Orthostatic dizziness is feeling dizzy or lightheaded when standing up. Hemodynamic orthostatic dizziness can be caused by autonomic dysfunction such as orthostatic hypotension or postural tachycardia syndrome. The interpretation of the autonomic function test results in patients with orthostatic dizziness is crucial for diagnosing and managing the underlying condition. The head-up tilt and Valsalva tests are especially important for evaluating adrenergic function in patients with hemodynamic orthostatic dizziness. However, it is important to note that autonomic function tests do not cover the entire diagnostic process, since their findings need to be considered along with the detailed history and physical examination results of the patient because various differential diagnoses exist for orthostatic dizziness. Ensuring appropriate treatment by interpreting the autonomic function test results can help to determine the improvement of and prevents falls from orthostatic dizziness.

This paper introduces new diagnostic criteria and differential diagnosis of orthostatic dizziness to help clinicians to diagnose hemodynamic orthostatic dizziness. Clinicians need to be able to discriminate hemodynamic orthostatic dizziness from other types of dizziness that are induced or aggravated when standing or walking. Measurements of the orthostatic blood pressure and heart rate are important when screening hemodynamic orthostatic dizziness. Detailed history-taking, a physical examination, and laboratory tests are essential for finding the cause of hemodynamic orthostatic dizziness. The differential diagnosis of hemodynamic orthostatic dizziness is crucial because it can be caused by various autonomic neuropathies.

Citations

• Mareo y vértigo ortostático, funcional y cinetosis
  Liliana F. Invencio-Da-Costa, Carmen Sánchez-Blanco, Raquel Yáñez-González, Hortensia Sánchez-Gómez, Paula Peña-Navarro, Sofía Pacheco-López, Susana Marcos-Alonso, Cristina Nicole Almeida-Ayerve, Luis Cabrera-Pérez, Victoria Díaz-Sánchez
  Revista ORL.2023; 15(3): e31540.     CrossRef

Postural orthostatic tachycardia syndrome (POTS) is characterized by increased heart rate with preserved blood pressureon orthostatic stress. Many patients with postural orthostatic tachycardia syndrome can be misdiagnosed as neurosis, chronicfatigue or anxiety disorder. We report a patient with POTS who presented chronic dizziness and fatigue. In approaching toa patient with orthostatic or nonspecific chronic dizziness, the postural heart rate as well as blood pressure should be checkednot to miss the diagnosis.