Postural hypotension Flashcards

1
Q

What is the definition of postural hypotension?

A

When someones blood pressures falls by more than 20/10mmHg within 3 mins of standing compared to when they sit/lie down

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2
Q

What is the pathology of postural hypotension?

A
  • Normally the blood pressure of a person rises if someones stands up due to ↑ venous return/venoconstriction
  • Loss of extracellular fluid prevents this = ↓ BP
  • Baroreflex mechanism that controls heart rate and vascular resistance declines with age
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3
Q

What are the risk factors/aetiology of postural hypotension?

A
  • Elderly
  • Diabetes = hypovolaemia
  • Systemic amyloidosis = hypovolaemia
  • Age = hypovolaemia
  • Parkinson’s disease
  • Tricyclic antidepressents – interference with autonomic function
  • Nitrates – interference with peripheral vasoconstriction
  • Ca channel blockers – interference with peripheral vasoconstriction
  • Diuretics = hypovolemia
  • Prolonged bed rest
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4
Q

What are the signs/symptoms of postural hypotension?

A
  • JVP – when lying flat
  • Cold skin
  • Empty peripheral veins
  • Tachycardia
  • Dizziness
  • Headache
  • Blurred vision
  • Fatigue
  • Syncope
  • Nausea
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5
Q

What investigations are carried out for suspected postural hypotension?

A

• Lying and standing BP

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6
Q

What is the pharmacological treatment for postural hypotension?

A

• Midodrine

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7
Q

What is the non pharmacological treatment for postural hypotension?

A
  • Manage underlying cause
  • Drink more water
  • Compression stockings
  • Physical counterpressure manoeuvres
  • Sit up and then change position slowly
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