For me this is one of the best presentations ever to effectively communicate the subject matter to someone who suffers from this malady. I have this condition - it appeared when I was six or seven when I needed to leave church to sit outside to recover and it didn't appear until 60 years later, after I retired - and finally I can 'see' the mechanics involved. Originally the tilt-table test confirmed the condition and my cardiologist told me to give up all caffeine or else! Voila, that fixed it until now. I'm taking ADT cancer drugs, made conscious efforts to lose weight and apparently suddenly developed some inner-ear imbalances and I had one blackout experience. Cardiologist wants me to hydrate. Balance doctor confirmed a fixable issue. But still occasional light headedness. I can't tell you how meaningful this presentation has been for me to better see what metrics need to be checked to help regulate my behavior. Bravo! and hat tip to the camera girl.
I have hypermobile Ehlers danlos syndrome and also have orthostatic hypotension. I have had it for years now and doctors in the UK don't seem to understand it. Thank you so much for this talk.
Great video!!! Subbed. I became a fan of the humour immediately hahhhaaa 😁 And better yet, the explanation was extremely clear and I want to have more information provided in this way. Why, how, there is thousands of very fancy videos about this subject in RUclips, but nothing this excellent and easy to understand!!! Great job and extremely useful video!
Glad you enjoyed it, and thank you for the lovely comment! I enjoy teaching, and generally try to make things as simple and straightforward as I can--not that I always achieve that.
I have chronic low blood pressure, with dizziness and fainting. I have sustained 4 broken bones due to fainting on a hard surface. It never dawned on me to see a neurologist for help with treatment. Thank you so much for this!
Glad it was useful! Be aware that not all neurologists or cardiologists are familiar with treating OH. Autonomic disorder treatment is kind of a small niche in the neurologic and cardiovascular worlds. I would call ahead and make sure that's a condition the doctor is comfortable treating.
Hi Dr. Reeves, I have really enjoyed your videos. I suffer from POTS and would really love to see what kind of valuable information you have to share. You are an excellent teacher!
You are such a cool person. I wish my teachers were as patient as you and could explain concepts like this as well as you did in this video. I'm a physio student and I found this VERY helpful! Thank you :) Take home message: 20/10/20
thank you for the excellent tutorial.....and i LOVED your sense of humor....it's so important to include lightheartedness when treating people who are concerned about their health...
Thank you for this light hearted presentation about a serious subject. For years I was told I had panic attacks. Now we know it is OH since it happened to me in the neurologist’s office! Yay! Fast forward a few months and my totally awesome former pcp sent me to an electrophysiologist for TTT. I also have small fiber neuropathy so will head over to your autonomic dysfunction video. Thanks again for your down to earth presentation!
Best presentation I’ve seen so far. You are the only doctor who mentioned the heart. The others only focused on bp readings 🧐 When I stand for 3 minutes my pulse goes to 112 from 72 when I’m laying down. Also my bp goes down 20/10. My doctor took me off my bp meds. But I still have occasional feelings that I’m going to faint when I do dishes, or shower. My blood results are perfect, so is my weight, but I’m 78 years old 🤭😱. So I am going to try drinking a little more water and using a bit more salt 🧂 to see if it helps.🤓🤸🏼🙏
+Cassandra Coleman Lautredou I appreciate your kind words, Cassandra. "Logical and simple" is how I like my information, and I figure lots of people want the same. I need to shoot a POTS video soon....
So you pin point exactly how I feel.. ever since the bell palsy I feel out of whack... I been laying in bed and only get up when I'm getting food, but their was this one time I stood up so quick to talk to my friend and I felt tunnel vision... so this could be what is going on with me.. how everytime I eat I feel like I'm about to faint... you explain every detail and symptom. I sleep in my back and don't like to move or for up some time. Wow great doctor
Maybe this is what happened to me years ago. I was asleep and jumped to answer the phone and fainted when I picked up the receiver. Or it could have been a threatening bill collector. Who knows? Thanks for posting. Enjoyed your video. The camera person deserves a raise. Lol
Thank you doctor for the good explanation, I was really searching everywhere in google for the reason when i am experiencing this saw this video w the good explanation
Great video. Very helpful. I feel like I can talk about orthostatic hypotension in an intelligent way now. And I liked your 'shitty' sense of humor, made me laugh. Thanks. Subbed.
I wish I had doctors who were patient and thorough at explaining orthostatic hypotension. I sometimes get a light headed feeling when I stand up too quickly and sometimes get nauseous. I sometimes get stabbing eye pain in one eye when the weather changes that goes away when I eat. I wonder if you have any informational videos on any condition like that?
So, I was texting while sitting in the toilet for about 20 minutes and then stood up stretching my body... i woke up to myself on the floor with cuts on my head, broken phone and bruised hand... turned out I blacked out/collapsed almost immediately in the bathroom. Got so terrified, Started googling and landed here. Thanks a lot Doc! So glad it’s not a critical issue.
I have been feeling like I haven't found my sea legs lately and apparently I have some inner ear issue. But I also have syncope - but I always had warning signs of it coming on. The other night I was leaning on the sink brushing my teeth and next memory is opening my eyes to the sight of carpet - blackout. I was luckier than you (only a slight rug burn on my forehead) but equally as shocked. I've been talking to all my docs not getting any clearer explanation, except to hydrate and then this wonderful doctor with his incredible chart. Hope you're doing well. Going to send this video to all my doctors!
+Erik Alexander I hope that means you liked it, Erik! Orthostatic hypotension is not nearly as uncommon as some people (especially some doctors) think it is.
I have been having this problem for a long time, I have actually fainted once for like 10 seconds, but there happend again.. it has happend to me many times that I have my whole vision blacked and all of a sudden I just lost most of my energy/power and I can barely stand up, my legs sort of want to let lose and it’s incredibly hard to stand up
Thank you so much for this video. I have a doubt ...I have dizziness and intense headache after a wake up in the morning or when I stand up after sitting but I have not fainted yet . Is it a sign of Orthostatic Hypotension?
Thanks, Charlotte. As far as brilliance is concerned, I'm not sure Mrs. Reeves would always agree....lol! Thanks for watching. Feel free to share. Videos are free, noncommercial, and for everyone.
