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Encyclopedia > Orthostatic hypotension
Orthostatic hypotension
Classification & external resources
ICD-10 I95.1
ICD-9 458.0
DiseasesDB 10470
eMedicine ped/2860 
MeSH D007024

Orthostatic hypotension (also known as postural hypotension, orthostatic intolerance and, colloquially, as head rush or a dizzy spell) is a sudden fall in blood pressure, typically greater than 20/10 mm Hg, that occurs when a person assumes a standing position, usually after a prolonged period of rest. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... A sphygmomanometer, a device used for measuring blood pressure. ... The torr is a unit of pressure. ... Standing is a human position in which the body constantly is in an orthostatic state. ...

Contents

Symptoms

Symptoms, which generally occur after sudden standing, include dizziness, lightheadedness, headache, blurred or dimmed vision (possibly to the point of momentary blindness), and fainting. They are consequences of insufficient blood pressure and cerebral perfusion (blood supply). // Pre-syncope is a sensation of feeling faint. ... A headache (cephalalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... A human eye Eyes are organs of vision that detect light. ... Blindness is the condition of lacking visual perception due to physiological or psychological factors. ... It has been suggested that Central Ischaemic Response be merged into this article or section. ... A sphygmomanometer, a device used for measuring blood pressure. ... Wikipedia does not yet have an article with this exact name. ... In physiology, perfusion is the process of nutritive delivery of arterial blood to a capillary bed in the biological tissue. ...


Causes

Orthostatic hypotension is primarily caused by gravity-induced blood pooling in the lower extremities, which in turn compromises venous return, resulting in decreased cardiac output and subsequently lowering of arterial pressure. For example, if a person changes from a lying position to standing, he or she will lose about 700 ml of blood from the thorax. It can also be noted that although there is a decreased systolic (contracting) blood pressure, there is actually an increased diastolic (resting) blood pressure. However, the overall effect is an insufficient blood perfusion in the upper part of the body. Cardiac output is the volume of blood being pumped by the heart, in particular a ventricle in a minute. ... The litre or liter (see spelling differences) is a unit of volume. ... Diagram of a tsetse fly, showing the head, thorax and abdomen The thorax is a division of an animals body that lies between the head and the abdomen. ... Blood pressure is the pressure exerted by the blood on the walls of the blood vessels. ... Blood pressure is the pressure exerted by the blood on the walls of the blood vessels. ...


Still, the blood pressure does not normally fall very much, because it immediately triggers a vasoconstriction, pressing the blood up into the body again. Therefore, a secondary factor is required that, in turn, cause a fall in blood pressure greater than normal. Such factors include hypovolemia, diseases, medications, or, very rarely, safety harnesses[1]. The blood vessels are part of the circulatory system and function to transport blood throughout the body. ...


Hypovolemia

Orthostatic hypotension may be caused by hypovolemia (a decreased amount of blood in the body), resulting from bleeding, the excessive use of diuretics, vasodilators, or other types of drugs, dehydration, or prolonged bed rest. It also occurs in people with anemia. In physiology and medicine, hypovolemia (also hypovolaemia) is a state of decreased blood volume; more specifically, decrease in volume of blood plasma. ... Human blood smear: a - erythrocytes; b - neutrophil; c - eosinophil; d - lymphocyte. ... A diuretic (colloquially called a water pill) is any drug or herb that elevates the rate of bodily urine excretion (diuresis). ... Vasodilation is where blood vessels in the body become wider following the relaxation of the smooth muscle in the vessel wall. ... Dehydration (hypohydration) is the removal of water (hydro in ancient Greek) from an object. ... Anemia (AmE) or anæmia (BrE), from the Greek () meaning without blood, is a deficiency of red blood cells (RBCs) and/or hemoglobin. ...


Diseases

The disorder may be associated with Addison's disease, atherosclerosis (build-up of fatty deposits in the arteries), diabetes, pheochromocytoma, and certain neurological disorders including Shy-Drager syndrome and other forms of dysautonomia. Addisons disease (also known as chronic adrenal insufficiency, hypocortisolism or hypocorticism) is a rare endocrine disorder in which the adrenal gland produces insufficient amounts of steroid hormones (glucocorticoids and often mineralocorticoids). ... This article is about the disease that features high blood sugar. ... A phaeochromocytoma (pheochromocytoma in the US) is a neuroendocrine tumor of the medulla of the adrenal glands originating in the chromaffin cells, which secretes excessive amounts of catecholamines, usually adrenaline and noradrenaline (epinephrine and norepinephrine in the US). ... Neurology is a branch of medicine dealing with disorders of the nervous system. ... Shy-Drager syndrome is a rare, progressively degenerative disease of the autonomic nervous system. ... Dysautonomia is any disease or malfunction of the autonomic nervous system. ...


It is also present in many patients with Parkinson's Disease resulting from sympathetic denervation of the heart or as a side effect of dopaminomimetic therapy. This rarely leads to syncope unless the patient has developed true autonomic failure or has an unrelated cardiac problem. This article or section does not cite its references or sources. ...


Medication

Orthostatic hypotension can be a side effect of certain anti-depressants, such as tricyclics[2] or MAOIs.[3] It is also a side effect of the short-term use of marijuana.[4] An antidepressant is a medication used primarily in the treatment of clinical depression. ... Chemical structure of the tricyclic antidepressant amitriptyline Tricyclic antidepressants are a class of antidepressant drugs first used in the 1950s. ... Monoamine oxidase inhibitors (MAOIs) are a class of antidepressant drugs prescribed for the treatment of depression. ... A Cannabis sativa plant The drug cannabis, also called marijuana, is produced from parts of the cannabis plant, primarily the cured flowers and gathered trichomes of the female plant. ...


