Orthostatic hypotension


Orthostatic hypotension

Description, Causes and Risk Factors:

Alternative Names: Postural hypotension, orthostatic hypopiesis.

Abbreviation: OH.

Orthostatic hypotension is not a specific disease but rather a manifestation of abnormal blood pressure regulation due to a variety of causes. Orthostatic hypotension has been observed in all age groups, but it occurs more frequently in the elderly, especially in persons who are sick and frail. Orthostatic hypotension is a common problem in people with autonomic disorders such as Multiple System Atrophy (MSA) and Pure Autonomic Failure.

The causes of orthostatic hypotension can be categorized as nonneurogenic and neurogenic. The non-neurogenic causes include cardiac pump failure, venous pooling, reduced intravascular volume, and medication effects. The neurogenic causes include primary disorders and secondary autonomic system failure which is more common and can result from diseases of the central or peripheral nervous system.

Risk Factors:

    Arrhythmia.

  • Heart failure.

  • Deconditioning.

  • Pregnancy.

  • Anemia.

  • Dehydration.

  • Dialysis.

  • Certain food.

  • Infection.

  • Hyperventilation.

  • Hot weather.

  • Lifting of heavy objects.

Symptoms:

The most common symptoms include:

    Feeling light-headed, dizzy, or faint soon after arising.

  • Pain across the back of shoulders and neck - `coathanger' pain.

  • Pain in lower back and buttocks.

  • Sweating.

  • Blurred vision.

  • Passing out.

  • These symptoms are a direct result of lowered blood pressure and lack of enough blood flow to the brain. People whofaint may fall and injure themselves.

Diagnosis:

The health care provider will examine you and try to determine what is causing the low blood pressure. Your vital signs (temperature, pulse, heart rate, blood pressure) will be checked frequently. You may need to stay in the hospital for a while.

The following tests may be done:

    Blood cultures to check for infection.

  • Complete blood count (CBC) and other blood tests, including blood differential.

  • ECG.

  • Urinalysis.

  • X-ray of the abdomen.

  • X-ray of the chest.

  • Tilt test: During a tilt test, you will lie on a bed that will change positions and angles. Your blood pressure will be monitored during these changes to assess how serious the problem is.

Treatment:

The first steps in treatment of orthostatic hypotension are diagnosis and management of the underlying cause. A patient with symptomatic orthostatic hypotension who has a disease with no complete or specific cure may benefit from nonpharmacologic interventions. Increasing salt and fluid intake often is an initial step, although it may be difficult to undertake in some patients, such as those with severe congestive heart failure. Nonsteroidal anti-inflammatory drugs can be used to increase intravascular volume.

There are some exercises that help circulation and some maneuvers which reduce symptoms.

These simple exercises stimulate your circulation. You can do them in bed, or whilst sitting or standing and should do them before you change position or if you have been sitting or lying down for a while.

    Move your feet up and down at the ankle.

  • Do gentle `marching' on the spot.

  • If you get symptoms when you stop moving (e.g. after climbing up a flight of stairs), use these exercises after you have stopped.

Maneuvers:

    Avoid standing still, cross and uncross your legs.

  • Crouch or squat down (as if to tie your shoe laces or look in your bag).

  • Bend forward and press your stomach, this is the position most people use when feeling faint.

Disclaimer: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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