Why do you see small spots when you stand up quickly?
You stand up quickly from the sofa, bed, or a chair, and suddenly small spots, dark specks, flickering, or a brief “veil” appears in your vision. Some describe it as stars, black dots, or the visual field narrowing for a few seconds. Usually, it passes quickly once the body has adjusted blood pressure again.
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This usually happens because blood pressure briefly drops when you stand up. Gravity causes more blood to pool in the legs, and it can take a moment before the nervous system tightens the blood vessels, increases heart rate, and ensures enough blood flow to the brain and eyes. When blood supply to the visual system is slightly reduced for a few seconds, vision may flicker, spot, or darken.
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The body must quickly move blood towards the head
When you are lying or sitting, the body does not have to work as hard to keep blood flow to the brain stable. When you stand up, the situation changes quickly. Blood is affected by gravity and is pulled more downward towards the legs and abdomen.
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For the brain to receive enough blood, the body must respond immediately. This is done through automatic regulation of heart rate, blood vessels, and blood pressure.
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When this regulation works well, you notice little. When it is slightly delayed, you may experience symptoms such as:
• Small spots in vision
• Blacking out of vision
• Dizziness
• Mild unsteadiness
• A rushing sensation in the head
• Feeling as if you are about to faint
• Brief weakness in the legs
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This often lasts only a few seconds. In healthy people, it is usually harmless, but frequent or strong episodes should be assessed more closely.
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Blood pressure can briefly fall
Blood pressure is the pressure blood exerts against the walls of blood vessels. When you stand up quickly, blood pressure may fall for a moment because blood is not immediately distributed optimally.
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This is often called orthostatic blood pressure drop or orthostatic hypotension when the fall is clear enough and causes symptoms. Orthostatic means that it has to do with an upright position.
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In many people, the reaction is mild and temporary. The body corrects it quickly by:
• Constricting blood vessels in the legs and abdomen
• Increasing heart rate slightly
• Increasing resistance in the blood vessels
• Activating the sympathetic nervous system
• Prioritising blood flow to the brain
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If this response arrives a little late, the brain and eyes may briefly receive reduced blood supply. This is when the visual phenomena can occur.
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The baroreflex is the body’s rapid regulation system
An important mechanism is the baroreflex. This is an automatic reflex that helps the body stabilise blood pressure when posture, activity, or load changes.
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Baroreceptors are pressure-sensitive sensory cells in large blood vessels, especially in the carotid arteries and the aorta. They detect how much the blood vessels are stretched by blood pressure.
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When you stand up and blood pressure falls slightly, the baroreceptors detect less stretch. The signal is sent to the brain, which responds by increasing sympathetic activity and reducing parasympathetic activity.
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This happens quickly, but not always quickly enough to prevent symptoms completely. That is why you may get a few seconds of spots or darkening in vision before the system has adjusted.
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Why is vision affected?
Vision depends on stable blood supply to the eyes, optic nerve, and visual areas of the brain. When blood pressure briefly falls, these structures may receive slightly less oxygen and blood flow for a few seconds.
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Many people say that their vision “goes black”. This does not necessarily mean that the eyes are damaged. It often means that the brain and visual system briefly receive less blood flow than optimal.
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When blood pressure stabilises, the symptoms usually disappear quickly.
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The eyes are not always the problem
When you see spots, it is easy to think that the problem is in the eye. With spots after standing up quickly, the explanation is often more circulatory than eye-related.
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The eye may be completely healthy, but the visual experience is affected because the brain and visual system are sensitive to changes in blood flow.
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This differs from more eye-specific symptoms such as:
• New floaters that do not disappear
• Flashes of light in one eye
• A shadow or curtain in the visual field
• Persistent vision loss
• Eye pain
• A red and irritated eye with vision change
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Such symptoms should be assessed differently, especially if they are new, one-sided, or persistent.
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Spots that appear exactly when you stand up quickly and disappear after a short time more often fit with blood pressure regulation.
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Why does it happen more often when getting out of bed?
Many people notice the spots most when they get up in the morning. There are several possible explanations.
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After a night in a lying position, the body has been still for a long time. When you suddenly sit up or stand, circulation must adapt quickly. In addition, you may be slightly dehydrated after the night, especially if you have sweated, drunk little, or slept in a warm room.