I've had this happen since I was 10 when I would lay down on my stomach to read a book or watch cartoons. It happens when I stand up, when I roll over after laying down on my back , and it used to happen when I stretched my arms backwards. I've had double vision and temporary headaches while having a head rush and I still get weak in my extremities. My hearing can get muffled sounding and Its like I can hear the blood rushing to my head. I'm 41 now
Dr. Reeves, I just watched this video (thank you very much for the information!) but ... I cannot find the video that you promised - Scout’s honor! - to shoot on Autonomic Disorders! I don’t see it anywhere on your channel. Where is it? 🤷🏻♀️ Because I really need that information. Please let me know so I can find it as soon as possible. Thank you so very much for your help. 🙏🏻
Easton Seiler I later identified it as a syncope although it was not diagnosed by a medical professional a syncope is a more proper definition for my episode that day
Hello..thanks for the very informative video with simple explanation. Could you please confirm to me if you did the video you mentioned at the end of this video? I have been diagnosed with POTS and wanted to understand how its related.. Any help or reply would be highly appreciated.. Thanks
Dr. Reeves - Great video. My PCP diagnosed me w Orthostatic Hopotension last week and now I'm referred to a cardiologist for further care. I just wonder now if I should be seeing a Neurologist as well, or instead? My other question Is, is "Orthostatic Hypotension" & "Neurogenic Orthostatic Hypotention" the same thing? Or are they different in some way? Thanks very much!
Great question about OH versus "Neurogenic OH." OH is, of course, a result. Neurogenic processes can result in OH, as can other processes (e.g., certain hormone disorders, certain cardiac disorders, etc.) It's our job as doctors to pick up on clues as to what process(es) led to the OH.
Bryan: Thanks for your comments, and I'm really glad the video was of some help. I need to pull together some idea and notes for an autonomic disorders video. I'm also going to a "So, you've had a stroke" video and probably an MS video. Haven't had enough time of late, but I'm hoping I can get to those soon. The autonomic video I also want to do is to cover POTS. I've been seeing POTS patients for years, and only now is it becoming more widely known. Lots to do...!
I hope you will get a chance to do MS with Orthostatic Hypotention soon. I have been suffering with this for 8 years now and was thinking of asking my MS Doctor for a prescription of Midodrine if that would help. Thanks, Mabel.
Thank you. Especially for the positional lesson. By chance, Is there evidence to support blood pressure position omitted at the dependent position. That is, when conducting orthostatic blood pressure checks lying, sitting and standing. If so, I was trained inappropriately. Also, please provide rationales. Thank you very much, Bobby
Bobby: Thanks for the question. I get it a lot from doctors and nurses, and I was trained wrong too, so I'm not up on my high horse! It comes down to, "Why are we doing orthostatic BP/Pulse in the first place?" If it's to make things look as GOOD as possible, then lying/sitting/standing makes sense. After all, when someone drops their pressure well tell the to sit down because it reduces the problem. If it's to see how BAD things can get--presumably in someone with relevant symptoms--then lying/standing reveals much more. I kind of joke (only partly) that doing orthos lying/sitting/standing is a way of saying, "I don't want to find orthostatic hypotension unless it's REALLY bad!" Doesn't make sense to me, and I feel it does our patients a disservice. We don't take an x-ray and say, "I only want to find a broken bone if it's really badly broken. Don't bother me with those small breaks and cracks." Once I learnt the right way to search for OH, I found a LOT more of it!
Very informative video. Lying. 123/80/77 Standing 101/74/109 According to a test I have low DBH activity (dopamine to noradrenaline), could this be causing near OH.
Yes, dopamine beta-hydroxylase deficiency is a known cause of autonomic dysfunction, usually with a chronic stuffy nose. As I recall, it's pretty rare.
Thanks. Why are symptoms twice and three times as difficult in the summer months and why can't heart compensate to resolve then? V incapacitating. I feel my best in February. (New York).
My first time experance with this desease, I thought I was going to die, but i never did die, so now i just tolarate it's effects and i'm a nurse. Education in medical feild is understanding but experancing a desease personaly is a whole differant aspect.
My symptoms are debilitating pain over left eye as I rise from lying to sitting to standing, and from prolonged sitting to standing. In recent past I've had lightheadedness when raising from bending down to tie my shoes. I have stage3-4 kidney disease and chronic anemia. I think I may be sufferring from OH. Thoughts?
Well, the question of whether you have OH can be settled. Find someone / somewhere you can have your blood pressure and pulse measured whilst lying and standing (multiple times standing) and find out! Then discuss the findings with your doctor, especially your kidney doctor.
So what would it be classified as if say you stand and all of a sudden your vitals is 120/ pulse 122 when usually your systolic as around 130 to 140 and the diastolic is around 80ish?
Sounds more like Postural Orthostatic Tachycardia Syndrome (POTS), which more recently has been renamed Postural Tachycardia Syndrome (PTS). I have been meaning to shoot a video on POTS. Maybe it's time....
I have had exactly what you describe four different episodes, two were sitting down and they came on as extreme dizziness, then blackout. From what you’ve said, that could be an indication of heart problems? My daughter took me to the emergency room and I was hospitalized overnightand they did every kind of test including an ultrasound of my heart. I’m going to see my doctor Monday regarding this. Do you have any suggestions as to what I should do?
What if, while standing, the systolic pressure goes down, but the diastolic pressure goes up instead of down? Causing the lines of the graph going towards each other? What is it called then, and what causes it? Example: (this is how my blood pressure looks) Sitting: 105/65 (HR 55) (difference between the two 40) Standing 3/4 minutes: 98/84 (HR 113) (difference between the two 14) Standing 5/6 minutes: 96/85 (HR 114) (difference between the two 11) This is what gives problems for me. Whenever the difference between the two is low, I feel symptoms. (dizziness, feeling faint, nausea, sweating, trembling, twitching fingers and face, confusion, the pain neck pain you talked about etc). When I sit down again, the diastolic pressure goes down, and the systolic goes up, causing the two lines to go further apart again and I will feel better. If I remain standing I will faint after 5 or 6 minutes. This is not really orthostatic hypotension right? / What is it? :) It causes memory problems for me, for some reason. Thanks for posting the awesome video, I will be one of the Dozens in the future. :D
Julia: Great question! What you're describing is called a "Narrow pulse pressure." Pulse pressure being the difference between the systolic and the diastolic pressures, exactly as you describe. This is most typically caused by problems with heart valves or other heart functions...rather than autonomic problems. In patients with a narrow pulse pressure we often look for aortic valve problems, changes in how the heart squeezes blood out, or things restricting the heart or aorta. And when the pressure gradient is low between systolic and diastolic pressures, not that much blood gets pumped out with each beat, and you can get the same symptoms as having your blood pressure drop too much. You'd want to discuss all this with your regular doctor and/or cardiologist. Best of health to you, Julia!
