This document discusses orthostatic hypotension, including its definition, causes, symptoms, diagnosis, and management. Orthostatic hypotension is defined as a decrease in blood pressure within 3 minutes of standing compared to lying down. It may be caused by neurogenic issues like Parkinson's disease or non-neurogenic issues like dehydration. Symptoms include lightheadedness, dizziness, and weakness. Diagnosis involves measuring blood pressure in lying and standing positions. Management includes both non-pharmacological approaches like compression garments and leg exercises, as well as pharmacological treatments like fludrocortisone and midodrine.
2. Definition
BLOOD PRESSURE
The pressure exerted by flowing column of
blood on arterial wall.
Normal BP- Systolic 100-140 mm Hg
Diastolic 60-90 mm Hg
3. Orthostatic hypotension
• Decrease in systolic BP≥20 mm Hg or decrease
in diastolic BP≥10 mm Hg within 3 minutes of
standing when compared with BP from sitting
or supine position
or
• Similar drop in BP within 3 minutes in a head
up position on tilt table test at angle ≥60°
4. Normal mechanism of BP regulation
There are two basic mechanisms for
regulating blood pressure:
(1) short-term mechanisms
(2) long-term mechanisms
Blood Pressure = cardiac output x peripheral
resistance
7. I. Nervous System
• Control BP by changing blood distribution in the
body and by changing blood vessel diameter.
• Sympathetic & Parasympathetic activity
• The vasomotor center – medulla
It sends efferent motor fibers that innervate
smooth muscle of blood vessels
9. Baroreceptors
• The best known of nervous mechanisms for
arterial pressure control(baroreceptor reflex)
• Baroreceptor are stretch receptors found in
the carotid sinus ,aortic sinus
• Respond more to a rapidly changing pressure
than stationary
11. Effect of Baroreceptors
EFFECT
VASODILATATION OF THE
VEINS AND ARTERIOLES
DECREASED HEART RATE AND
STRENGTH OF HEART
CONTRACTION
Therefore, excitation of baroreceptors by high pressure in the arteries
reflexly causes arterial pressure to decrease (as decrease in PR and CO)
16. Chemoreceptor
• Chemosensitive cells that respond to changes in pCO2 and pO2 and
pH levels (Hydrogen ion).
pO2 and pH
pCO2
Stimulation of
vasomotor center
CO HR vasoconstriction
BP (speeding return of blood to
the heart and lungs)
18. • Any interruption in the
body's natural process of
counteracting low blood
pressure
19. Causes of Postural Hypotension
Neurogenic causes
Primary causes-
Autonomic failure due to idiopathic central and peripheral
neurodegenerative diseases—the “synucleinopathies”
• Parkinson’s disease
• Lewy body dementia
• Pure autonomic failure
• Multiple system atrophy (Shy-Drager syndrome)
25. Venous pooling
• Postprandial dilation of splanchnic vessel beds
• Vigorous exercise with dilation of skeletal vessel
beds
• Heat: hot environment, hot showers and baths,
fever
• Prolonged recumbency or standing
27. Symptoms
Characteristic symptoms are
• Light-headedness
• Dizziness
• Presyncope (near-faintness)
However, symptoms may be absent or nonspecific like
• Generalized weakness
• Fatigue
• Cognitive slowing
• Headache.
28. • Visual blurring
• Neck pain—typically in
-suboccipital
-posterior cervical
-shoulder region
( “coat-hanger
headache”)
29. • Patients may report orthostatic dyspnea
• Symptoms may be exacerbated by exertion,
prolonged standing, increased ambient
temperature, or meals
• Syncope is usually preceded by warning
symptoms, but may occur suddenly, suggesting
the possibility of a seizure or cardiac cause
33. • The head of the bed of a patient with
orthostatic hypotension should be elevated by
10 to 20 degrees or 4 inches (10 cm)
34. • Move legs while standing
• Get up slowly
• Avoid bending at waist
• FES
• Exercise-Calf muscle exercise, when getting out of bed,
sit on edge of bed for a minute before standing