Lightheadedness
Often, in the evenings, after a bit of prolonged sitting with my feet up in my recliner, I will stand and feel very lightheaded where I need to brace myself and pause before proceeding. It occurs when I get out of bed as well. This morning I got out of bed and went to close the window and fainted for a moment, finding myself on the floor with my wife yelling at me.
This seems to occur more frequently on days when I have done tougher workouts.
Anybody else experience this problem? Should I be concerned?
Thank you.
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Umm, yeah you should be concerned. That is called postural hypotension. In more severe situations it can cause a person to black out like you did. It can range from being barely noticeable up through momentary dizziness to fainting. Depending on your medical point of view, the blame can be placed a few different places but the adrenal glands are often high on the list.
Cardiovascular physiology review here: Your body has various mechanisms that sense the balance between your blood pressure and the demands of your body. In the carotid arteries, the aortic arch are a couple places, for example. They send signals to the vasomotor center in the brain for a very fast response. When you're lying down or at least mostly level, the heart doesn't have to work all that hard to get sufficient blood flow to the brain. Not so when you're standing. It takes a little time for the cardiovascular system to respond to the VMC's signals and ramp up the supply of blood to the brain when it suddenly has to work against gravity. In those few seconds you're relying on a combination of a quick increase in both the HR and the force of individual contractions to raise the cardiac output as well as some strategic vasoconstriction and muscular assistance helping push the blood back up the venous system to the heart. If you're overly fatigued, this reflex tachycardia and vascular response takes too much time to kick in - and you fall down, go boom.
What is the signaling system for this sudden adaptation? Mainly the sympathetic nervous system (nerves releasing norepinephrine [noradrenaline]) and the adrenal medulla (releasing a combination of epinephrine [adrenaline] and norepinephrine) are what get called into action.
There are some nutritional situations that can cause such weakness and some folks suggest supplements like choline and other stuff to correct it - this approach is mainly from the holistic side of medicine. There are various things like Applied Kinesiology that can sort it out and treat it for you from the chiropractic side. A more Western approach would be to examine your resting HR and blood pressure to get a sense of whether you're dehydrated or over fatigued.
When was the last time you had a check up from whatever type of doc you go to? Do you take any medicines? Lots of medicines can cause the vasculature to not be as responsive to this reflex as you might need.
I am a 62 year old guy and did undergo (at my request) in August and EKG and the doc found no problems. I did not think to mention this issue when talking with the doc.
I also had a Colonostopy last month (my resting HR was 40 while lying in the bed pre-procedure) and have always taken pride in maintaining below average blood pressure readings.
It sounds like a re-visit is in order?
Your age could be a factor here but that isn't a guarantee and who knows what may have changed to bring this on at a more advanced level. Your low resting HR and usually low blood pressure are contributing to this problem. You're already starting at a point where your brain is susceptible to not getting enough blood flow upon standing up. You obviously have been living with this for years and years so your body is adjusted. BUT... What has been going on lately that coincides with this pattern creeping up on you? What is the deal with your recent training load? Stress level (from all different places)? Any changes in your nutrition? Have you been getting enough restful sleep or has there been a change there?
Please revisit your doc and mention this. Ask him if he'll do a test where you're lying down on the table for several minutes, take your pulse and blood pressure, then stand right up and take your pulse and blood pressure within seconds. See what they think.
Nothing much as changed for me. Just like most others here, my training ebbs and flows depending on where I am in the season. Right now I am following the get faster plan at 6-8 hours per week just to keep in the mix until the off season starts in January.
I will definitely make an appt to revisit my doc.
I would be somewhat less concerned then Peter. But yes get checked out by your doc with bloodwork, etc.
I have had the same thing for a lifetime. Have actually fainted rarely too. My tallness probably factors into it. Of course watch the basics like hydration.
But yes as your orthostasis has worsened, see the doc.
You say there's a higher likelihood of feeling dizziness that coincides with tougher workouts. Now, I'm not familiar with the get faster plan but I suppose that it involves some Z4 and maybe Z5 interval work, yes? It sounds like your recovery may be lacking, both in the hours after the workout and during the time between hard days. Have you considered wearing calf compression sleeves in the meantime before you see your doc? I like the CEP brand myself but maybe you have your own preference. That is a non-drug option that could help you avoid such episodes. I wouldn't sleep in them though, but others might disagree.
