You stand up and your vision grays out. You’ve fainted in the shower, in church, or in line at the pharmacy. Or you never quite faint, but you have to grab the counter every morning.
Dizziness or fainting when you stand has several possible causes. Some are harmless, some are forms of dysautonomia, and a few need prompt heart evaluation. Here’s how they differ.
Common causes
Initial orthostatic hypotension
A brief drop in blood pressure within the first seconds of standing, causing momentary lightheadedness that passes quickly. It’s common, especially in young people and when standing up fast.
Orthostatic hypotension
A sustained drop in blood pressure on standing. The consensus definition (Freeman et al., 2011) is a fall of at least 20 points in systolic or 10 points in diastolic blood pressure within three minutes of standing. Causes include:
- dehydration or blood loss,
- medications, especially for blood pressure, prostate, mood, or sleep,
- autonomic neuropathy, such as from diabetes, and
- certain neurological conditions.
Some people have delayed orthostatic hypotension, which appears only after more than three minutes of standing.
POTS
Heart rate rises sharply on standing without a significant blood pressure drop. See POTS in Oklahoma City.
Vasovagal (reflex) syncope
The most common cause of fainting. A reflex briefly slows the heart and drops blood pressure. It often has warning signs: warmth, sweating, nausea, tunnel vision, or fading hearing. Common triggers include:
- prolonged standing,
- heat or crowded spaces,
- pain, blood draws, or the sight of blood, and
- dehydration.
Warning signs that point to the heart
According to the 2017 ACC/AHA/HRS syncope guideline, certain features suggest a heart-related cause and need prompt evaluation:
- fainting during exercise or while lying down,
- palpitations right before fainting,
- fainting with no warning at all,
- chest pain or shortness of breath,
- known heart disease, or
- a family history of sudden death at a young age.
How it is evaluated
- A careful history: what happened before, during, and after each episode.
- Orthostatic vital signs: blood pressure and heart rate lying down and standing, sometimes over 10 minutes.
- Medication review.
- An EKG, and cardiology referral when warning signs are present.
- Formal autonomic or tilt table testing when the cause remains unclear. See autonomic testing explained.
When to get emergency care
Call 911 for:
- fainting with chest pain, palpitations, or shortness of breath,
- fainting during exercise or while lying down,
- a head injury from fainting, or
- stroke symptoms such as facial drooping, arm weakness, or slurred speech.
Serving Oklahoma City, Tulsa, and all of Oklahoma
Venturis Clinic sees patients from Oklahoma City and surrounding areas, including Tulsa, and from across Oklahoma. Learn more on our Dysautonomia in Oklahoma City page.
Frequently asked questions
Is it normal to get dizzy when I stand up?
A brief moment of lightheadedness is common. Frequent, prolonged, or worsening dizziness deserves evaluation.
What’s the difference between POTS and orthostatic hypotension?
In POTS, heart rate rises sharply without a significant blood pressure drop. In orthostatic hypotension, blood pressure drops.
Can medications cause dizziness when standing?
Yes. Blood pressure, prostate, mood, and sleep medications are common contributors.
When is fainting dangerous?
Fainting during exercise, while lying down, with chest pain or palpitations, or with a family history of sudden death needs prompt heart evaluation.
Tired of grabbing the counter every time you stand? Book a free 15-minute discovery call, or learn more about dysautonomia care in Oklahoma City.
This page is for educational purposes and is not a substitute for individual evaluation.
By Alvin Philipose, DC, ICCP
Sources
- Freeman R, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clinical Autonomic Research. 2011;21(2):69–72.
- Shen WK, et al. 2017 ACC/AHA/HRS Guideline for the evaluation and management of patients with syncope. Circulation. 2017;136:e60–e122.