrected or treated will make the problem worse.
You can learn more about all these on the different sections and pages. For example: check out Symptoms of OI, Common Triggers, Managing OI and Recovering from OI.
References
- Moya, Guidelines for the diagnosis and management of syncope (version 2009). European Heart Journal (2009); 30: 2631-2671.*Abstract. Article PDF.
- Jacob G, Costa F, Shannon JR, Robertson RM et al. The Neuropathic Postural Tachycardia Syndrome. N Engl J Med 2000;343: 1008-14.* Abstract. Article PDF.
- Freeman, Roy. Neurogenic orthostatic hypotension.NEJM 2008;358(6):615-624.* Abstract
- Brignole, M. The syndromes of orthostatic intolerance. E-journal of Cardiology Practice. 2007: 6(5).* Access.http://www.escardio.org/communities/councils/ccp/e-journal/volume6/Pages/vol6n5.aspx
- Medow MS, Stewart JM, Sanyal S, Mumtaz A, Stca D and Frishman WH. Pathophysiology, Diagnosis, and Treatment of Orthostatic Hypotension and Vasovagal Syncope. Cardiology in Review 2008;16(1):4-20.* Abstract
- Soliman, K., Sturman, S., Sarkar, PK, Michael, M. Postural Orthostatic tachycardia Syndrome (POTS): A Diagnostic Dilemma. Br J Cardiol.2010: 17(1);36-39.*
- Low PA and Singer W. Update on Management of Neurogenic Orthostatic Hypotension. Lancet Neurol. 2008 May ; 7(5): 451–458.* Abstract. Article PDF.
- Rowe, Pete. General Information Brochure on Orthostatic Intolerance and Its Treatment. June 2010. Accessed from http://www.cfids.org/webinar/cfsinfo2010.pdf. Accessed May 28.2012.*
- Robertson D, Kincaid DW, Haile V, Roberston RM.The head and neck discomfort of autonomic failure: an unrecognized aetiology of headache. Clin Autonom Res. 1994: 4; 99-103
- Low PA, Sandroni P, Joyner M, Shen WK. Postural Tachycardia Syndrome (POTS). J Cardiovasc Electrophysiol. March 2009: 20; 352-358.
- Grubb BP. Postural tachycardia syndrome. Circulation. 2008;117:2814–2817. Abstract. Article PDF.
- Thieben MJ, Sandroni P, Sletten DM, et al. Postural orthostatic tachycardia syndrome: The Mayo Clinic experience. Mayo Clin Proc. 2007;82:308–313. Abstract. Article PDF.
- Sullivan SD, Hanauer J, Rowe PC, Barron DF, Darbari A, Oliva-Hemker M. Gastrointestinal symptoms associated with orthostatic intolerance. J Pediatr Gastroenterol Nutr. 2005 Apr;40(4):425-8. Abstract.
- Gordon, Victor. Assessment of the Autonomic Nervous System in Patients with Neuropathies. Presentation. Faculty of Pain Medicine. Autonomic laboratory, Melbourne Victoria. Assessed July 6, 2012.
- Johnson JN, Mack KJ, Kuntz NL, Brands CK, Porter CJ and Fischer PR. Postural Orthostatic Tachycardia Syndrome: A Clinical Review. Pediatr Neuro 2010; 42:77-85. Abstract.
- Capuron L, Welberg L, Heim C, Wagner D, Solomon L, Papanicolaou DA, Craddock RC, Miller AH, Reeves WC. Cognitive dysfunction relates to subjective report of mental fatigue in patients with chronic fatigue syndrome. Psychosom Med. 2008 Sep;70(7):829-36. Epub 2008 Jul 7.Abstract. Article PDF.
Author: Kay E. Jewell, MD
Page Last Updated: June 22, 2012