Type of Orthostatic Problem - Using the Time of Symptoms & Changes in BP & P

The key to diagnosis is to create the orthostatic stress - have the persons stand up. Then, record when the person gets symptoms, what symptoms and how long after standing up..

There are a number of syndromes or types of problems that can be causing a person's orthostatic symptoms. It is possible to have more than one kind of problem.The delayed OI problems don't show up until the person has been standing for awhile. That is the reason most tests or evaluations will go for 45 minutes to see if a person has more than one kind of orthostatic problem. As you can see, a part of deciding what type of syndrome a person has depends on both the symptoms they have AND how soon the symptoms start after they stand up.

Time of Symptoms and Types of Orthostatic Intolerance (OI):
Fainting (Syncope), OH/NMH &/or POTS

Symptoms	Time from standing to start of symptoms	Type of Orthostatic Problem	Most frequently associated with
Lightheadedness or dizziness, visual changes. Fainting (syncope) - rare	0-30 sec	Initial Orthostatic Hypotension (OH) (NMH)	Young, asthenic subjects, old age, drug induced (α-blockers), CSS*
Classic Prodome symptoms^: Dizziness, fatigue, weakness, palpitations, visual and hearing disturbances, short of breath Fainting - rare	30 sec - 3 min	Classical OH (classical autonomic failure) (AKA - NMH)	Old age, drug induced (any drugs that affect vessels and diuretics)
Prolonged prodrome** frequently followed by a rapid faint	3-30 min	Delayed (progressive) OH (NMH)	Old age, autonomic failure, drug induced, other medical conditions
Prolonged prodrome** always followed by a rapid faint	3-45 min	Delayed (progressive) OH (NMH) + reflex syncope	Old age, autonomic failure, drug induced, other medical conditions
Classic prodrome^ and triggers. Always followed by a faint.	3-45 min	Reflex syncope-triggered by standing (VasoVagal Syncope)	Young healthy, more female than males
Symptomatic, marked heart rate increases + instability of blood pressure. No faint.	Variable, usual within 10 min	POTS	Young female

"sec"=seconds. "min"=minutes. OH=orthostatic hypotension. OI=orthostatic intolerance. POTS=Postural Orthostatic Tachycardia Syndrome. OH-this is also called NMH - neurally-mediated hypotension. See Orthostatic Hypotension.

Table Resource: Moya¹

*CSS - Carotid Sinus Syndrome

**Prolonged Prodrome symptoms-Dizziness, fatigue, weakness, palpitations, visual and hearing disturbances, sweating, neck/shoulder pain, chest pain/pressure, and low back pain.

About the table below: The first column has a partial list of the orthostatic symptoms a person might have. The second column describes how soon the symptoms start after the person stands up.

Comment:

• As you go over the list, you will notice that symptoms start right away for some. For others, the symptoms are delayed and happen after the person has been standing a longer time.
• Some have fainting, some don't.
• It is also possible to have more than 1 problem - fainting and symptoms with low blood pressure (NMH or OH), or POTS and NMH, or POTS and delayed fainting.

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Author's Note: There are different ways that physicians and articles classify and name the types of orthostatic syndromes. We have chosen this one because it seems to be the easiest to understand from the perspective of the person who has the symptoms or problem.

For a more complete list of the classic and prolonged symptoms of orthostatic intolerance (OI), go to Symptoms of OI.

To learn more about  fainting & types of fainting, go to Fainting (Syncope) Types & Causes.

For orthostatic hypotension (low blood pressure with orthostatic symptoms) , go to Orthostatic Hypotension (OH) & What is NMH

To learn more about POTS - Postural Orthostatic Tachycardia Syndrome, go to POTS.

 

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General References

1. Moya, Guidelines for the diagnosis and management of syncope (version 2009). European Heart Journal (2009); 30: 2631-2671. Abstract. Article PDF.

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