Unmasking orthostatic intolerance in youth: A case illustrating dynamic cardiovascular assessment beyond resting parameters

Orthostatic intolerance (OI) can be an underappreciated diagnosis in young healthy individuals since resting blood pressure (BP) may mask an otherwise symptomatic patient. A previously healthy 28-year-old active female with no comorbidities or medications presented with complaints of intermittent light-headedness upon standing. Vital signs revealed a BP of 128/82 mmHg sitting and a heart rate (HR) of 72 beats/min. The patient’s orthostatic BP response included a short-lived drop of 18 mmHg in systolic pressure, along with a reflexive increase in HR to 92 bpm at one minute, with both the tachycardia and light-headedness resolving by the 3-min mark. Her symptoms were consistent with OI secondary to intact but briefly overwhelmed baroreflexes. This case illustrates that orthostatic hypotension is not exclusive to elderly patients with multiple medical problems, but can occur in younger patients, and positional BP testing is important when evaluating these patients. Nonpharmacological treatment was used after understanding the underlying physiology and resulted in the resolution of symptoms.