Orthostatic hypotension - Revision history

ClaireLewis at 17:34, 25 October 2020

2020-10-25T17:34:04Z

← Older revision		Revision as of 17:34, 25 October 2020
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	==Clinical Features==		==Clinical Features==
	* Sudden postural changes resulting in cerebral hypoperfusion		* Sudden postural changes resulting in cerebral hypoperfusion
	* Weakness, lightheadedness, visual blurring		* [[Weakness]], lightheadedness, visual blurring
	* Occasionally syncope		* Occasionally, [[syncope]]

	==Differential Diagnosis==		==Differential Diagnosis==
	* Autonomic dysfunction		* Autonomic dysfunction
	** Parkinson ~~Disease~~		** [[Parkinson's disease]]
	** Lewy Body Dementia		** [[Lewy Body Dementia]]
	** Shy-Drager Syndrome		** Shy-Drager Syndrome
	** Diabetes		** [[Diabetes]]
	* Aging		* Aging
	* Volume depletion		* [[hypovolemia\|Volume depletion]]
	** Diuretics		** [[Diuretics]]
	** Hemorrhage		** [[Hemorrhage]]
	** Vomiting/ Diarrhea		** [[Vomiting]]/ [[Diarrhea]]
	* Medications		* Medications
	** [[Antihypertensives]], antiparkinsonism, [[beta blockers]], vasodilatory drugs		** [[Antihypertensives]], antiparkinsonism, [[beta blockers]], vasodilatory drugs
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	* CBC (anemia)		* CBC (anemia)
	* BMP (electrolytes, BUN, Cr, glucose)		* BMP (electrolytes, BUN, Cr, glucose)
	* EKG		* [[EKG]]

	==Management==		==Management==
	* Address the underlying cause		* Address the underlying cause
	** Fluids, blood transfusion when appropriate		** [[Fluids]], blood [[transfusion]] when appropriate
	** Consider discontinuing at risk medications		** Consider discontinuing at risk medications

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	==References==		==References==
	<references/>		<references/>
			[[Category:Cardiology]]

NadavNahumi: /* Disposition */

2020-03-28T19:40:35Z

Disposition

← Older revision		Revision as of 19:40, 28 March 2020
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	==Disposition==		==Disposition==
	Depends on patient's risk, etiology of orthostasis ~~disposition~~, secondary complications		Depends on patient's risk, etiology of orthostasis, secondary complications such as worsening hypovolemia, potential for falls

	==See Also==		==See Also==

NadavNahumi: /* Differential Diagnosis */

2020-03-28T19:34:45Z

Differential Diagnosis

← Older revision		Revision as of 19:34, 28 March 2020
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	==Differential Diagnosis==		==Differential Diagnosis==
	* Autonomic dysfunction		* Autonomic dysfunction
			** Parkinson Disease
			** Lewy Body Dementia
			** Shy-Drager Syndrome
			** Diabetes
			* Aging
	* Volume depletion		* Volume depletion
	** Diuretics		** Diuretics
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	** [[Antihypertensives]], antiparkinsonism, [[beta blockers]], vasodilatory drugs		** [[Antihypertensives]], antiparkinsonism, [[beta blockers]], vasodilatory drugs
	* Alcohol use		* Alcohol use
	* Aging
	* [[Syncope]]		* [[Syncope]]
	* [[Seizure]]		* [[Seizure]]

NadavNahumi: /* Differential Diagnosis */

2020-03-28T19:24:35Z

Differential Diagnosis

← Older revision		Revision as of 19:24, 28 March 2020
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	* [[Syncope]]		* [[Syncope]]
	* [[Seizure]]		* [[Seizure]]
			* Postural tachycardia syndrome (POTS)

