Hypotension highlights

Question 1

True or false: syncope is not a primary neurologic issue

Answer 1

True

Question 2

To Dx orthostatic hypotension in a pt you’re evaluating for Sx, how do you do that?

Answer 2

Orthostatic BP measurements (supine and standing BP)

Question 3

Differentiate between neurogenic and nonneurogenic orthostatic hypotension

Answer 3

Neurogenic – baroreflex dysfunction
Nonneurogenic – external factors (e.g. medications) inhibiting normal compensatory physiologic function

Question 4

What is a big cause of orthostatic hypotension?

Answer 4

Medication changes

Question 5

What part of orthostatic hypotension eval is especially important in elderly (Beers Criteria 2024)?

Answer 5

Medication review

Question 6

List some meds that can induce orthostatic hypotension

Answer 6

1) Adrenergic receptor agonist
Midodrine: short acting alpha-1 agonist
Droxidopa: short acting prodrug of norepinephrine
2) Mineralocorticoid
Fludrocortisone: increases salt reabsorption, IV volume, and vascular tone

Question 7

Are Sx required for orthostatic hypotension Dx?

Answer 7

Pt is usually coming in because of their symptoms, but do not have to have Sx in the office. There just has to be symptoms at some point in the process.