If this problem has increased in its prominence then something has changed. Whether you're just tired is only something you know. Did you take a significant break after your season-ending race before you got on what sounds like an intense regimen?
All solid advice for sure. Do and follow up what is comfortable for you. I do get this when I train hard on the weekends in season. It could be as simple or complex depending on your health, see below. Would like to hear your thoughts, plan, an outcome.And yes Robin is not vertically challenged!
http://www.nursingtimes.net/nursing-practice/clinical-zones/cardiology/postural-hypotension-symptoms-and-management/206128.article
Postural hypotension, or orthostatic hypotension, is as previously decribed is not uncommon especiallly as we get older and is a not uncommon cause of syncope (fainting). Couple that with a harder workout which may have resulted in some dehydration and, voila, one gets symptomatic and passes out A few things that might help. When you are getting up from a supine position or, less commonly, standing from a sitting position, take your time. So instead of standing right up, sit up for a couple of seconds (perhaps no more than 1 or 2 seconds. This will allow your carotid sinus receptors to better respond to the decrease in blood flow that it senses and therefore vasoconstrict your vessels so you don't pass out.
Now one thing you didn't mention is whether you are on any medications. Some medications may adversely blunt this response leading to an exaggerated response.
If you are passing out frequentlly passing out in other situations or have other symptoms ie chest pain, palpitations, shortness of breath, then it would be much more concerning. As it is, I would attempt getting up slower and seeing if that might help.
Here is a patient level information for you to peruse:
http://www.uptodate.com/contents/syncope-fainting-beyond-the-basics?source=search_result&search=orthostatic+hypotension&selectedTitle=1~2
Let me know if I can help futher or clarify any medicalspeak. BTW, although I am a newbie with EN, I am a pulmonary & critical care physician.
Aa-n-n-yway, that makes me wonder if these intense workouts are making you lose more electrolytes than you think you are. Do you sweat a lot? Are they indoor workouts? Do you ever use electrolyte replacement stuff while doing these workouts? They're probably shorter workouts and you could be fooled into thinking you don't have to worry about that. However, since you're already running at a low blood pressure in your natural state, slight drops in your electrolytes and fluid loss from sweating could be setting you up for dizziness more so than a person with a higher diastolic blood pressure.
Interesting points but I think that it is unlikely that this is an electrolyte issue. The predominant electrolyte that you are referring to would be sodium as this is the major extracellular electrolye in our body. Potassium, magnesium are predominantly intracellular. Manifestations of significant hyponatremia would be confusion and even seizures. Typically when someone "loses" electrolytes it is the volume depletion that results in tthe lower BP or syncope. A person's BP is very individiual and so what is low for me may in acutality be normal for someone. . .within reason, of course. The use of florinef is not commonly done and I would be hesitant to suggest this as a treatment for your symptoms.
Sure, potassium is mostly an intracellular electrolyte but consider that since it's plasma concentration is only around 3.5-4.5 mEq/L, losing around 0.2 g/L in sweat (no, I don't wanna do the conversion in my head either) makes a person susceptible to hypokalemia. While we usually hear of sodium problems, what does already running a low BP mean in terms of sensitivity to low potassium levels in a fit person? Hopefully the answer is not much. I haven't been in a clinic on the other side of the chart in some 20+ years so I wouldn't know.
Sodium levels in the plasma are much higher (in the high 130's - low 140's mEq/L) and while you lose about 0.9 g/L in sweat, you have a greater margin for error. I know about that from Lake Placid this summer. I wound up with a Na+ level of 126 mEq/L and a low plasma volume after I finished the death march. Uh, I mean marathon. Is there a point at which low sodium messes with your cardiovascular parameters but not so low that it is also causing confusion and or seizures?
Anyway, Al, Kar-Ming's comments about dehydration and advice about getting up more gradually should help you avoid further problems.
I had the same reaction when reading this.. holy crappage!