	==Evaluation==		==Evaluation==

NadavNahumi: /* Background */

2020-03-28T19:23:18Z

Background

← Older revision		Revision as of 19:23, 28 March 2020
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	==Background==		==Background==
	* More common in older patients		* More common in older patients
	* Symptomatic orthostasis more important than actual change in vitals		* Symptomatic orthostasis is clinically much more important than actual change in vitals
	* Classically drop in SBP ≥20 mm Hg or increase in HR ≥ 30 bpm when moving from lying to standing		** Classically, drop in SBP ≥20 mm Hg or increase in HR ≥ 30 bpm when moving from lying to standing
	** Studies show that orthostatic vitals common at baseline health, and not necessarily abnormal in moderate volume loss <ref>Ooi WL, Barrett S, Hossain M, Kelley-Gagnon M, Lipsitz LA. Patterns of Orthostatic Blood Pressure Change and Their Clinical Correlates in a Frail, Elderly Population. JAMA. 1997;277(16):1299–1304. doi:10.1001/jama.1997.03540400049030</ref><ref>Skinner, J. E., Driscoll, S. W., Porter, C. B. J., Brands, C. K., Pianosi, P. T., Kuntz, N. L., Nelson, D. E., Burkhardt, B. E., Bryant, S. C., & Fischer, P. R. (2010). Orthostatic heart rate and blood pressure in adolescents: Reference ranges. Journal of Child Neurology, 25(10), 1210-1215. https://doi.org/10.1177/0883073809359539</ref><ref>McGee S, Abernethy III WB, Simel DL. Is This Patient Hypovolemic? JAMA. 1999;281(11):1022–1029. doi:10.1001/jama.281.11.1022</ref>		** Studies show that orthostatic vitals common at baseline health, and not necessarily abnormal in moderate volume loss <ref>Ooi WL, Barrett S, Hossain M, Kelley-Gagnon M, Lipsitz LA. Patterns of Orthostatic Blood Pressure Change and Their Clinical Correlates in a Frail, Elderly Population. JAMA. 1997;277(16):1299–1304. doi:10.1001/jama.1997.03540400049030</ref><ref>Skinner, J. E., Driscoll, S. W., Porter, C. B. J., Brands, C. K., Pianosi, P. T., Kuntz, N. L., Nelson, D. E., Burkhardt, B. E., Bryant, S. C., & Fischer, P. R. (2010). Orthostatic heart rate and blood pressure in adolescents: Reference ranges. Journal of Child Neurology, 25(10), 1210-1215. https://doi.org/10.1177/0883073809359539</ref><ref>McGee S, Abernethy III WB, Simel DL. Is This Patient Hypovolemic? JAMA. 1999;281(11):1022–1029. doi:10.1001/jama.281.11.1022</ref>

NadavNahumi: /* Background */

2020-03-28T19:22:35Z

Background

← Older revision		Revision as of 19:22, 28 March 2020
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	* Symptomatic orthostasis more important than actual change in vitals		* Symptomatic orthostasis more important than actual change in vitals
	* Classically drop in SBP ≥20 mm Hg or increase in HR ≥ 30 bpm when moving from lying to standing		* Classically drop in SBP ≥20 mm Hg or increase in HR ≥ 30 bpm when moving from lying to standing
	** Studies show that orthostatic vitals common at baseline health, and not necessarily abnormal in ~~acutely ill~~ <ref>Ooi WL, Barrett S, Hossain M, Kelley-Gagnon M, Lipsitz LA. Patterns of Orthostatic Blood Pressure Change and Their Clinical Correlates in a Frail, Elderly Population. JAMA. 1997;277(16):1299–1304. doi:10.1001/jama.1997.03540400049030</ref><ref>Skinner, J. E., Driscoll, S. W., Porter, C. B. J., Brands, C. K., Pianosi, P. T., Kuntz, N. L., Nelson, D. E., Burkhardt, B. E., Bryant, S. C., & Fischer, P. R. (2010). Orthostatic heart rate and blood pressure in adolescents: Reference ranges. Journal of Child Neurology, 25(10), 1210-1215. https://doi.org/10.1177/0883073809359539</ref>		** Studies show that orthostatic vitals common at baseline health, and not necessarily abnormal in moderate volume loss <ref>Ooi WL, Barrett S, Hossain M, Kelley-Gagnon M, Lipsitz LA. Patterns of Orthostatic Blood Pressure Change and Their Clinical Correlates in a Frail, Elderly Population. JAMA. 1997;277(16):1299–1304. doi:10.1001/jama.1997.03540400049030</ref><ref>Skinner, J. E., Driscoll, S. W., Porter, C. B. J., Brands, C. K., Pianosi, P. T., Kuntz, N. L., Nelson, D. E., Burkhardt, B. E., Bryant, S. C., & Fischer, P. R. (2010). Orthostatic heart rate and blood pressure in adolescents: Reference ranges. Journal of Child Neurology, 25(10), 1210-1215. https://doi.org/10.1177/0883073809359539</ref><ref>McGee S, Abernethy III WB, Simel DL. Is This Patient Hypovolemic? JAMA. 1999;281(11):1022–1029. doi:10.1001/jama.281.11.1022</ref>

	==Clinical Features==		==Clinical Features==

NadavNahumi: /* Differential Diagnosis */

2020-03-28T19:01:34Z

Differential Diagnosis

← Older revision		Revision as of 19:01, 28 March 2020
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	* Alcohol use		* Alcohol use
	* Aging		* Aging
	* [Syncope]		* [[Syncope]]
	* [Seizure]		* [[Seizure]]

