If the malaise and lightheadedness occur only within 10 minutes of the patients rising to the full standing position, then presyncope/syncope from orthostatic hypotension is a probable diagnosis. There is no clear-cut vertigo, but there is often pallor, sweatiness, and a "look of alarm." The patient may reach out in an effort to stabilize an upright position. Similar symptoms, even when the patient is supine, occurring in association with palpitations suggest cardiogenic hypotension from arrhythmia. However, palpitation is not always a prominent symptom.
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