Thank you for the awesome answer, I appreciate that a lot! A 24-hour blood pressure test was done (yesterday and today), which at first seemed like the best idea in the history of ..... me! I was happy they where going to look at all of it. But, when I was wearing the device, the numbers it gave where 'completely' different then the numbers that my own blood pressure machine gave. Its an Omron comfort 6 IT, and I checked if it worked by comparing it to two other machines. They all gave similar results, so I figured it worked fine. But the one from the hospital gives systolic readings that are much higher, between 15 and 20 points higher. And the diastolic numbers that it gives are generally 6 to 8 points lower. Which gives a much wider pulse pressure as a result. I told the nurse when I brought the device back, but she said that home blood pressure devices cannot be trusted.. So,.. I hope my doctor will believe me when I tell him. My blood pressure is generally low and narrow. But the device from the hospital will probably show higher readings and wider as well. I am not sure what to do now. Sorry for the long story. No need to reply to all of that :). Thank you for your awesome and helpful reply.
My moms doctors are at a loss as to "what" is causing her BP to be very high 255/117 while lying down and then drop 25 points when she stands up! She has been in the hospital for a week now, they have ran every test known to mankind yet they can't find a reason. Any suggestions?
Some people with autonomic dysfunction have marked supine hypertension (high BP lying) and drop a lot when they stand up (OH). Autonomic disorders can be due to central issues (brain, brainstem) or peripheral nerve. My former colleague, Eduardo Benarroch, is a world expert on central autonomic networks, if you think that's what she might have a problem with (peripheral autonomic disorders are a lot easier to find, and you said her doctors are stumped, so...). Eduardo has written lots of articles and edited at least one textbook I'm aware of.
Hi there, I have had this since im 26 years old, I had a test by the cardiologist in the hospital back in 1996. I am taking medicine for it now because its terrible!
Edward Gonzalez Sorry for the delay. Although it is rare, people can faint "long enough and hard enough" that it triggers a seizure. Fortunately, it's not very common. Another version of events is to have the reverse: a seizure that slows the heart rate and drops the blood pressure so much that the person faints due to the seizure. This is called "the Ictal Bradycardia Syndrome." I published a paper about it in the late 90's, and several other authors have since expanded on the syndrome.
I also have a video on treating orthostatic hypotension. As there is not a universal cause of OH, likewise there is not a universal treatment, but there are things which can help.
Andrew Reeves Neurology and how does it all of a sudden just appear out of nowhere? I lost 10 lbs recently I now weigh 118...I wasn’t trying to but to correct early IR and my lipid panel I went low carb and higher healthy fats. This life change perfected my blood results and dropped my BP from around 125/85 to 110/70..and at the 6 month mark of this diet my orthostatic hypotension started. So I’m upping the calories now hoping that will fix this.....it’s not neurological.
I have vertigo when I go from lying to standing. I went to USC Neurology, and they diagnosed ortho hypotension. However when they tested my bp lying down then standing, my bp went up not down. How can this be explained? They presribed me Valium 2mg 4x day
There is a somewhat unusual syndrome called orthostatic HYPERtension, where the blood pressure goes abnormally up with standing, not down. It is poorly understood, and little is known how to treat it--or whether it always even needs treatment. Perhaps you might see someone who can do more formal autonomic testing (tilt table, cardiovagal tests, and QSART testing) as that might shed more light on how things are working. Most vertigo when going from lying to standing in my experience, especially if the vertigo comes on within a second or two of it, is due to inner ear problems rather than blood pressure problems, so you might need more evaluation in that area.
Andrew thank you. The neurologist did mention my inner ear as a possible cause. I don't understand the Valium prescription (which I did not take). They performed some blood tests, which showed the following: red blood count 5.80 (max 5.65), MCH 25.5 (minimum 27), sodium 142 (max 145), urea nitrogen 21 (max 25), creatinine 1.1 (max 1.3). Doctor said all point to dehydration. I have been drinking 1/2 - 1 gallon water a day and vertigo has stopped, but still slightly dizzy for 1-2 seconds when I sit up from laying down
@@andyreevesarchive528 I was dizzy so I studied myself, I started shaking and my legs went from under me, I didn’t pass out. I lay there for a few minutes the shaking and tremors subsided, then I got up slowly.
So I almost passed out today... Still feel weird tense on my head... Sitting 119/69 Standing 117/72 Just tried again standing 93/67 I have been in a 118/79 as a normal average But I’m not leveling out... I had a steroid epidural 6 days ago and it was horrible after. I also came off Xanax 6.5 months ago... But this time I dropped to the ground 😰
Robert Long it’s crazy you mention this I was just fine until I had the Tdap Vaccination about a week ago my dizziness came back when I had been ok for about two months I regret getting vaccinated
There is an autonomic condition called orthostatic HYPERtension, which is still poorly understood. It often seems to be associated with syncope, in my experience.
Never had Orthostatic Hypotension until I started taking Lisinopril, which was prescribed for kidney health. My blood preassure had always been 120 -125 over 60-70. Now I have HBP which ranges between 140 -170 over 80 plus. Lisinopril. BAD MEDICINE for me
Well, then the OH may be due to cardiac causes. Blood pressure = heart output x systemic vascular resistance. In order to drop BP, either heart output goes down, or vascular resistance goes down (or both). So, if heart output drops due to reduced heart rate, it could easily be a contributing factor. The next question naturally becomes, "Why is heart rate dropping?"