	==Evaluation==		==Evaluation==

NadavNahumi: /* Background */

2020-03-28T19:01:05Z

Background

← Older revision		Revision as of 19:01, 28 March 2020
Line 3:		Line 3:
	* Symptomatic orthostasis more important than actual change in vitals		* Symptomatic orthostasis more important than actual change in vitals
	* Classically drop in SBP ≥20 mm Hg or increase in HR ≥ 30 bpm when moving from lying to standing		* Classically drop in SBP ≥20 mm Hg or increase in HR ≥ 30 bpm when moving from lying to standing
	** Studies show that orthostatic vitals common in, and not necessarily abnormal in acutely ill <ref>Ooi WL, Barrett S, Hossain M, Kelley-Gagnon M, Lipsitz LA. Patterns of Orthostatic Blood Pressure Change and Their Clinical Correlates in a Frail, Elderly Population. JAMA. 1997;277(16):1299–1304. doi:10.1001/jama.1997.03540400049030</ref><ref>Skinner, J. E., Driscoll, S. W., Porter, C. B. J., Brands, C. K., Pianosi, P. T., Kuntz, N. L., Nelson, D. E., Burkhardt, B. E., Bryant, S. C., & Fischer, P. R. (2010). Orthostatic heart rate and blood pressure in adolescents: Reference ranges. Journal of Child Neurology, 25(10), 1210-1215. https://doi.org/10.1177/0883073809359539</ref>		** Studies show that orthostatic vitals common at baseline health, and not necessarily abnormal in acutely ill <ref>Ooi WL, Barrett S, Hossain M, Kelley-Gagnon M, Lipsitz LA. Patterns of Orthostatic Blood Pressure Change and Their Clinical Correlates in a Frail, Elderly Population. JAMA. 1997;277(16):1299–1304. doi:10.1001/jama.1997.03540400049030</ref><ref>Skinner, J. E., Driscoll, S. W., Porter, C. B. J., Brands, C. K., Pianosi, P. T., Kuntz, N. L., Nelson, D. E., Burkhardt, B. E., Bryant, S. C., & Fischer, P. R. (2010). Orthostatic heart rate and blood pressure in adolescents: Reference ranges. Journal of Child Neurology, 25(10), 1210-1215. https://doi.org/10.1177/0883073809359539</ref>


	==Clinical Features==		==Clinical Features==

NadavNahumi: Created page with "==Background== * More common in older patients * Symptomatic orthostasis more important than actual change in vitals * Classically drop in SBP ≥20 mm Hg or increase in HR..."

2020-03-27T22:45:17Z

Created page with "==Background== * More common in older patients * Symptomatic orthostasis more important than actual change in vitals * Classically drop in SBP ≥20 mm Hg or increase in HR..."

New page

==Background==
* More common in older patients
* Symptomatic orthostasis more important than actual change in vitals
* Classically drop in SBP ≥20 mm Hg or increase in HR ≥ 30 bpm when moving from lying to standing
** Studies show that orthostatic vitals common in, and not necessarily abnormal in acutely ill <ref>Ooi WL, Barrett S, Hossain M, Kelley-Gagnon M, Lipsitz LA. Patterns of Orthostatic Blood Pressure Change and Their Clinical Correlates in a Frail, Elderly Population. JAMA. 1997;277(16):1299–1304. doi:10.1001/jama.1997.03540400049030</ref><ref>Skinner, J. E., Driscoll, S. W., Porter, C. B. J., Brands, C. K., Pianosi, P. T., Kuntz, N. L., Nelson, D. E., Burkhardt, B. E., Bryant, S. C., & Fischer, P. R. (2010). Orthostatic heart rate and blood pressure in adolescents: Reference ranges. Journal of Child Neurology, 25(10), 1210-1215. https://doi.org/10.1177/0883073809359539</ref>

==Clinical Features==
* Sudden postural changes resulting in cerebral hypoperfusion
* Weakness, lightheadedness, visual blurring
* Occasionally syncope

==Differential Diagnosis==
* Autonomic dysfunction
* Volume depletion
** Diuretics
** Hemorrhage
** Vomiting/ Diarrhea
* Medications
** [[Antihypertensives]], antiparkinsonism, [[beta blockers]], vasodilatory drugs
* Alcohol use
* Aging
* [Syncope]
* [Seizure]

==Evaluation==
* Review medication list
* History of potential volume loss
* CBC (anemia)
* BMP (electrolytes, BUN, Cr, glucose)
* EKG

==Management==
* Address the underlying cause
** Fluids, blood transfusion when appropriate
** Consider discontinuing at risk medications

==Disposition==
Depends on patient's risk, etiology of orthostasis disposition, secondary complications

==See Also==

==External Links==

==References==
<references/>