Hypotension Flashcards
What is the definition of hypotension?
Hypotension is defined as a BP that is much lower than usual, often causing symptoms such as dizziness or light-headedness. It is typically defined as systolic BP < 90 mm Hg or diastolic BP < 60 mm Hg.
What investigations are recommended as first-line for hypotension?
First-line investigations for hypotension include:
Full blood count (FBC)
Urea & Electrolytes (U&E)
Fasting glucose
Pregnancy test (if unsure)
ECG
Echocardiogram (if cardiac issue is suspected)
Tilt-table testing for orthostatic hypotension
What is orthostatic hypotension?
Orthostatic hypotension is defined as a sustained reduction in systolic BP of at least 20 mm Hg or diastolic BP of at least 10 mm Hg within three minutes of standing or a head-up tilt.
What are common symptoms of orthostatic hypotension?
Common symptoms include dizziness, light-headedness, blurred vision, weakness, fatigue, nausea, palpitations, and headache. Less common symptoms include syncope, dyspnoea, and chest pain.
Which medications and substances are commonly associated with orthostatic hypotension?
Medications and substances associated with orthostatic hypotension include:
Vasodilators (alpha blockers, calcium-channel blockers, nitrates)
Opioids
Tricyclic antidepressants
Alcohol
What are the management strategies for orthostatic hypotension?
Management includes:
Educating patients about BP-affecting factors
Avoiding triggers like high temperatures
Reviewing medications
Advice on standing slowly and physical counterpressure (compression hosiery)
Maintaining high fluid and salt intake
Medications like midodrine and fludrocortisone if necessary
What is the goal of treatment for orthostatic hypotension?
The goal of treatment is to improve the patient’s functional capacity and quality of life, preventing injury, rather than targeting a specific BP.
What is acute hypotension, and how is it related to shock?
Acute hypotension can lead to serious damage to renal, cerebral, and myocardial tissue. It can be associated with various forms of shock, such as sepsis, hypovolaemia, anaphylactic, cardiogenic, and neurogenic shock.
What is vasovagal syncope?
Vasovagal syncope is a common faint, often triggered by prolonged standing, emotional stress, or pain, leading to a brief period of sweating, pre-syncope symptoms, and loss of consciousness. It often resolves spontaneously.
What is postprandial hypotension?
Postprandial hypotension is a decline in systolic BP of 20 mm Hg or more, or a systolic BP below 90 mm Hg, within two hours of consuming a meal, commonly seen in people with autonomic dysfunction.
What dietary changes are recommended for postprandial hypotension?
Patients should take smaller, more frequent meals, and reduce carbohydrate intake. If necessary, medications may be prescribed.
What medications may be used to treat postprandial hypotension?
Medications such as acarbose (a glucosidase inhibitor) and subcutaneous octreotide can help treat postprandial hypotension.
What are common conditions associated with orthostatic hypotension?
Common conditions include:
Parkinson’s disease
Diabetes
Arrhythmias
Severe heart failure
Spinal cord lesions
How should patients with severe orthostatic hypotension be managed?
Severe cases may require higher interventions, such as increasing fluid and salt intake, using compression hosiery, and considering medications like midodrine or fludrocortisone.
What is the primary goal of treating shock?
The primary goal is to prevent tissue hypoxia and organ failure by addressing the profound hypotension associated with shock.
What is the main difference in fluid management between cardiogenic shock and other types of shock?
In cardiogenic shock, fluid replacement may worsen myocardial performance and exacerbate tissue ischemia due to high peripheral resistance, whereas in other types of shock, such as haemorrhagic or septic shock, volume replacement is essential.
What medications can improve cardiac output in shock?
Sympathomimetic inotropes such as adrenaline/epinephrine, dobutamine, and dopamine hydrochloride can be used to improve cardiac output depending on the hemodynamic status.
When might vasoconstrictor sympathomimetics, like norepinephrine, be used in shock management?
Vasoconstrictor sympathomimetics like norepinephrine are considered if fluid replacement and inotropic support fail to maintain blood pressure.
What is the main effect of vasoconstrictor sympathomimetics?
What is the main effect of vasoconstrictor sympathomimetics?
What are the risks associated with using vasoconstrictors?
While they raise blood pressure, vasoconstrictors can also reduce perfusion to vital organs, such as the kidneys.
How might spinal and epidural anaesthesia affect blood pressure, and how can it be managed?
Spinal and epidural anaesthesia may cause sympathetic block leading to hypotension, which can be managed with intravenous fluids, oxygen, leg elevation, and a pressor drug such as ephedrine hydrochloride.
What dual action does ephedrine hydrochloride have, and why is it useful in managing hypotension?
Ephedrine hydrochloride constricts peripheral vessels and accelerates the heart rate, which helps manage hypotension and associated bradycardia.
What additional medication might be needed if bradycardia persists during hypotension management?
Intravenous atropine sulfate may be required if bradycardia persists.