Let’s say your sitting down for a while then you go to the basketball court for a hour and you sit down and lie down a lot because you play video games would your blood pressure drop so much that your eyesight becomes blurry to the point where you can’t see and your really tired you have nausea and it’s 98 degrees which probably worsened the problem happened to me this morning ima go take a nap
I'm so confused. I get these spells when I go from sitting to standing, but not from lying to standing. At least not from my bed to standing up. Sometimes if I'm lying on the floor at work (don't ask, I have a very boring job) and stand up it'll happen. But most of the time it's when I'm sitting too long and get up. Also I seem to have it happen to a lesser extent when I roll over in bed. And the more embarrassing moment I have it happen is when I'm going to the bathroom and straining. I actually find myself having to grab on to something to keep myself upright. Except of course when I roll over and it happens, then it just goes away and I'll be fine. But the problem is just getting worse and worse for me. It's getting harder to hide it. I am almost positive people can tell it's happening now when it does. Before I could just power through it. I went to the doctor and they did that lying, sitting, standing BP, but their machine was wonky and kept giving errors. They joked saying I must not have any blood pressure lol. But it doesn't always happen, so I don't think they're gonna be able to catch it in the doctor's office unless I actually feel it happening while they're testing it. I'm going to buy a bp monitor and see if I can check my bp during a spell. Which is going to be difficult because of the nature of the spell. But we'll see.
+Andrew Reeves Neurology I've had vertigo before, it's totally different than this. with the vertigo the room spins and it's even more scary but lasts less time for me. like a split second compared to 20-30. This is me standing up and forgetting to do it slowly and my vision goes dark and I feel like I'm literally going down. And it's fairly reliable that it will happen. I almost fainted when I went in to the gas station the other night cuz I'd been driving for a while. I also can't really hear during them. I must look just fantastic during them lol sarcasm. if I can make it to a wall or a counter and hold on I do. But I feel like if I didn't I'd actually fall. The vertigo spells are so few and far between that I'm not concerned about them at all. I don't like them of course, but they don't scare me like these. Now. I am diabetic. I test my blood sugar after them and it's never really low or high. I *am* on 2.5 mg of lisinopril which from what I understand is to protect my kidneys? it was 5mg but I asked for it to be lowered when this first started last year. Now I've been on this dose and it's worse than ever. I'm waiting to message my doctor until I can buy a BP monitor and see if I can get a reading when they happen. Cuz like I said, in clinic they don't seem to. Though they did say one of my numbers was quite a bit lower when I stood up but not enough or not consistently or because the other number wasn't lower they didn't say anything about it definitively. So I have a conundrum. If this is from the tiny dose of lisinopril, I might have to live with it because it protects my kidneys? I have had high bp before, mostly after I ate carby meals. I think when my blood sugar goes up my BP does. I'm eating much better these days and doing some exercise (it doesn't seem to cause these spells, I assume because I'm moving around a lot.) It does cause low sugars but I've been dealing with that fine. I've started taking my lisinopril at night instead of in the morning. I'm praying that helps. Even if it makes the rolling over spells worse, at least I'm in bed and wouldn't get hurt if I did faint...
So more has happened. I tried to donate blood on monday and my hemoglobin was too low. That prompted me to get in touch with my doctor about it. My ferritin is 6, among some other less abnormal levels in my bloodwork. I'm on iron pills right now, and my doctor wants me to come back in for an EKG and another positional BP test. Also I think we're going to look inside to check for internal bleeding from my severe acid reflux. I have been only slightly more tired than normal. I have also been eating ice for about 6 months, but I swear on my life I thought I just suddenly liked it and it wasn't a craving really. I guess it was lol.
AnimaSola3o4 You need to start wearing compression stockings to help the blood stay elevated and not drop to your lower body. My mom has this condition, as we speak. One can begin to lose consciousness and weakness is a precursor as well as needing to stoop down from dizziness or weakness. All the best in navigating successfully.
For me this is one of the best presentations ever to effectively communicate the subject matter to someone who suffers from this malady. I have this condition - it appeared when I was six or seven when I needed to leave church to sit outside to recover and it didn't appear until 60 years later, after I retired - and finally I can 'see' the mechanics involved. Originally the tilt-table test confirmed the condition and my cardiologist told me to give up all caffeine or else! Voila, that fixed it until now. I'm taking ADT cancer drugs, made conscious efforts to lose weight and apparently suddenly developed some inner-ear imbalances and I had one blackout experience. Cardiologist wants me to hydrate. Balance doctor confirmed a fixable issue. But still occasional light headedness. I can't tell you how meaningful this presentation has been for me to better see what metrics need to be checked to help regulate my behavior. Bravo! and hat tip to the camera girl.
I have hypermobile Ehlers danlos syndrome and also have orthostatic hypotension. I have had it for years now and doctors in the UK don't seem to understand it. Thank you so much for this talk.
Great video!!! Subbed. I became a fan of the humour immediately hahhhaaa 😁 And better yet, the explanation was extremely clear and I want to have more information provided in this way. Why, how, there is thousands of very fancy videos about this subject in RUclips, but nothing this excellent and easy to understand!!! Great job and extremely useful video!
Glad you enjoyed it, and thank you for the lovely comment! I enjoy teaching, and generally try to make things as simple and straightforward as I can--not that I always achieve that.
Internet sensation watched by DOZENS was awesome Doc. You have helped me with much needed information so it was SENSATIONal. :-)
I have chronic low blood pressure, with dizziness and fainting. I have sustained 4 broken bones due to fainting on a hard surface. It never dawned on me to see a neurologist for help with treatment. Thank you so much for this!
Glad it was useful! Be aware that not all neurologists or cardiologists are familiar with treating OH. Autonomic disorder treatment is kind of a small niche in the neurologic and cardiovascular worlds. I would call ahead and make sure that's a condition the doctor is comfortable treating.
Hi Dr. Reeves, I have really enjoyed your videos. I suffer from POTS and would really love to see what kind of valuable information you have to share. You are an excellent teacher!
You are such a cool person. I wish my teachers were as patient as you and could explain concepts like this as well as you did in this video. I'm a physio student and I found this VERY helpful! Thank you :) Take home message: 20/10/20
thank you for the excellent tutorial.....and i LOVED your sense of humor....it's so important to include lightheartedness when treating people who are concerned about their health...