Harnesses

The use of a safety harness can also contribute to orthostatic hypotension in the event of a fall. While a harness may safely rescue its user from a fall, the leg loops of a standard safety or climbing harness further restrict return blood flow from the legs to the heart, contributing to the decrease in blood pressure.


Other risk factors

Patients who are prone to orthostatic hypotension are the elderly, postpartum mothers, and those who have been on bedrest. Postnatal (Latin for after birth) is the period beginning immediately after the birth of a child and extending for about six weeks. ...


Treatment and management

There are medications to treat hypotension. In addition, there are many lifestyle advices. Many of them, however, are specific for a certain cause of orthostatic hypotension.


Medical management

Some drugs that are used in the treatment of orthostatic hypotension include fludrocortisone (Florinef), erythropoietin and midodrine. Fludrocortisone acetate is a synthetic corticosteroid with moderate glucocorticoid potency and much greater mineralocorticoid potency. ... Erythropoietin (IPA pronunciation: , alternative pronunciations: ) or EPO is a glycoprotein hormone that is a cytokine for erythrocyte (red blood cell) precursors in the bone marrow. ... Midodrine is an alpha-sympathomimetic drug. ...


Pyridostigmine bromide (Mestinon) is now also used to treat orthostatic hypotension.[5] Pyridostigmine is a parasympathomimetic and a reversible cholinesterase inhibitor. ...


Lifestyle advice

Some suggestions for minimizing the effects include:

  • Checking blood pressure regularly with a home monitoring kit. Check when lying flat and when standing as well as when symptoms occur.
  • Standing slowly rather than quickly, as the delay can give the blood vessels more time to constrict properly. This can help avoid incidents of syncope (fainting).
  • Take a deep breath and flex your abdominal muscles while rising to maintain blood and oxygen in the brain. This, however, may be contraindicated in individuals with Stage 3 hypertension. Usually medical personnel have their patients "dangle" before rising from bed to decrease the likelihood of dizziness/falling due to orthostatic hypotension. The dangling is done by having the patient sit on the side of their bed for about a minute so they do not have the sudden dizziness.
  • Maintaining an elevated salt intake, through sodium supplements or electrolyte-enriched drinks. A suggested value is 10 g per day; overuse can lead to hypertension and should be avoided.
  • Maintaining a proper fluid intake to prevent the effects of dehydration.
  • As eating lowers blood pressure, eat multiple smaller meals rather than fewer larger meals. Take extra care when standing after eating.
  • When orthostatic hypotension is caused by hypovolemia due to medications, the disorder may be reversed by adjusting the dosage or by discontinuing the medication.
  • When the condition is caused by prolonged bed rest, improvement may occur by sitting up with increasing frequency each day. In some cases, physical counterpressure such as elastic hose or whole-body inflatable suits may be required.

It has been suggested that Central Ischaemic Response be merged into this article or section. ... Florentine particolored hose, c. ...

Prognosis

The prognosis for individuals with orthostatic hypotension depends on the underlying cause of the condition.


References

  1. ^ Suspension trauma. Lee C, Porter KM.
  2. ^ Jiang W, Davidson JR. (2005). "Antidepressant therapy in patients with ischemic heart disease.". Am Heart J 150 (5): 871-81. PMID 16290952. 
  3. ^ Delini-Stula A, Baier D, Kohnen R, Laux G, Philipp M, Scholz HJ. (1999). "Undesirable blood pressure changes under naturalistic treatment with moclobemide, a reversible MAO-A inhibitor--results of the drug utilization observation studies.". Pharmacopsychiatry 32 (2): 61-7. PMID 10333164. 
  4. ^ Jones RT. (2002). "Cardiovascular system effects of marijuana.". J Clin Pharmacol 42 (11 Suppl): 58S-63S. PMID 12412837. 
  5. ^ Singer W, Opfer-Gehrking TL, McPhee BR, Hilz MJ, Bharucha AE, Low PA. (2003). "Acetylcholinesterase inhibition: a novel approach in the treatment of neurogenic orthostatic hypotension.". J Neurol Neurosurg Psychiatry 74 (9): 1294-8. PMID 12933939. 

External links


  Results from FactBites:
 
Orthostatic Hypotension (350 words)
Orthostatic hypotension is a sign of autonomic dysfunction and dysautonomia in adults and in children.
However, the experience of transient hypotension often associated with the symptom of lightheadedness with standing is common among teenagers and is familiar to pediatricians.
Transient orthostatic hypotension in children and teenagers is a normal phenomenon related to the relative rapidity of blood translocating from the thorax to the dependent parts of the body during orthostasis.
Orthostatic Hypotension (1906 words)
Although measurements for orthostatic hypotension are not part of the standard physical examination, they should be taken if a patient's history suggests symptoms of cerebral hypoperfusion or a disease associated with orthostatic hypotension.
Orthostatic hypotension may have more than one cause; a patient with mild neurogenic orthostatic hypotension who becomes dehydrated or starts taking a new medication could develop symptomatic orthostatic hypotension.
Orthostatic hypotension is a systolic blood pressure decrease of at least 20 mm Hg or a diastolic blood pressure decrease of at least W mm Hg within three minutes of standing.
  More results at FactBites »

 
 

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