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   , lightheadedness, dizziness, or loss of consciousness from IOH, affects up to   
   40% of the general population (all ages), while presyncope is probably even   
   more common. Despite this, the condition is relatively understudied and there   
   is minimal information available about the underlying mechanisms or symptom   
   management and treatment. Currently, there are very few options available to   
   patients with IOH and no pharmacological treatments. The most common   
   recommendations have been to stand up slowly or sit up first before standing.   
      
   "Almost everyone has probably experienced some lightheadedness at some time   
   after standing up," explained lead investigator Satish R. Raj, MD, MSCI, FHRS,   
   Professor of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School   
   of Medicine, University of Calgary, Calgary, AB, Canada. "For some people this   
   is a frequent occurrence and may happen several times a day, which can be very   
   frightening and negatively impact their quality of life. We wanted to explore   
   this further and provide novel and effective symptom management techniques   
   with the goal of improving the IOH patient's quality of life."   
      
   This study investigated physical maneuvers before or after standing and their   
   efficacy in reducing the drop in blood pressure as well as the symptoms   
   typically seen in IOH patients upon standing. Study participants included 24   
   young women (mean age 32 ? 8 years) with a high burden history of fainting   
   immediately after standing and more than four episodes of presyncope or   
   syncope per month. The study participants were required to have a significant   
   drop in systolic blood pressure of at least 40 mmHg upon standing to fulfill   
   the diagnostic criteria of IOH on the study day. Two participants had   
   inadequate heart rate recordings and were excluded from the analysis.   
      
   The 22 study participants completed three sit-to-stand maneuvers including a   
   stand with no intervention (control), and two interventions. Researchers found   
   that both lower body muscle preactivation (thighs) through repeated knee   
   raises prior to standing (PREACT) and lower body muscle tensing (thighs and   
   buttocks) through leg crossing and tensing immediately after standing (TENSE)   
   effectively improve the blood pressure drop. This led to a reduction in   
   symptoms upon standing. They found that the PREACT maneuver accomplished this   
   by increasing cardiac output, while the TENSE maneuver did so by increasing   
   stroke volume.   
      
   "Our study provides a novel and cost-free symptom management technique that   
   patients with IOH can use to manage their symptoms," noted first author Nasia   
   A. Sheikh, MSc, Libin Cardiovascular Institute, Cumming School of Medicine,   
   University of Calgary, Calgary, AB, Canada. "Since it is a physical maneuver,   
   it simply requires the lower body limbs, which patients can utilize at any   
   time and from anywhere to combat their symptoms."   
      
   "Our study demonstrates the physiology of IOH and assesses the utility of   
   physical maneuvers that can help the IOH patient manage their symptoms. A   
   diagnosis of IOH is identified by patients as the critical first step to   
   empowering them to understand and master their symptoms and thus minimize the   
   disruptions to daily living caused by this common, but not commonly   
   understood, condition," added co-investigator Mary Runte, PhD, University of   
   Lethbridge, Lethbridge, AB, Canada.   
      
   In an accompanying editorial, Bert Vandenberk, MD, PhD, Department of Cardiac   
   Sciences, Libin Cardiovascular Institute, Cumming School of Medicine,   
   University of Calgary, Calgary, AB, Canada; and Department of Cardiovascular   
   Sciences, KU Leuven, Leuven, Belgium; and Carlos A. Morillo, MD, FHRS,   
   Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School   
   of Medicine, University of Calgary, Calgary, AB, Canada, commented that   
   "PREACT and TENSE provide an elegant and simple effective symptom relief   
   option for patients with IOH." However, they noted, "The study needs to be   
   validated in men, as well as being explored in the elderly where multiple   
   confounders should be addressed. Understanding the role of cardiopulmonary   
   mechanoreceptors should also provide further mechanistic insights into the   
   effects of these simple yet very effective physiologic maneuvers."   
      
   And?   
      
      
      
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