Thank you for this light hearted presentation about a serious subject. For years I was told I had panic attacks. Now we know it is OH since it happened to me in the neurologist’s office! Yay! Fast forward a few months and my totally awesome former pcp sent me to an electrophysiologist for TTT.
I also have small fiber neuropathy so will head over to your autonomic dysfunction video.
Thanks again for your down to earth presentation!
thank you for taking the time to make this, it was really helpful.
You're welcome. OH is rather more common than many believe.
Best presentation I’ve seen so far. You are the only doctor who mentioned the heart. The others only focused on bp readings 🧐 When I stand for 3 minutes my pulse goes to 112 from 72 when I’m laying down. Also my bp goes down 20/10. My doctor took me off my bp meds. But I still have occasional feelings that I’m going to faint when I do dishes, or shower. My blood results are perfect, so is my weight, but I’m 78 years old 🤭😱. So I am going to try drinking a little more water and using a bit more salt 🧂 to see if it helps.🤓🤸🏼🙏
Oh, btw, I subscribed🤗
Thank you 🙏
Glad you found it useful! Stay healthy.
Thank for a logical and simple explanation of orthostatic hypotension!
+Cassandra Coleman Lautredou I appreciate your kind words, Cassandra. "Logical and simple" is how I like my information, and I figure lots of people want the same. I need to shoot a POTS video soon....
Very informative and charming as heck.
Great video! As informative and entertaining as you are sir, your camera girl absolutely makes your video golden.
So you pin point exactly how I feel.. ever since the bell palsy I feel out of whack... I been laying in bed and only get up when I'm getting food, but their was this one time I stood up so quick to talk to my friend and I felt tunnel vision... so this could be what is going on with me.. how everytime I eat I feel like I'm about to faint... you explain every detail and symptom. I sleep in my back and don't like to move or for up some time. Wow great doctor
You deserve way more views! Love the explanation, tysm.
Thanks, Alice! I'm glad you found it helpful.
You are such a great doctor.
the only good video on the topic on youtube. thanks!
First time watching you doc. Subscribed.
Maybe this is what happened to me years ago. I was asleep and jumped to answer the phone and fainted when I picked up the receiver. Or it could have been a threatening bill collector. Who knows? Thanks for posting. Enjoyed your video. The camera person deserves a raise. Lol
Thank you doctor for the good explanation, I was really searching everywhere in google for the reason when i am experiencing this saw this video w the good explanation
Great video. Very helpful. I feel like I can talk about orthostatic hypotension in an intelligent way now. And I liked your 'shitty' sense of humor, made me laugh. Thanks. Subbed.
Great video.
I wish I had doctors who were patient and thorough at explaining orthostatic hypotension. I sometimes get a light headed feeling when I stand up too quickly and sometimes get nauseous. I sometimes get stabbing eye pain in one eye when the weather changes that goes away when I eat. I wonder if you have any informational videos on any condition like that?
So, I was texting while sitting in the toilet for about 20 minutes and then stood up stretching my body... i woke up to myself on the floor with cuts on my head, broken phone and bruised hand... turned out I blacked out/collapsed almost immediately in the bathroom.
Got so terrified, Started googling and landed here.
Thanks a lot Doc!
So glad it’s not a critical issue.
I have been feeling like I haven't found my sea legs lately and apparently I have some inner ear issue. But I also have syncope - but I always had warning signs of it coming on. The other night I was leaning on the sink brushing my teeth and next memory is opening my eyes to the sight of carpet - blackout. I was luckier than you (only a slight rug burn on my forehead) but equally as shocked. I've been talking to all my docs not getting any clearer explanation, except to hydrate and then this wonderful doctor with his incredible chart. Hope you're doing well. Going to send this video to all my doctors!
Just an excellent video
Glad you enjoyed it
Hysterical.. and Informative
Simply amazing.
+Erik Alexander I hope that means you liked it, Erik! Orthostatic hypotension is not nearly as uncommon as some people (especially some doctors) think it is.
I have been having this problem for a long time, I have actually fainted once for like 10 seconds, but there happend again.. it has happend to me many times that I have my whole vision blacked and all of a sudden I just lost most of my energy/power and I can barely stand up, my legs sort of want to let lose and it’s incredibly hard to stand up
"Camera Girl have a problem, we will treat her later" lol you are funny.....
Very good Alanna. ur cool
i loved that video informational and cute!!
Thank you so much for this video. I have a doubt ...I have dizziness and intense headache after a wake up in the morning or when I stand up after sitting but I have not fainted yet . Is it a sign of Orthostatic Hypotension?
Thank you for this video. I am being diagnosed for Orthostatic hypotension. This helped a lot.
I'm glad you found it useful! Best of luck to you.
You are brilliant! And hilarious!:) Thank you!
Thanks, Charlotte. As far as brilliance is concerned, I'm not sure Mrs. Reeves would always agree....lol! Thanks for watching. Feel free to share. Videos are free, noncommercial, and for everyone.
I've had this happen since I was 10 when I would lay down on my stomach to read a book or watch cartoons. It happens when I stand up, when I roll over after laying down on my back , and it used to happen when I stretched my arms backwards. I've had double vision and temporary headaches while having a head rush and I still get weak in my extremities. My hearing can get muffled sounding and Its like I can hear the blood rushing to my head. I'm 41 now
Dr. Reeves, I just watched this video (thank you very much for the information!) but ... I cannot find the video that you promised - Scout’s honor! - to shoot on Autonomic Disorders! I don’t see it anywhere on your channel. Where is it? 🤷🏻♀️ Because I really need that information. Please let me know so I can find it as soon as possible. Thank you so very much for your help. 🙏🏻
I promise I laughed at every joke!! Alana's hair color is fantastic!!
I recently had a seizure due to this thank you for teaching me why this happens
Easton Seiler I later identified it as a syncope although it was not diagnosed by a medical professional a syncope is a more proper definition for my episode that day
thank you it was very helpful.
Giuliana Silva Glad you liked it! I still need to shoot the video about how to treat OH.... It's on the list, once I get the time/energy.
this was a very useful video :D
Does prolonged fasting make this happen? I've never had this problem before.. Until 5 days into the fast... Didn't happen on my first 7 day fast
like your video... keep it up... sir...
