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What Causes Orthostatic Hypotension?
Question: Hello, my 12 year old daughter has fainted several times during the last year, including three times since January including twice in two weeks. Most of the faints happen either after getting out of bed at night or after getting up in the morning. She's never fainted while exercising although she says that she's felt lightheaded before. She was seen by a pediatric cardiologist who gave her an ECG which was normal. The cardiologist feels that she's probably fainting due to dehydration and advised my daughter to drink more water and eat more salt. The cardiologist doesn't feel that any additional testing is necessary. Does this sound like the correct diagnosis, or should additional testing be sought out? Thank you, Anamarie
Asked by Me , Mon, 6 Apr 2015
Asked by Me , Mon, 6 Apr 2015
Brief Answer:
It could be orthostatic hypotension or vasovagal.
Detailed Answer:
Hi
Welcome to health care magic,
Frequent fainting while getting up from a lying down position or a condition is known as syncope or a presyncope.
It means it follows dizziness and temporary semi consciousnesses for a while without actual becoming unconscious.
Here,I would like to ask you some questions regarding medical history of previous disease (if any),history of medications,any recent or past surgery,family history of heart problem, any past history of head injury (like in accident)or is there any other symptoms like chest pain,palpitations,fatigue, blurring vision etc.
We must rule out causes of syncope from cardiac and non cardiac for which you will require detailed history, thoroughly clinical examination for heart like ECG(already done and came normal),blood pressure measurements in different positions like supine,sitting and immediately after standing, echo cardiography of heart etc.
The underlying cause could be vasovagal, orthostatic hypotension or postural tachycardia ,neurogenic syncope or syncope due to anxiety etc.
You will have to consult your physician first for thoroughly clinical assessment to detect the underlying cause.
We must rule out the commonest causes first like orthostatic hypotension,dehydration,low blood sugar or vasovagal rather than the rare possibilities like sick siness syndrome or adrenal insufficiency or congenital cardiac anomalies etc.
The later diseases are rarest causes among apparently healthy individuals.
Treatment will depend on the underlying cause.
Meanwhile you can do this things,
1) maintain proper hydration and electrolyte balance by taking proper fluid intake through the day.
2) Positioning on the grounds immediately whenever there is fainting spells and leg elevation, will cause pooling of blood in the upper part of body mainly in brain.
3) always wait for 4 to 5 minutes before getting up from the bed means never change the posture so suddenly I.e in your daughter's case,she must wait for few minutes before getting up from the bed.
Do ask me follow up question.
Thanks and Regards,
Dr.sandipkabra
It could be orthostatic hypotension or vasovagal.
Detailed Answer:
Hi
Welcome to health care magic,
Frequent fainting while getting up from a lying down position or a condition is known as syncope or a presyncope.
It means it follows dizziness and temporary semi consciousnesses for a while without actual becoming unconscious.
Here,I would like to ask you some questions regarding medical history of previous disease (if any),history of medications,any recent or past surgery,family history of heart problem, any past history of head injury (like in accident)or is there any other symptoms like chest pain,palpitations,fatigue, blurring vision etc.
We must rule out causes of syncope from cardiac and non cardiac for which you will require detailed history, thoroughly clinical examination for heart like ECG(already done and came normal),blood pressure measurements in different positions like supine,sitting and immediately after standing, echo cardiography of heart etc.
The underlying cause could be vasovagal, orthostatic hypotension or postural tachycardia ,neurogenic syncope or syncope due to anxiety etc.
You will have to consult your physician first for thoroughly clinical assessment to detect the underlying cause.
We must rule out the commonest causes first like orthostatic hypotension,dehydration,low blood sugar or vasovagal rather than the rare possibilities like sick siness syndrome or adrenal insufficiency or congenital cardiac anomalies etc.
The later diseases are rarest causes among apparently healthy individuals.
Treatment will depend on the underlying cause.
Meanwhile you can do this things,
1) maintain proper hydration and electrolyte balance by taking proper fluid intake through the day.
2) Positioning on the grounds immediately whenever there is fainting spells and leg elevation, will cause pooling of blood in the upper part of body mainly in brain.
3) always wait for 4 to 5 minutes before getting up from the bed means never change the posture so suddenly I.e in your daughter's case,she must wait for few minutes before getting up from the bed.
Do ask me follow up question.
Thanks and Regards,
Dr.sandipkabra
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
My daughter says she doesn't have any feelings of palpitations or chest pains. She has said that she's felt dizzy a few times during exercise, but has never passed out. She's never had any major health problems or injuries and there's not really a history of family heart conditions or sudden deaths. She's very active physically and plays several sports.
All of her fainting has taken place within a few minutes of getting out of bed except for one time when she was standing in a hot room. She says she usually sees black spots immediately before fainting.
My daughter's pediatrician and cardiologist both measured her blood pressure in various positions. she's never had an echo test.
All of her fainting has taken place within a few minutes of getting out of bed except for one time when she was standing in a hot room. She says she usually sees black spots immediately before fainting.
My daughter's pediatrician and cardiologist both measured her blood pressure in various positions. she's never had an echo test.
Brief Answer:
Seems to be a orthostatic hypotension.
Detailed Answer:
Hi,
Thanks for the follow-up query,
In that case,i think the cause of fainting after getting up could be orthostatic hypotension which occurs mostly due to low blood pressure in which a person's blood pressure falls when suddenly standing up or stretching from a lying down position.The symptom usually occurs as a result of blood pooling in the lower extremities upon a change in body position.
Now,we need to find out what are the causes of this orthostatic hypotension.
You should go for,
1) Complete blood count (to rule out anaemia),
2) 2D-echo-cardiography of heart ( to rule out heart pathology)
3) Fasting and post-prandial blood sugar(to rule out low blood sugar-diabetes)
4) serum vitamin B12
5) Middle ear examination by ENT specialist
Here,i would advise you to consult physician as your 12 years daughter should be considered as an adult from the clinical point of view,so there is no need to see paediatric or paediatric cardiologist.
Meanwhile you should do what i advised in my previous answer from 1 to 3 and this will certainly going to help to relieve from fainting spells.
The definitive treatment will depend on the underlying cause (if detected).
Thanks and Regards,
Dr.SandipKabra
Seems to be a orthostatic hypotension.
Detailed Answer:
Hi,
Thanks for the follow-up query,
In that case,i think the cause of fainting after getting up could be orthostatic hypotension which occurs mostly due to low blood pressure in which a person's blood pressure falls when suddenly standing up or stretching from a lying down position.The symptom usually occurs as a result of blood pooling in the lower extremities upon a change in body position.
Now,we need to find out what are the causes of this orthostatic hypotension.
You should go for,
1) Complete blood count (to rule out anaemia),
2) 2D-echo-cardiography of heart ( to rule out heart pathology)
3) Fasting and post-prandial blood sugar(to rule out low blood sugar-diabetes)
4) serum vitamin B12
5) Middle ear examination by ENT specialist
Here,i would advise you to consult physician as your 12 years daughter should be considered as an adult from the clinical point of view,so there is no need to see paediatric or paediatric cardiologist.
Meanwhile you should do what i advised in my previous answer from 1 to 3 and this will certainly going to help to relieve from fainting spells.
The definitive treatment will depend on the underlying cause (if detected).
Thanks and Regards,
Dr.SandipKabra
Note: For further queries related to your child health, Talk to a Pediatrician. Click here to Book a Consultation.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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