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In the morning, the reaction can be influenced by:
• A long time in a lying position
• Little fluid intake during the night
• Lower blood volume in some people
• Rapid transition from lying to standing
• Tiredness and low activation
• Medications that work through the night
• Alcohol the evening before
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It may therefore help to sit up first, wait a little, and then stand more slowly.
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Dehydration can make it more noticeable
Fluid deficiency can reduce blood volume. When blood volume is lower, it may be harder for the body to maintain stable blood pressure during rapid postural changes.
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You may be more prone to spots in vision when standing up if you:
• Have drunk little
• Have sweated a lot
• Have had fever
• Have had vomiting or diarrhoea
• Have trained hard
• Have consumed a lot of alcohol
• Have spent a long time in warm surroundings
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This does not mean that all such episodes are caused by dehydration. But fluid status is a common and practical factor.
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If symptoms occur more often on warm days, after training, or after low fluid intake, this may be part of the explanation.
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Heat dilates blood vessels
Heat can make a blood pressure drop when standing up more noticeable. When the body is warm, blood vessels in the skin dilate to release heat. This may cause more blood to be located in peripheral blood vessels.
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If you then stand up quickly, the body has a larger regulation task. It must manage both blood distribution to the skin and enough blood supply to the brain.
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Spots in vision may therefore be more common:
• After a hot shower
• In a sauna
• On hot summer days
• After exercise
• During fever
• In warm rooms
• When standing still for a long time
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Many people feel more dizzy if they stand up quickly right after a shower. This is often due to the combination of heat, dilated blood vessels, and rapid postural change.
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Low blood pressure is not always dangerous
Some people naturally have lower blood pressure than others. This can be completely normal, especially in young, slim, or physically active people. Low blood pressure is not necessarily a problem if you otherwise function well.
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It can still make postural changes more noticeable. When the starting point is low, less of a temporary fall is needed before symptoms appear.
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Typical mild symptoms may include:
• Brief dizziness
• Mild spots in vision
• Need to hold onto something
• Discomfort when standing up quickly
• Improvement after a few seconds
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Low blood pressure becomes more relevant if it causes frequent fainting, falls, significant loss of function, or occurs together with other symptoms.
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Blood sugar can also play a role
Low or fluctuating blood sugar can make you feel weak, shaky, dizzy, or unwell. This is not exactly the same as orthostatic blood pressure drop, but it can feel similar.
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If you stand up quickly after a long time without food, hard training, or low energy intake, the body may already be in a more vulnerable state. Both blood pressure regulation and the feeling of energy can then be affected.
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Possible signs that food intake or blood sugar may play a role include:
• Shaking
• Cold sweat
• Hunger
• Restlessness
• Weakness
• Improvement after food or drink
• Symptoms after long fasting
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In people with diabetes or use of blood sugar lowering medications, such symptoms must be assessed more specifically because low blood sugar can be serious.
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Anaemia can cause more dizziness
Anaemia means that the blood has a reduced ability to transport oxygen, often due to low haemoglobin levels. The body may then have less reserve during exertion or postural changes.
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Anaemia can cause symptoms such as:
• Fatigue
• Paleness
• Shortness of breath during activity
• Palpitations
• Dizziness
• Headache
• Reduced performance
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If spots in vision when standing up occur together with persistent tiredness, shortness of breath, palpitations, or paleness, it may be relevant to check blood values.
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This is especially relevant with heavy menstruation, low iron intake, pregnancy, gastrointestinal bleeding, or other conditions that can affect haemoglobin levels.
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Medications can affect blood pressure regulation
Several types of medication can make it easier to become dizzy or experience visual disturbances when standing up. This especially applies to medications that affect blood pressure, fluid balance, heart rate, or the nervous system.
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Examples may include:
• Blood pressure medications
• Diuretics
• Some antidepressants
• Medications for Parkinson’s disease
• Sedative medications
• Some painkillers
• Alcohol combined with medications
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This does not mean that you should stop taking medication on your own. But if symptoms started after beginning a medication or changing dose, it should be discussed with a doctor.
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In older adults, this is especially important because orthostatic blood pressure drop can increase the risk of falls.
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Prolonged sitting can make the transition larger
If you have been sitting still for a long time, the muscle pump in the legs has done little work. The muscle pump helps blood return to the heart when the calf and thigh muscles contract.