Glad you liked it. Thanks! I'm hoping to get some time for more videos soon, and I'm open to suggestions for neurology topics.
Hello..thanks for the very informative video with simple explanation.
Could you please confirm to me if you did the video you mentioned at the end of this video?
I have been diagnosed with POTS and wanted to understand how its related..
Any help or reply would be highly appreciated..
Thanks
He did a video on treatment. You can find it in his channel.
Dr. Reeves - Great video. My PCP diagnosed me w Orthostatic Hopotension last week and now I'm referred to a cardiologist for further care. I just wonder now if I should be seeing a Neurologist as well, or instead?
My other question Is, is "Orthostatic Hypotension" & "Neurogenic Orthostatic Hypotention" the same thing? Or are they different in some way? Thanks very much!
Great question about OH versus "Neurogenic OH." OH is, of course, a result. Neurogenic processes can result in OH, as can other processes (e.g., certain hormone disorders, certain cardiac disorders, etc.) It's our job as doctors to pick up on clues as to what process(es) led to the OH.
i have a neurology exam tomorrow! thank you doc :)
I hope you did well on the test!
thank you sir
Do you have the video on autonomic disorders? I am anxiously waiting to see it. Thank you!
Bryan: Thanks for your comments, and I'm really glad the video was of some help. I need to pull together some idea and notes for an autonomic disorders video. I'm also going to a "So, you've had a stroke" video and probably an MS video. Haven't had enough time of late, but I'm hoping I can get to those soon. The autonomic video I also want to do is to cover POTS. I've been seeing POTS patients for years, and only now is it becoming more widely known. Lots to do...!
Thank you doc, g/f is a long time sufferer of chronic vertigo and low BP. Every little bit helps.
Vertigo...now there is a good topic!
I hope you will get a chance to do MS with Orthostatic Hypotention soon. I have been suffering with this for 8 years now and was thinking of asking my MS Doctor for a prescription of Midodrine if that would help. Thanks, Mabel.
Dr. Peepers, what do you do when patients don’t respond to medication changes? My numbers drop 30 to 50 and I need help.
thnx doc
Thank you.
Especially for the positional lesson. By chance, Is there evidence to support blood pressure position omitted at the dependent position. That is, when conducting orthostatic blood pressure checks lying, sitting and standing. If so, I was trained inappropriately. Also, please provide rationales.
Thank you very much,
Bobby
Bobby: Thanks for the question. I get it a lot from doctors and nurses, and I was trained wrong too, so I'm not up on my high horse! It comes down to, "Why are we doing orthostatic BP/Pulse in the first place?" If it's to make things look as GOOD as possible, then lying/sitting/standing makes sense. After all, when someone drops their pressure well tell the to sit down because it reduces the problem. If it's to see how BAD things can get--presumably in someone with relevant symptoms--then lying/standing reveals much more. I kind of joke (only partly) that doing orthos lying/sitting/standing is a way of saying, "I don't want to find orthostatic hypotension unless it's REALLY bad!" Doesn't make sense to me, and I feel it does our patients a disservice. We don't take an x-ray and say, "I only want to find a broken bone if it's really badly broken. Don't bother me with those small breaks and cracks." Once I learnt the right way to search for OH, I found a LOT more of it!
Andrew Reeves Neurology
We'll done.
Thank you for your time Dr. Reeves.
Very informative video.
Lying. 123/80/77
Standing 101/74/109
According to a test I have low DBH activity (dopamine to noradrenaline), could this be causing near OH.
Yes, dopamine beta-hydroxylase deficiency is a known cause of autonomic dysfunction, usually with a chronic stuffy nose. As I recall, it's pretty rare.
Thanks. Why are symptoms twice and three times as difficult in the summer months and why can't heart compensate to resolve then? V incapacitating. I feel my best in February. (New York).
My first time experance with this desease, I thought I was going to die, but i never did die, so now i just tolarate it's effects and i'm a nurse. Education in medical feild is understanding but experancing a desease personaly is a whole differant aspect.
My symptoms are debilitating pain over left eye as I rise from lying to sitting to standing, and from prolonged sitting to standing.
In recent past I've had lightheadedness when raising from bending down to tie my shoes. I have stage3-4 kidney disease and chronic anemia. I think I may be sufferring from OH.
Thoughts?
Well, the question of whether you have OH can be settled. Find someone / somewhere you can have your blood pressure and pulse measured whilst lying and standing (multiple times standing) and find out! Then discuss the findings with your doctor, especially your kidney doctor.
So what would it be classified as if say you stand and all of a sudden your vitals is 120/ pulse 122 when usually your systolic as around 130 to 140 and the diastolic is around 80ish?
Sounds more like Postural Orthostatic Tachycardia Syndrome (POTS), which more recently has been renamed Postural Tachycardia Syndrome (PTS). I have been meaning to shoot a video on POTS. Maybe it's time....
I have had exactly what you describe four different episodes, two were sitting down and they came on as extreme dizziness, then blackout. From what you’ve said, that could be an indication of heart problems? My daughter took me to the emergency room and I was hospitalized overnightand they did every kind of test including an ultrasound of my heart. I’m going to see my doctor Monday regarding this. Do you have any suggestions as to what I should do?
My episodes happened four days ago.
I experienced being lightheaded so my reading was
132/89 lying
110/82 standing.
Is it still considered OH even if the latter BP reading is normal?
Yes. The top number drops by >20.
What if, while standing, the systolic pressure goes down, but the diastolic pressure goes up instead of down? Causing the lines of the graph going towards each other? What is it called then, and what causes it?
Example: (this is how my blood pressure looks)
Sitting: 105/65 (HR 55) (difference between the two 40)
Standing 3/4 minutes: 98/84 (HR 113) (difference between the two 14)
Standing 5/6 minutes: 96/85 (HR 114) (difference between the two 11)
This is what gives problems for me. Whenever the difference between the two is low, I feel symptoms. (dizziness, feeling faint, nausea, sweating, trembling, twitching fingers and face, confusion, the pain neck pain you talked about etc). When I sit down again, the diastolic pressure goes down, and the systolic goes up, causing the two lines to go further apart again and I will feel better. If I remain standing I will faint after 5 or 6 minutes.
