Why Do I Feel Dizzy When I Stand Up?
Dizziness, a racing heart, blurred vision, or feeling faint when standing may indicate orthostatic intolerance, including POTS or other forms of dysautonomia.
These symptoms can occur when the autonomic nervous system struggles to regulate circulation and blood flow during changes in posture.
At NeuroSport, we look beyond the symptoms to understand the underlying physiology and guide individualized care.
Why Orthostatic Dizziness Is Often Misunderstood
Patients experiencing dizziness, rapid heart rate, trembling, or weakness when standing may undergo multiple evaluations before an underlying cause is identified.
Because these symptoms overlap with anxiety, dehydration, vestibular disorders, and other medical conditions, identifying their physiological triggers is important.
At NeuroSport, we examine how symptoms relate to posture, cardiovascular regulation, and autonomic function. This approach helps distinguish orthostatic intolerance from other potential causes and guides appropriate clinical management.
The goal is not simply to identify dizziness, but to understand why it occurs.
What Happens in Your Body When You Stand Up?
When you stand, gravity causes blood to shift toward the legs and abdomen. Normally, the autonomic nervous system rapidly adjusts heart rate and blood vessel tone to maintain blood pressure, circulation, and adequate blood flow to the brain.
In people with POTS or other forms of orthostatic intolerance, these compensatory responses may be altered.
Depending on the underlying physiology:
Blood may pool excessively in the lower extremities and abdomen.
Reduced venous return may decrease the amount of blood returning to the heart.
Heart rate may increase excessively to help maintain circulation.
Blood pressure regulation may become unstable.
Cerebral blood flow regulation may be altered, contributing to dizziness, cognitive symptoms, or presyncope.
These physiological disturbances can produce dizziness, palpitations, fatigue, brain fog, and difficulty tolerating prolonged standing.
An elevated heart rate is not necessarily the primary problem. In some patients, it represents the body's attempt to compensate for impaired circulatory regulation.
How Blood Flow Changes When You Stand
This diagram illustrates how standing redistributes blood volume, reduces venous return, and activates compensatory cardiovascular responses. These changes may contribute to orthostatic symptoms.
CBV = Central Blood Volume
CBF = Cerebral Blood Flow
Clinical Insight
Dizziness when standing is often not a primary heart problem. In many cases, the heart is responding appropriately to reduced blood return caused by impaired vascular regulation.
Common Causes of Dizziness When Standing
Dizziness when standing, also called orthostatic dizziness, can result from several physiological disturbances. Although these conditions may produce similar symptoms, their underlying mechanisms and treatment approaches can differ.
Postural Orthostatic Tachycardia Syndrome (POTS)
POTS is a form of orthostatic intolerance characterized by an excessive, sustained increase in heart rate when upright, accompanied by symptoms such as dizziness, palpitations, fatigue, and brain fog.
The increased heart rate may represent a compensatory response to reduced venous return, altered vascular regulation, or other physiological disturbances.
Learn more about different types of POTS.
Orthostatic Hypotension
Orthostatic hypotension occurs when blood pressure falls abnormally after standing, potentially reducing cerebral perfusion and producing dizziness, weakness, visual disturbances, or fainting.
Unlike POTS, which is defined by excessive orthostatic tachycardia without significant orthostatic hypotension, orthostatic hypotension is characterized by a measurable reduction in blood pressure.
Post-Concussion Autonomic Dysfunction
Concussion can disrupt autonomic cardiovascular regulation and contribute to abnormal heart rate responses, altered cerebral blood flow regulation, exercise intolerance, and dizziness when standing.
These symptoms may overlap with vestibular and cervical spine disorders, making a comprehensive evaluation particularly important.
Hypovolemia and Physical Deconditioning
Reduced circulating blood volume (hypovolemia) can decrease venous return and contribute to compensatory tachycardia and orthostatic symptoms.
Physical deconditioning may also contribute to reduced exercise tolerance and abnormal cardiovascular responses. However, deconditioning should not automatically be assumed to be the cause of persistent orthostatic symptoms.