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When you stand up after prolonged sitting, both blood vessels and muscles must quickly contribute to circulation. If you stand up abruptly, the transition may be more noticeable.
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This can happen after:
• Long car journeys
• Flights
• Gaming or office work
• Sofa and screen time
• Illness with a lot of rest
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Moving the ankles, tightening the calf muscles, or standing up more slowly can make the transition easier.
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Why does sitting down again help?
If you become dizzy or get spots in vision, sitting or lying down often helps. This reduces the challenge of gravity, and blood more easily returns to the brain.
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Lying down can quickly improve blood supply to the head. This is why people who almost faint often feel better when they get lower.
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If you notice that your vision darkens significantly, you should not try to “push through it” while standing. This can increase the risk of falling.
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Practical measures in the moment:
• Sit down
• Lie down if necessary
• Raise the legs slightly if you are close to fainting
• Breathe calmly
• Stand up gradually when it has passed
• Drink fluids if dehydration may be involved
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Fall injury is often the greatest immediate risk with brief dizziness.
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Orthostatic hypotension in older adults
Older adults are more prone to orthostatic blood pressure drop. This may be due to changes in blood vessels, the nervous system, fluid balance, medications, and other diseases.
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In older adults, symptoms may be more serious because the consequences of falls are greater. In addition, some may have less obvious warning symptoms before becoming unsteady or falling.
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Signs that should be taken seriously in older adults include:
• Repeated near-fainting episodes
• Falls when standing up
• Dizziness after medication changes
• Unsteadiness in the morning
• Confusion or weakness with postural change
• New symptoms after illness or dehydration
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Assessment of blood pressure while lying, sitting, and standing can be useful in such cases. This should be done systematically, especially if there is fall risk.
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POTS is different from ordinary brief dizziness
Some people experience a marked increase in heart rate, dizziness, palpitations, fatigue, and discomfort when upright, without blood pressure necessarily falling much. In some cases, this may be consistent with postural orthostatic tachycardia syndrome, often abbreviated POTS.
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POTS is not the same as ordinary brief spots in vision when standing up quickly. In POTS, symptoms are often more persistent in the upright position and can significantly affect function.
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Possible signs may include:
• Marked heart rate increase when upright
• Dizziness that lasts as long as you stand
• Palpitations
• Fatigue and brain fog
• Discomfort in heat
• Improvement when lying down
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This must be assessed by healthcare personnel. It is important not to self-diagnose based on one simple episode of dizziness.
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A vasovagal reaction can look similar
A vasovagal reaction is a common cause of fainting. It can be triggered by pain, blood tests, heat, fear, prolonged standing, or strong emotions.
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During a vasovagal reaction, heart rate and blood pressure may fall, so the brain briefly receives reduced blood supply. You may then become dizzy, nauseous, cold and sweaty, and experience visual disturbances before possibly fainting.
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Warning signs may include:
• Nausea
• Feeling warm
• Cold sweat
• Paleness
• Spots or darkening in vision
• Ringing or rushing in the ears
• Feeling that you need to lie down
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If you recognise such signs, it is wise to sit or lie down immediately. This can often prevent fainting and falling.
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Migraine can also cause spots in vision
Not all spots in vision are related to standing up and blood pressure. Migraine with aura can cause visual phenomena such as bright zigzag patterns, flickering, blind spots, or wave-like visual disturbances.
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Migraine aura often lasts longer than the few seconds seen with orthostatic dizziness. It may develop gradually over several minutes and last up to an hour.
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Typical features of migraine aura:
• The visual disturbance often lasts 5–60 minutes
• It may have a bright or wave-like pattern
• It may be followed by headache
• It does not have to occur exactly when you stand up
• It may affect parts of the visual field
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New, strong, or unusual visual disturbances should be assessed, especially if they occur with neurological symptoms.
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Eye floaters are different
Many people have small spots, threads, or shadows that move in their vision. These are often called floaters. They are usually caused by small structures or opacities in the vitreous body inside the eye.