This is not really orthostatic hypotension right? / What is it? :)
It causes memory problems for me, for some reason.
Thanks for posting the awesome video, I will be one of the Dozens in the future. :D
Julia: Great question! What you're describing is called a "Narrow pulse pressure." Pulse pressure being the difference between the systolic and the diastolic pressures, exactly as you describe. This is most typically caused by problems with heart valves or other heart functions...rather than autonomic problems. In patients with a narrow pulse pressure we often look for aortic valve problems, changes in how the heart squeezes blood out, or things restricting the heart or aorta. And when the pressure gradient is low between systolic and diastolic pressures, not that much blood gets pumped out with each beat, and you can get the same symptoms as having your blood pressure drop too much. You'd want to discuss all this with your regular doctor and/or cardiologist. Best of health to you, Julia!
Thank you for the awesome answer, I appreciate that a lot!
A 24-hour blood pressure test was done (yesterday and today), which at first seemed like the best idea in the history of ..... me! I was happy they where going to look at all of it.
But, when I was wearing the device, the numbers it gave where 'completely' different then the numbers that my own blood pressure machine gave. Its an Omron comfort 6 IT, and I checked if it worked by comparing it to two other machines. They all gave similar results, so I figured it worked fine.
But the one from the hospital gives systolic readings that are much higher, between 15 and 20 points higher. And the diastolic numbers that it gives are generally 6 to 8 points lower.
Which gives a much wider pulse pressure as a result.
I told the nurse when I brought the device back, but she said that home blood pressure devices cannot be trusted..
So,.. I hope my doctor will believe me when I tell him. My blood pressure is generally low and narrow. But the device from the hospital will probably show higher readings and wider as well. I am not sure what to do now.
Sorry for the long story. No need to reply to all of that :).
Thank you for your awesome and helpful reply.
My moms doctors are at a loss as to "what" is causing her BP to be very high 255/117 while lying down and then drop 25 points when she stands up! She has been in the hospital for a week now, they have ran every test known to mankind yet they can't find a reason. Any suggestions?
Some people with autonomic dysfunction have marked supine hypertension (high BP lying) and drop a lot when they stand up (OH). Autonomic disorders can be due to central issues (brain, brainstem) or peripheral nerve. My former colleague, Eduardo Benarroch, is a world expert on central autonomic networks, if you think that's what she might have a problem with (peripheral autonomic disorders are a lot easier to find, and you said her doctors are stumped, so...). Eduardo has written lots of articles and edited at least one textbook I'm aware of.
Hi there, I have had this since im 26 years old, I had a test by the cardiologist in the hospital back in 1996. I am taking medicine for it now because its terrible!
I was a Nurse, RN, I did some videos showing how to do an Orthostatic Diary.
My body can't tolerate standing up but I feel ok when sitting but I got my blood pressure checked which was normal.
Can this be induced by a UTI?
is it possible to have orthostatic hypotension and have it turn into a seizure?
Edward Gonzalez Sorry for the delay. Although it is rare, people can faint "long enough and hard enough" that it triggers a seizure. Fortunately, it's not very common. Another version of events is to have the reverse: a seizure that slows the heart rate and drops the blood pressure so much that the person faints due to the seizure. This is called "the Ictal Bradycardia Syndrome." I published a paper about it in the late 90's, and several other authors have since expanded on the syndrome.
Sir when i walk i feel my head is heavy what the reason
So what do we do about it? My labs just came back so excellent! Very confused. Had a calcium score of zero...and great result on cIMT.
I also have a video on treating orthostatic hypotension. As there is not a universal cause of OH, likewise there is not a universal treatment, but there are things which can help.
Andrew Reeves Neurology thank you so much! I will search for your video. I want my carefree, active life back. I’m only 56 😊
Andrew Reeves Neurology and how does it all of a sudden just appear out of nowhere? I lost 10 lbs recently I now weigh 118...I wasn’t trying to but to correct early IR and my lipid panel I went low carb and higher healthy fats. This life change perfected my blood results and dropped my BP from around 125/85 to 110/70..and at the 6 month mark of this diet my orthostatic hypotension started. So I’m upping the calories now hoping that will fix this.....it’s not neurological.
I have this thank you for this video
You're welcome 😊
I have vertigo when I go from lying to standing. I went to USC Neurology, and they diagnosed ortho hypotension. However when they tested my bp lying down then standing, my bp went up not down. How can this be explained? They presribed me Valium 2mg 4x day
There is a somewhat unusual syndrome called orthostatic HYPERtension, where the blood pressure goes abnormally up with standing, not down. It is poorly understood, and little is known how to treat it--or whether it always even needs treatment. Perhaps you might see someone who can do more formal autonomic testing (tilt table, cardiovagal tests, and QSART testing) as that might shed more light on how things are working. Most vertigo when going from lying to standing in my experience, especially if the vertigo comes on within a second or two of it, is due to inner ear problems rather than blood pressure problems, so you might need more evaluation in that area.
Andrew thank you. The neurologist did mention my inner ear as a possible cause. I don't understand the Valium prescription (which I did not take). They performed some blood tests, which showed the following: red blood count 5.80 (max 5.65), MCH 25.5 (minimum 27), sodium 142 (max 145), urea nitrogen 21 (max 25), creatinine 1.1 (max 1.3). Doctor said all point to dehydration. I have been drinking 1/2 - 1 gallon water a day and vertigo has stopped, but still slightly dizzy for 1-2 seconds when I sit up from laying down
Does it also feel like your head is under water, everything seems muffled.? I associate shake, then my body shakes then my legs give way.
Yes. Muffled hearing occurs in OH sometimes.
@@andyreevesarchive528 I was dizzy so I studied myself, I started shaking and my legs went from under me, I didn’t pass out. I lay there for a few minutes the shaking and tremors subsided, then I got up slowly.
So I almost passed out today...
Still feel weird tense on my head...
Sitting 119/69
Standing 117/72
Just tried again standing 93/67
I have been in a 118/79 as a normal average
But I’m not leveling out...
I had a steroid epidural 6 days ago and it was horrible after.
