Question

I have orthostatic hypotension and, although I'm under treatment, I still faint. I've also got bradycardia (slow heart rate). Do you have any information that will help me?

Answer

Fainting when you stand up is often due to a very low blood pressure occurring on standing, so that not enough oxygen-rich blood reaches the head. It's called orthostatic hypotension, or postural hypotension.

These instructions from San Francisco General Medical Hospital for people with this problem can help:

1. Eat a diet high in salt

2. Drink lots of fluids

3. Be upright - sitting or standing most of the day

4. If you are dizzy while standing, squat, lie down or sit in a chair with feet elevated to relieve dizziness. Do NOT have someone support you in a standing position.

5. Get out of bed or out of a chair slowly. Sit on edge of bed for a few minutes before standing. If you are dizzy, sit or lie down for a few minutes, then stand up slowly.

6. Straining such as on the toilet or when lifting may cause your blood pressure to drop and cause dizziness. Avoid these situations where possible.

7. Tilt bed at night - place bricks or blocks under head of bed.

8. Avoid standing still for prolonged periods.

9. Avoid hot showers - If you take one, make it short. If you get dizzy sit down. (A chair in the shower is helpful).

10. Following meals blood pressure often becomes quite low and you may feel dizzy or faint. Eating smaller more frequent meals and resting after eating may lessen these episodes of dizziness. Avoid large meals if you need to be active shortly after the meal.

11. Hot weather and viral illness (colds or flu) will make dizziness worse - plan extra salt and drink more fluids and do not plan strenuous activities.

12. Fludrocortisone (Florinef®) is a medicine which you may be taking. This causes salt and fluid retention and may cause some swelling of fingers or feet. Some swelling is necessary to improve your blood pressure. If you become short of breath, stop the drug and contact a physician immediately.

13. Fludrocortisone treatment is often associated with loss of potassium from the body. For this reason you may be given potassium to take. Signs of low potassium include muscle weakness, vomiting or irregular heart rhythms.

14. Some people benefit from the use of waist-high elastic stockings. These should be put on while in bed, with legs elevated for a few minutes prior to pulling the stockings on. Stockings are particularly useful when you anticipate standing or walking for prolonged periods. Remove stockings when lying down.

15. Over-the-counter cold medications, diet pills, nose drops and sprays and eye drops may dangerously elevate your blood pressure. Do not take these without consulting your physician.