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Floaters differ from orthostatic spots because they often:
• Move with eye movement
• Are especially visible against a bright background
• Can be present regardless of body position
• Do not necessarily disappear after a few seconds
• Can gradually appear with age
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New floaters together with flashes of light, a shadow in the visual field, or a sudden increase in the number of floaters should be assessed quickly by an eye doctor or emergency service, because in some cases it may involve retinal problems.
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When are spots when standing up usually harmless?
Brief spots in vision when standing up quickly are often harmless when they are mild, rare, and pass quickly.
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A typically harmless pattern is:• It happens right after you stand up quickly• It lasts only a few seconds• It improves when you stand still, sit down, or walk calmly• You have no chest pain, shortness of breath, or neurological symptoms• It happens especially with low fluid intake, heat, or prolonged sitting• You feel normal afterwards
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In such cases, it is often due to normal, but slightly delayed, circulatory regulation.
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This does not mean that all episodes should be ignored. Frequency, severity, and accompanying symptoms are decisive.
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When should it be investigated?
It is sensible to contact healthcare personnel if spots in vision or dizziness when standing up are frequent, strong, new, or affect daily life.
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Assessment is especially important if you experience:
• Fainting
• Falls or near-falls
• Chest pain
• Shortness of breath
• Palpitations that are strong or irregular
• Neurological symptoms such as speech difficulties, facial drooping, or weakness
• Persistent vision loss
• New severe headache
• Blood in the stool or signs of bleeding
• Dizziness after a new medication or dose change
• Symptoms that gradually worsen
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With acute neurological symptoms, chest pain, severe shortness of breath, or sudden vision loss, help should be sought quickly.
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What can you do yourself?
If you get mild spots in your vision when standing up quickly, simple measures can reduce the problem.
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Practical advice:
• Stand up a little more slowly, especially in the morning
• Sit on the edge of the bed for a few seconds before standing
• Drink enough fluids through the day
• Be extra aware during heat, fever, or after training
• Avoid standing completely still for long periods
• Move the ankles and calves before standing up
• Eat regularly if long fasting gives symptoms
• Discuss medications with a doctor if symptoms started after a change
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For many people, it is enough to change the speed of standing up and be more aware of fluids, heat, and prolonged sitting.
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If you often become dizzy when standing up, you should avoid rapid postural changes in situations where falling could be dangerous, such as in the shower, on stairs, or on hard surfaces.
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Counter-pressure can help some people
When dizziness begins, certain counter-pressure manoeuvres can help the body maintain blood pressure. This is especially used by people who recognise early signs of fainting.
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Such measures can increase venous return and briefly support blood pressure. They should not be used as a replacement for medical assessment if symptoms are strong, new, or unclear.
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If you are close to fainting, it is safer to sit or lie down than to try to remain standing.
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Common misconceptions
Spots in vision do not always mean eye disease. When it happens right after standing up quickly, it is often due to a brief drop in blood pressure.
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It does not necessarily mean that the brain is dangerously deprived of oxygen. Often, it is a brief and quickly corrected delay in regulation.
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Low blood pressure is not always dangerous. It becomes more relevant if it causes fainting, falls, or significant symptoms.
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Standing up more slowly can genuinely help. It gives the baroreflex and blood vessels more time to adjust.
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Persistent visual disturbances are different. Spots that do not pass quickly, or that occur with vision loss, flashes of light, or neurological symptoms, should be assessed.
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Summary
Small spots in vision when you stand up quickly are usually caused by a brief drop in blood pressure as the body moves from sitting or lying to standing. Gravity causes more blood to pool in the legs, and it takes a moment for the baroreflex, blood vessels, and heart rate to adjust blood flow to the brain. When the visual system receives slightly reduced blood supply for a few seconds, vision may flicker, spot, or darken. This is often harmless if it is brief and passes quickly. Frequent episodes, fainting, falls, chest pain, shortness of breath, palpitations, neurological symptoms, or persistent vision changes should be assessed by healthcare personnel.
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Sources
• Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clinical Autonomic Research. 2011;21(2):69–72.
• Ricci F, De Caterina R, Fedorowski A. Orthostatic hypotension: epidemiology, prognosis, and treatment. Journal of the American College of Cardiology. 2015;66(7):848–860.
• Wieling W, Krediet CTP, van Dijk N, Linzer M, Tschakovsky ME. Initial orthostatic hypotension: review of a forgotten condition. Clinical Science. 2007;112(3):157–165.
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