I also came off Xanax 6.5 months ago...
But this time I dropped to the ground 😰
Robert Long it’s crazy you mention this I was just fine until I had the Tdap Vaccination about a week ago my dizziness came back when I had been ok for about two months I regret getting vaccinated
Have u an weird feeling in ur head non-stop? I have an weird feeling :(
Hey. It's very informative.
Whats the cure? Is it chronic?
There are many causes of OH. Cures, or at least treatments, depend upon what the cause is.
What causes orthostatic hypotension ?
BASICALLY I wanna hug you .
i get symptoms but when i measure my bp it actually is higher when I stand, but i feel lightheaded and my vision tunneld
There is an autonomic condition called orthostatic HYPERtension, which is still poorly understood. It often seems to be associated with syncope, in my experience.
@@AndrewReevesNeurology wow interesting. There's so much we dont understand
R u in Cali
I'm a loooong way from California.
Never had Orthostatic Hypotension until I started taking Lisinopril, which was prescribed for kidney health. My blood preassure had always been 120 -125 over 60-70. Now I have HBP which ranges between 140 -170 over 80 plus. Lisinopril. BAD MEDICINE for me
what if you heart rate drops
Well, then the OH may be due to cardiac causes. Blood pressure = heart output x systemic vascular resistance. In order to drop BP, either heart output goes down, or vascular resistance goes down (or both). So, if heart output drops due to reduced heart rate, it could easily be a contributing factor. The next question naturally becomes, "Why is heart rate dropping?"
Dr Reeves
Let’s say your sitting down for a while then you go to the basketball court for a hour and you sit down and lie down a lot because you play video games would your blood pressure drop so much that your eyesight becomes blurry to the point where you can’t see and your really tired you have nausea and it’s 98 degrees which probably worsened the problem happened to me this morning ima go take a nap
I'm so confused. I get these spells when I go from sitting to standing, but not from lying to standing. At least not from my bed to standing up. Sometimes if I'm lying on the floor at work (don't ask, I have a very boring job) and stand up it'll happen. But most of the time it's when I'm sitting too long and get up. Also I seem to have it happen to a lesser extent when I roll over in bed. And the more embarrassing moment I have it happen is when I'm going to the bathroom and straining. I actually find myself having to grab on to something to keep myself upright. Except of course when I roll over and it happens, then it just goes away and I'll be fine. But the problem is just getting worse and worse for me. It's getting harder to hide it. I am almost positive people can tell it's happening now when it does. Before I could just power through it. I went to the doctor and they did that lying, sitting, standing BP, but their machine was wonky and kept giving errors. They joked saying I must not have any blood pressure lol. But it doesn't always happen, so I don't think they're gonna be able to catch it in the doctor's office unless I actually feel it happening while they're testing it. I'm going to buy a bp monitor and see if I can check my bp during a spell. Which is going to be difficult because of the nature of the spell. But we'll see.
I'm planning to put together a video on vertigo. When that comes up, it might be of interest.
+Andrew Reeves Neurology I've had vertigo before, it's totally different than this. with the vertigo the room spins and it's even more scary but lasts less time for me. like a split second compared to 20-30. This is me standing up and forgetting to do it slowly and my vision goes dark and I feel like I'm literally going down. And it's fairly reliable that it will happen. I almost fainted when I went in to the gas station the other night cuz I'd been driving for a while. I also can't really hear during them. I must look just fantastic during them lol sarcasm. if I can make it to a wall or a counter and hold on I do. But I feel like if I didn't I'd actually fall.
The vertigo spells are so few and far between that I'm not concerned about them at all. I don't like them of course, but they don't scare me like these.
Now. I am diabetic. I test my blood sugar after them and it's never really low or high. I *am* on 2.5 mg of lisinopril which from what I understand is to protect my kidneys? it was 5mg but I asked for it to be lowered when this first started last year. Now I've been on this dose and it's worse than ever. I'm waiting to message my doctor until I can buy a BP monitor and see if I can get a reading when they happen. Cuz like I said, in clinic they don't seem to. Though they did say one of my numbers was quite a bit lower when I stood up but not enough or not consistently or because the other number wasn't lower they didn't say anything about it definitively.
So I have a conundrum. If this is from the tiny dose of lisinopril, I might have to live with it because it protects my kidneys? I have had high bp before, mostly after I ate carby meals. I think when my blood sugar goes up my BP does. I'm eating much better these days and doing some exercise (it doesn't seem to cause these spells, I assume because I'm moving around a lot.) It does cause low sugars but I've been dealing with that fine.
I've started taking my lisinopril at night instead of in the morning. I'm praying that helps. Even if it makes the rolling over spells worse, at least I'm in bed and wouldn't get hurt if I did faint...
So more has happened. I tried to donate blood on monday and my hemoglobin was too low. That prompted me to get in touch with my doctor about it. My ferritin is 6, among some other less abnormal levels in my bloodwork. I'm on iron pills right now, and my doctor wants me to come back in for an EKG and another positional BP test. Also I think we're going to look inside to check for internal bleeding from my severe acid reflux. I have been only slightly more tired than normal. I have also been eating ice for about 6 months, but I swear on my life I thought I just suddenly liked it and it wasn't a craving really. I guess it was lol.
AnimaSola3o4 You need to start wearing compression stockings to help the blood stay elevated and not drop to your lower body. My mom has this condition, as we speak. One can begin to lose consciousness and weakness is a precursor as well as needing to stoop down from dizziness or weakness. All the best in navigating successfully.
❤️💯😃🙏🏽
I like your humor lol
+DeathGodPain96 Thanks for your comment, Bendyprissy. I figure learning about all this doesn't have to be boring!
+Andrew Reeves Neurology Oops, wrong username! Sorry!
I fell n broke my ankle 2 times 2013 n 2020
hey there are hundreds of us now! :P
PS: "Camera girl"! :-D She sounds like my daughter!
After covid it left me with low blood pressure
Hahaha! Very nice :-)
Glad you liked it!
Haha 😆 I like you doc
I think I have it no Capp 😣
Make surrre u drink lots of water
what is Orthostatic hypotension i dont want to watch a 12 min video
Fainting if you have conditions mentioned in the video