Other Potential Contributors
Dehydration, medication effects, anemia, cardiac conditions, and certain neurological disorders can also cause dizziness when standing.
Identifying the underlying mechanism is more important than treating every episode of orthostatic dizziness as POTS.
At NeuroSport, we evaluate these patterns through clinical history, orthostatic cardiovascular testing, and individualized assessment to help guide appropriate care.
How NeuroSport Evaluates Dizziness When Standing
At NeuroSport Spine and Concussion Center, our evaluation focuses on identifying the physiological mechanisms contributing to dizziness, rather than relying on symptoms or heart rate alone.
Depending on the patient's history and clinical presentation, assessment may include:
Comprehensive clinical history: Review of symptom patterns, positional triggers, medications, medical history, and functional limitations.
NASA Lean Test: A 10-minute orthostatic assessment measuring heart rate and blood pressure responses during upright posture.
Active Stand Test: A structured assessment of cardiovascular responses during the transition from lying down to standing.
Autonomic assessment: Additional testing, including the Cold Pressor Test when indicated, to evaluate cardiovascular responses associated with sympathetic activation.
Neurological, vestibular, and cervical examination: Assessment of other potential contributors to dizziness, particularly following concussion.
Symptom and functional assessment: Standardized measures to characterize symptom burden and monitor changes over time.
These findings help distinguish patterns consistent with POTS, orthostatic hypotension, other forms of autonomic dysfunction, and nonautonomic causes of dizziness.
Specialized Evaluation at NeuroSport
Our clinical approach integrates orthostatic cardiovascular findings with neurological, vestibular, and musculoskeletal assessment when appropriate.
The objective is not simply to document an abnormal heart rate, but to understand the physiological disturbances contributing to the patient's symptoms and develop an appropriate management strategy.
Learn more about dysautonomia flares, common triggers, and recovery strategies.
How These Conditions Are Treated
Treatment depends on the underlying cause of orthostatic dizziness. Patients with POTS, orthostatic hypotension, post-concussion autonomic dysfunction, or other conditions may experience similar symptoms but require different management strategies.
At NeuroSport, our approach emphasizes identifying the contributing physiological mechanisms and developing an individualized care plan.
Management may include:
Hydration and sodium strategies: Individualized recommendations to support circulating blood volume when appropriate, considering cardiovascular, renal, and other medical factors.
Compression garments: Selected patients may benefit from abdominal and lower-extremity compression to reduce venous pooling.
Physical rehabilitation: Carefully monitored conditioning and functional rehabilitation may improve orthostatic tolerance in appropriately selected patients.
Vestibular and cervical rehabilitation: Targeted treatment when dizziness is associated with vestibular dysfunction, concussion, or cervical spine disorders.
Activity modification: Education regarding positional changes, heat exposure, prolonged standing, and other symptom triggers.
Medical collaboration: Coordination with other healthcare professionals when medication management, additional testing, or specialty evaluation is indicated.
The Moreau POTS Protocol™
For appropriately selected patients with POTS or dysautonomia, NeuroSport offers the Moreau POTS Protocol™, an emerging, structured rehabilitation approach incorporating physiological monitoring, symptom tracking, and individualized activity progression.
The protocol is not appropriate for every patient. Those experiencing post-exertional malaise (PEM) may require pacing and energy management rather than conventional progressive exercise.
Learn more about exercise intolerance and post-exertional malaise.
Effective management begins with identifying the cause of dizziness, not applying the same treatment to every patient.
Dizziness When Standing: Understanding the Cause Is the First Step
Persistent dizziness, lightheadedness, rapid heart rate, or near-fainting episodes can interfere with work, school, exercise, and everyday activities.
Although these symptoms may arise from different conditions, identifying the underlying physiological disturbances can help guide appropriate management.
At NeuroSport Spine and Concussion Center, we combine clinical assessment, orthostatic cardiovascular testing, and individualized rehabilitation planning to help patients better understand their symptoms and available treatment options.
Ready to Take the Next Step?
If dizziness when standing, unexplained heart rate changes, or persistent orthostatic symptoms are affecting your daily activities, NeuroSport can help evaluate your condition and discuss appropriate management options.