Orthostatic hypotension: Difference between revisions
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==Background== | ==Background== | ||
* More common in older patients | * More common in older patients | ||
* Symptomatic orthostasis more important than actual change in vitals | * Symptomatic orthostasis is clinically much more important than actual change in vitals | ||
* Classically drop in SBP ≥20 mm Hg or increase in HR ≥ 30 bpm when moving from lying to standing | ** Classically, drop in SBP ≥20 mm Hg or increase in HR ≥ 30 bpm when moving from lying to standing | ||
** Studies show that orthostatic vitals common at baseline health, and not necessarily abnormal in moderate volume loss <ref>Ooi WL, Barrett S, Hossain M, Kelley-Gagnon M, Lipsitz LA. Patterns of Orthostatic Blood Pressure Change and Their Clinical Correlates in a Frail, Elderly Population. JAMA. 1997;277(16):1299–1304. doi:10.1001/jama.1997.03540400049030</ref><ref>Skinner, J. E., Driscoll, S. W., Porter, C. B. J., Brands, C. K., Pianosi, P. T., Kuntz, N. L., Nelson, D. E., Burkhardt, B. E., Bryant, S. C., & Fischer, P. R. (2010). Orthostatic heart rate and blood pressure in adolescents: Reference ranges. Journal of Child Neurology, 25(10), 1210-1215. https://doi.org/10.1177/0883073809359539</ref><ref>McGee S, Abernethy III WB, Simel DL. Is This Patient Hypovolemic? JAMA. 1999;281(11):1022–1029. doi:10.1001/jama.281.11.1022</ref> | ** Studies show that orthostatic vitals common at baseline health, and not necessarily abnormal in moderate volume loss <ref>Ooi WL, Barrett S, Hossain M, Kelley-Gagnon M, Lipsitz LA. Patterns of Orthostatic Blood Pressure Change and Their Clinical Correlates in a Frail, Elderly Population. JAMA. 1997;277(16):1299–1304. doi:10.1001/jama.1997.03540400049030</ref><ref>Skinner, J. E., Driscoll, S. W., Porter, C. B. J., Brands, C. K., Pianosi, P. T., Kuntz, N. L., Nelson, D. E., Burkhardt, B. E., Bryant, S. C., & Fischer, P. R. (2010). Orthostatic heart rate and blood pressure in adolescents: Reference ranges. Journal of Child Neurology, 25(10), 1210-1215. https://doi.org/10.1177/0883073809359539</ref><ref>McGee S, Abernethy III WB, Simel DL. Is This Patient Hypovolemic? JAMA. 1999;281(11):1022–1029. doi:10.1001/jama.281.11.1022</ref> | ||
Revision as of 19:23, 28 March 2020
Background
- More common in older patients
- Symptomatic orthostasis is clinically much more important than actual change in vitals
Clinical Features
- Sudden postural changes resulting in cerebral hypoperfusion
- Weakness, lightheadedness, visual blurring
- Occasionally syncope
Differential Diagnosis
- Autonomic dysfunction
- Volume depletion
- Diuretics
- Hemorrhage
- Vomiting/ Diarrhea
- Medications
- Antihypertensives, antiparkinsonism, beta blockers, vasodilatory drugs
- Alcohol use
- Aging
- Syncope
- Seizure
Evaluation
- Review medication list
- History of potential volume loss
- CBC (anemia)
- BMP (electrolytes, BUN, Cr, glucose)
- EKG
Management
- Address the underlying cause
- Fluids, blood transfusion when appropriate
- Consider discontinuing at risk medications
Disposition
Depends on patient's risk, etiology of orthostasis disposition, secondary complications
See Also
External Links
References
- ↑ Ooi WL, Barrett S, Hossain M, Kelley-Gagnon M, Lipsitz LA. Patterns of Orthostatic Blood Pressure Change and Their Clinical Correlates in a Frail, Elderly Population. JAMA. 1997;277(16):1299–1304. doi:10.1001/jama.1997.03540400049030
- ↑ Skinner, J. E., Driscoll, S. W., Porter, C. B. J., Brands, C. K., Pianosi, P. T., Kuntz, N. L., Nelson, D. E., Burkhardt, B. E., Bryant, S. C., & Fischer, P. R. (2010). Orthostatic heart rate and blood pressure in adolescents: Reference ranges. Journal of Child Neurology, 25(10), 1210-1215. https://doi.org/10.1177/0883073809359539
- ↑ McGee S, Abernethy III WB, Simel DL. Is This Patient Hypovolemic? JAMA. 1999;281(11):1022–1029. doi:10.1001/jama.281.11.1022