Orthostatic Hypotension

Question 1

An 84 y.o. lady with well controlled HTN is admitted after several falls at home.

Her daughter reports that she looks pale, then falls and briefly loses consciousness. There is no focal weakness or abnormal movements. She makes a full recovery each time.

Answer 1

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Question 2

a) apart from orthostatic (postural) hypotension, suggest 3 other disorders which are likely causes of her sx?

Answer 2

1) arrhythmias e.g. Adam-Stokes attack (complete heart block), sinus arrest or non-sustained VT
2) vasovagal syncope
3) AS
4) carotid sinus hypersensitivity

Question 3

b) on examination, you find that her BP drops markedly on standing up and she feels faint. suggest 2 factors which should be considered that might be aggravating this change.

Answer 3

• antihypertensive medication (iatrogenic)
• over-diuresis
• polypharmacy
• age (autonomic nervous system dysfunction: DM + multi-system atrophy)

Question 4

c) list 2 non-drug measures which may help to control postural hypotension.

Answer 4

• avoid rapid postural changes i.e. stand up slowly
• staying well hydrated
• elevating head of the bed while sleeping (reduces nocturia)
• avoiding alcohol

Question 5

d) what types of drug therapy would you consider prescribing in an effort to alleviate her sx? suggest 1.

Answer 5

fludrocortisone

Question 6

e) the pt improves on rx and you plan discharge. what other factors will you consider in your plan? suggest 2.

Answer 6

• medication review
• PT
• OT assessment
• dietetic assessment
• food and fluids