Test

Standing Test for Fainting and Orthostatic Symptoms

This is the test that most matches what happens to a person in real life with standing up.⁴ If you have a history of heart problems and pass out (faint) with standing, it is better that you do NOT do this test by yourself unless you have had a cardiac (heart) evaluation to be sure the cause of your problem is not a heart rate or rhythm problem or ischemia (lack of blood flow in an artery of the heart).

 

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When doing the Standing Test, it is very important that you do not move, cross your legs, or tighten your muscles while you are doing this test. This means just stand there, no tightening the muscles of your legs, buttocks, arms, or fits. No clenching muscles anywhere. This can be hard once the symptoms start. Just remember that moving your body/muscles moves the blood and changes the results. That's how the body prevents conditions that cause orthostatic symptoms and fainting.

• The test is trying to find out if you get symptoms and feel faint when you stand up. You want to find out what you feel and when and what your BP and pulse are doing when you feel them.

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The test should be stopped if
    •  BP systolic (top number) is lower than 80 mmHg
    •  Pulse goes over 140
    •  You get pale and start to sweat a really lot (profusely)

If you feel like you are going to faint, squat down, sit on the floor with your legs crossed (like the meditation poses) or lie down flat and pull your knees up to your chest, hug your knees. Be sure to write down how many minutes have gone by since you stood up when this happened.

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How the test is done⁵: The area around you when you stand up needs to be safe, in case they do faint and fall. Someone needs to be with you during the whole time the test is being done.

1. Lie down quietly for 10 minutes before taking your blood pressure and pulse.


2. Then, stand up, leaning back against a wall (or the bed) with your arm resting at your side.
   • If you are next to the wall, put the back of your feet (your heels) 2 to 6 inches from the baseboard.
   
   
3. Take your blood pressure& heart rate and write down your symptoms starting at 1 minute. It helps to use an automated blood pressure cuff. Take your blood pressure and heart rate after standing for 3, 5, and 10 minutes. Write down your symptoms each time.
   • The BP, pulse, all symptoms (like dizzy, vision/hearing changes, feeling short of breath, headache, funny skin sensations, feeling of hot/cold & where, "feel yucky", muscle twitching) are recorded as test data.
   • At the end, check the color of your skin on your legs & feet. Record whether they look darker pink or red or have a blue discoloration.⁵)
   
   
4. For a full evaluation in people who get symptoms after they have been up for awhile, the test should be continued for 45 minutes, taking the BP and pulse every 10 minutes.

It is recommended that a blood pressure cuff that is controlled by hand be used if you will be taking your BP and pulse more than the time recommended². The automated blood pressure cuffs take more time to inflate and take the blood pressure. It is difficult to get the automated cuffs to start and take a blood pressure fast enough to capture the BP and pulse changes every 1 minute.

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Author's Note: There is a clinical value to doing the test even for just 10 minutes. In 10 minutes, the main causes of Orthostatic Intolerance (OI) can be identified in many. The delayed problems of orthostatic hypotension and reflex syncope develop later and would not be identified in a 10 minute test.

 

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References

1. Strickberger SA, Benson DW, Biaggioni I, Callans DJ, Cohen MI, Ellenbogen KA, et al. AHA/ACCF Scientific statement on the evaluation of syncope. Circulation. 2006;113:316–327
2. Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M et al., Guidelines for the diagnosis and management of syncope (version 2009). European Heart Journal (2009); 30: 2631-2671.
3. Brignole M. Diagnosis and Treatment of Syncope. Heart 2007: 93; 130-136. Article PDF
4. Stewart JM, Medow MS, Alejos JC. Orthostatic Intolerance. Medscape article.
5. Grubb BP. Postural tachycardia syndrome. Circulation. 2008;117:2814–2817. Abstract. Article PDF.
6. Thieben MJ, Sandroni P, Sletten DM, et al. Postural orthostatic tachycardia syndrome: The Mayo Clinic experience. Mayo Clin Proc. 2007;82:308–313.