Orthostatic Hypotension

Question 1

Orthostacit Hypotension : Overview

Answer 1

***** **AKA Postural Hpotension **
* Occurs in 30 to 50 % elderly with disease and/or Rx risk factors
* Leads to falls, syncope, and hospitalizations

Question 1

Orthostiac Hypotension Definition

Answer 1

• Drop in **SBP >/= 20mmHg
  **Drop DBP: >/= 10 mmHg
  Within 3 mints of standing

Question 2

Neurogenci Component

Answer 2

Compensatory Increase in HR ( >15mmHg )
It’s Neurogenic component vs non-neurogenic

Question 3

Signs and Symptoms

Answer 3

• Generalized Weakness
• Dizziness Light Headiness
• Visual Blurring
• Darkening Visual field
• Pre syncop/Syncope
• Leg Bocking
• Cognitive Slowing
• Orthostatic Dyspnea
• Neck Pain
• S/s can be absent or non-specific geriatic population

Question 4

Non-Neurogenic Causes
5 reasons

Answer 4

***** **Volume Defisit **
* Hyperglycemia
* Dieretics
* Vomiting
* Hypoglycemia

**Venous Pooling **
Vegorous Exercieses
Heat
Hypersensitivity
Carotid synus

**Reflex Syncope **
Vasovagal syncope, this is the most common type of fainting. It occurs when there is a sudden drop in heart rate and blood pressure, leading to a temporary decrease in blood flow to the brain.

**Age Related **
Cardiac Related

**Medications **
Diuretics
Antidepressent
ETOH
Narcotics

Question 5

Primary Neurogenic Causes
Automatic Disorders

Answer 5

• Parkingson
• Lewy Dody Demetia
• Pure Automic Failure (PAF)
• Murliple Systme Atrophy (Shy -Drager Syndrome)

Question 6

Secondary Neurogenic Causes

Answer 6

• Spinal Injury
• Peripheral Polyneuropathies ( DM, Amyloid : Protein aggregates )

Question 7

The Weird Causes

Answer 7

**Cardiac
AC, Hypertrophic CM
Pulmonary
COPD, Pulmonary HTN, OSA
Endocrine
Adrenal Insufficiency, DI, Hypoaldosteronism, Renal Wastting
**Baroreceptor Destruction **
Neck Radiation, Surgrey, Tumor
**Dopamine Deficiency **

Question 8

Nonpharmacologic Treatment

Answer 8

• Remove offending medications
• Physical Maneuvers
• TED hose
• Patient education
• Caffeine
• Increase Fluid Intake

Question 9

Pharmacologic Treatment

Answer 9

***** Volume Challenge

• Isotonic Crystalloid Fluids (NSS 0.9)
• Midodine 2.5mg to 10mg ( only FDA Tx approved)
• S/E: Urinary Retension, Do not give with numerous heart problmes
  *** Fludrocortisone **
• 00.5 to 0.1 mg QD (can be BID)
• Not FDA Approved**
  S/E: edema, supine hypotension ,

**Midordrine SE: **Supone Hypotension, Urinalry Retension, Do not Give w

Question 10

Orthostatic Hypotension
Related Supine Hypertension

Answer 10

**Supine Hypetension **
* Concurrent Problem
* BP increases when lying down
* No proven tx
* Can lead to end-organ damage
* Lifestyle modifications : avoid of laying down during day