I think we really need to be precise in our own evaluation of our health. I believe (though I don't know any of you from Adam) that since we are all on the EN website that I can say with a high degree of likelihood that most members reading this forum thread do not have hypotension. Furthermore I would submit that a lot of our "low BP" is simply a manifestation of our excellent fitness level. Perhaps not excellent compared to the pros but excellent compared to the 99.99% of the population. Yes, we can all get lightheaded from getting up (I get this also) but this is an entirely normal physiologic response that is occurring in our bodies and occurs in all age groups. It definitely does not mean that we are in danger of any significant disease process.
In replying to this thread, I reread some of the articles on exercise induced hyponatremia. Here is an informative article that I found online. http://cjasn.asnjournals.org/content/2/1/151.full#T1
Briefly it found that there is an association with weight gain during a race (from ingestion of water and, interestingly, sports drinks as only a few are isotonic- meaning same amount of sodium in the drink as in your blood), duration of participation (longer = more time to drink), experience level, nonsteroidal use (Advil, Aleve, etc) to name a few. Typically when we get dehydrated in a race, we will tend to get hypernatremic (high sodium). The NSAID use was the one that really caught my eye as the article mentioned that many peeps use NSAIDS before, during and after training/races. So be careful.
Lastly re: potassium. Don't go out and start buying potassium supplements. Our bodies' potassium is comprised of 98% in the cells and 2% in the blood (where we measure it). Once we start losing the potassium in our sweat, the potassium in our cells releases more into the blood to maintain electrochemical balance. It takes a ton of dehydration to lose that much potassium in a normal healthy person. In diabetics who get admitted to the ICU, they often lose on the order of 5+liters of fluid before we see their potassium level drop dangerously low.
I know this is more than most want to know but I think it is important that people have some understanding of what goes on in their body so as to not needlessly get too worried when they might have symptoms similar to what others post. Anyways, I will get off my soapbox now
Again, thank you for the education on this issue. Your knowledge, insight and concern have touched me and validated my belief in the the value of a membership in such an esteemed, caring group.
Those diabetics, what was the manner of fluid loss? Urine or were these exercising diabetics, like in a marathon? I say this because I'm Type II. I also have difficulty finding the right balance of electrolyte, fluid and carbohydrate intake in long course (over 4 hours) events. I tend to sweat buckets and buckets and often it is very salty even though I try to eat a lower sodium diet.
Uh, maybe that is TMI... Sadder thing was, they didn't give me an IV because there were many other folks in worse shape that needed more attention. Yikes.
In type II the fluid simply follows the glucose and we urinate it all out.
Given your problems with low sodium and fluid retention, it might be worthwhile to adjust your intake. I am not 100% certain but I think there are companies that could measure your sodium loss. Another option is to weigh yourself pre- and post- exercise to determine amount of fluid loss. I use the generic Infinit drink but you could get a customized drink that has increased sodium. Anyways I like their mix as it is isotonic rather than hypotonic meaning that it has essentially the same amount of sodium/chloride/potassium as in your blood and shouldn't contribute to further decrease in sodium. When one has a hypotonic saline it means that there is more fluid than electrolytes compared to the blood. If enough fluid is consumed, it will result in dilution the the serum electrolytes. Water is the best example of a hypotonic solution as it has no lytes. Back to the story, by figuring out your hourly fluid losses (dependent on temperature, humidity) you can figure out approximately how much volume of fluids you need to take in.
Thanks and keep up the good work!!
PS...Al, please return and get yourself checked again and passing out or a syncopal episode if you will needs at least some more digging by your physician or health care provider. My wife recently told me, "remember this is your hobby and only a hobby"!!!!! I echo her words to you.
I get a very similar response from my wife.
Surprisingly, I've started using the Infinit Speed blend during my running and riding workouts and my lightheadedness seems to be almost gone. I would usually fuel up before and after workouts. I'm thinking that taking in more calories during exercise is better for my body. Not sure, but I feel a million times better.
I cannot believe so many people have this problem of lightheadedness when rising from a sitting or supine position. I have had this problem ever since I started structured training in 2011. It seems to be worse when I'm not well-fed. My BP and resting HR is very low and my sister who is a doc suspected orthostatic hypotension based on my description of symptoms over the Thanksgiving dinner table this year. I really paid this condition no attention until just before Thanksgiving when I fainted briefly for the first time. I had come close before but that time I actually hit the floor in a hotel bathroom while alone on a business trip in Korea. Somewhat scary to say the least...