Summary about Disease
Orthostatic Intolerance (OI) isn't a disease in itself, but rather a condition where the body struggles to regulate blood pressure and heart rate when transitioning from a lying or sitting position to standing. This can lead to various symptoms, primarily due to reduced blood flow to the brain. The common symptom is feeling lightheaded or dizzy upon standing.
Symptoms
Lightheadedness or dizziness upon standing
Blurred vision or "graying out"
Weakness or fatigue
Palpitations (feeling of a rapid or irregular heartbeat)
Headache
Nausea
Difficulty concentrating or "brain fog"
Tremors
Sweating
Fainting (syncope) in severe cases
Causes
OI can arise from various underlying factors that affect the autonomic nervous system, blood volume, or cardiovascular function. Some common causes and contributing factors include:
Autonomic nervous system dysfunction: Problems with the part of the nervous system that controls involuntary functions like heart rate and blood pressure. Conditions like Postural Orthostatic Tachycardia Syndrome (POTS) fall into this category.
Low blood volume (hypovolemia): Dehydration, blood loss, or conditions that affect fluid balance.
Medications: Certain medications can contribute to OI as a side effect.
Prolonged bed rest or inactivity: Can weaken the cardiovascular system's ability to adjust to changes in position.
Underlying medical conditions: Such as diabetes, autoimmune diseases, or neurological disorders.
Venous pooling: Blood accumulating in the legs upon standing.
Medicine Used
Treatment focuses on managing symptoms and addressing any underlying causes. Medications might include:
Fludrocortisone: A mineralocorticoid that helps the body retain sodium and water, increasing blood volume.
Midodrine: An alpha-1 adrenergic agonist that constricts blood vessels, raising blood pressure.
Beta-blockers: May be used in some cases of POTS to control heart rate.
Selective serotonin reuptake inhibitors (SSRIs): Can be helpful for some patients with OI and anxiety or depression.
Is Communicable
Orthostatic Intolerance is not communicable. It is not caused by an infectious agent and cannot be spread from person to person.
Precautions
Stay hydrated: Drink plenty of fluids, especially water and electrolyte-containing beverages.
Increase salt intake: If recommended by a doctor.
Avoid prolonged standing: Take breaks to sit or move around.
Wear compression stockings: To help prevent blood from pooling in the legs.
Elevate the head of the bed: Sleeping with the head slightly elevated can help reduce symptoms.
Avoid triggers: Such as hot showers, alcohol, and large meals.
Rise slowly: When transitioning from lying or sitting to standing.
Isometric counter-maneuvers: Squeezing muscles in legs before and while standing.
Physical Therapy: May assist with muscle strengthening and increasing tolerance to upright posture.
How long does an outbreak last?
OI is not an "outbreak"-related illness. It's a chronic condition. The duration of symptoms varies greatly depending on the underlying cause and how well the condition is managed. Symptoms can be persistent or intermittent, lasting for weeks, months, or even years.
How is it diagnosed?
Medical history and physical exam: including blood pressure and heart rate measurements in different positions.
Orthostatic vital signs testing: Measuring blood pressure and heart rate after lying down, sitting, and standing. A significant drop in blood pressure or increase in heart rate upon standing suggests OI.
Tilt table test: A test where you are strapped to a table that is tilted to simulate standing. Blood pressure and heart rate are monitored during the test.
Blood tests: To rule out other underlying conditions.
Autonomic testing: Further specialized testing to assess the function of the autonomic nervous system.
Timeline of Symptoms
The onset and progression of symptoms can vary.
Immediate: Dizziness, lightheadedness, blurred vision, or weakness upon standing.
Within minutes: Symptoms may worsen if standing continues, possibly leading to palpitations, nausea, or headache.
Prolonged standing: Fatigue, difficulty concentrating, and other symptoms can become more pronounced over time.
Variable: Some individuals may experience symptoms consistently, while others have periods of remission.
Important Considerations
OI can significantly impact quality of life, affecting daily activities and work/school performance.
It is often misdiagnosed or undiagnosed, leading to delays in appropriate treatment.
A multidisciplinary approach involving doctors, physical therapists, and other healthcare professionals is often beneficial.
Patient education and self-management strategies are crucial for long-term symptom control.
Symptoms can fluctuate. Keeping a symptom diary can help identify triggers and patterns.