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Orthostatic hypotension
 
 
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Orthostatic hypotension (also known as postural hypotension, and, colloquially, as head rush or a dizzy spell) is a form of hypotension
Hypotension

In physiology and medicine, hypotension refers to an abnormally low blood pressure. This is best understood as a physiologic state, rather than a disease....
 in which there is a sudden (less than 3 minutes) fall in blood pressure
Blood pressure

Blood pressure is the pressure exerted by circulating blood on the walls of blood vessels, and constitutes one of the principal vital signs. The pressure of the circulating blood decreases as it moves away from the heart through artery and capillary, and toward the heart through veins....
, typically greater than 20/10 mm Hg, that occurs when a person assumes a standing position
Standing (position)

Standing is a human position in which the body is held upright and supported only by the feet, referred to as an orthostatic state.Although quiet standing appears to be static, modern instrumentation shows it to be a process of rocking from the ankle in the Anatomical terms of location#Planes plane....
, usually after a prolonged period of rest.

The incidence increases with age.

toms, which generally occur after sudden standing, include dizziness
Dizziness

Dizziness describes a number of subjective symptoms, which the patient may describe as feelings of lightheadedness, floating, wooziness, giddiness, confusion, disorientation or loss of balance....
, lightheadedness, headache
Headache

In medicine a headache or wiktionary:cephalalgia is a symptom of a number of different conditions of the head and sometimes neck. Some of the causes are benign while others are medical emergencies....
, blurred or dimmed vision
Tunnel vision

In medical terms, tunnel vision is the loss of peripheral vision with retention of central vision, resulting in a constricted circular tunnel-like visual field....
 (possibly to the point of momentary blindness
Blindness

Blindness is the condition of lacking visual perception due to physiological or neurological factors.Various scales have been developed to describe the extent of vision loss and define "blindness." Total blindness is the complete lack of form and visual light perception and is clinically recorded as "NLP," an abbreviation for "no ligh...
), generalized (or extremity) numbness/tingling
Tingling

Tingling or Tili was a tribe union west of China before 300 BC. After c.300BC they were called tieloe or kauko. The avars was the tieloe tribe union most west members....
 and fainting, coat hanger pain (pain centered in the neck and shoulders), and in rare, extreme cases, vasovagal syncope
Vasovagal syncope

A vasovagal episode or vasovagal response is a malaise mediated by the vagus nerve. When it leads to fainting, it is called a vasovagal syncope, which is the most common type of fainting....
.






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Orthostatic hypotension (also known as postural hypotension, and, colloquially, as head rush or a dizzy spell) is a form of hypotension
Hypotension

In physiology and medicine, hypotension refers to an abnormally low blood pressure. This is best understood as a physiologic state, rather than a disease....
 in which there is a sudden (less than 3 minutes) fall in blood pressure
Blood pressure

Blood pressure is the pressure exerted by circulating blood on the walls of blood vessels, and constitutes one of the principal vital signs. The pressure of the circulating blood decreases as it moves away from the heart through artery and capillary, and toward the heart through veins....
, typically greater than 20/10 mm Hg, that occurs when a person assumes a standing position
Standing (position)

Standing is a human position in which the body is held upright and supported only by the feet, referred to as an orthostatic state.Although quiet standing appears to be static, modern instrumentation shows it to be a process of rocking from the ankle in the Anatomical terms of location#Planes plane....
, usually after a prolonged period of rest.

The incidence increases with age.

Symptoms

Symptoms, which generally occur after sudden standing, include dizziness
Dizziness

Dizziness describes a number of subjective symptoms, which the patient may describe as feelings of lightheadedness, floating, wooziness, giddiness, confusion, disorientation or loss of balance....
, lightheadedness, headache
Headache

In medicine a headache or wiktionary:cephalalgia is a symptom of a number of different conditions of the head and sometimes neck. Some of the causes are benign while others are medical emergencies....
, blurred or dimmed vision
Tunnel vision

In medical terms, tunnel vision is the loss of peripheral vision with retention of central vision, resulting in a constricted circular tunnel-like visual field....
 (possibly to the point of momentary blindness
Blindness

Blindness is the condition of lacking visual perception due to physiological or neurological factors.Various scales have been developed to describe the extent of vision loss and define "blindness." Total blindness is the complete lack of form and visual light perception and is clinically recorded as "NLP," an abbreviation for "no ligh...
), generalized (or extremity) numbness/tingling
Tingling

Tingling or Tili was a tribe union west of China before 300 BC. After c.300BC they were called tieloe or kauko. The avars was the tieloe tribe union most west members....
 and fainting, coat hanger pain (pain centered in the neck and shoulders), and in rare, extreme cases, vasovagal syncope
Vasovagal syncope

A vasovagal episode or vasovagal response is a malaise mediated by the vagus nerve. When it leads to fainting, it is called a vasovagal syncope, which is the most common type of fainting....
. They are consequences of insufficient blood pressure
Blood pressure

Blood pressure is the pressure exerted by circulating blood on the walls of blood vessels, and constitutes one of the principal vital signs. The pressure of the circulating blood decreases as it moves away from the heart through artery and capillary, and toward the heart through veins....
 and cerebral perfusion
Perfusion

In physiology, perfusion is the process of nutritive delivery of arterial blood to a capillary bed in the biological tissue. The word is derived from the French verb "perfuser" meaning to "pour over or through."...
 (blood supply).

Causes

Orthostatic hypotension is primarily caused by gravity-induced blood pooling in the lower extremities, which in turn compromises venous return, resulting in decreased cardiac output
Cardiac output

Cardiac output is the volume of blood being pumped by the heart, in particular by a ventricle in a minute. This is measured in dm3 min-1 ....
 and subsequently lowering of arterial pressure. For example, if a person changes from a lying position to standing, he or she will lose about 700 ml
Litre

The litre or liter is a unit of volume. There are two official symbols: the Latin letter L in lower and upper case . The lower case L is often written as a cursive l to avoid confusion with the number 1 in antiqua fonts....
 of blood from the thorax
Thorax

The thorax is a division of an animal's body that lies between the head and the abdomen.In mammals, the thorax is the region of the body formed by the sternum, the thoracic vertebrae and the ribs....
. It can also be noted that although there is a decreased systolic (contracting) blood pressure, there is actually an increased diastolic (resting) blood pressure. However, the overall effect is an insufficient blood perfusion in the upper part of the body.

Still, the blood pressure does not normally fall very much, because it immediately triggers a vasoconstriction
Vasoconstriction

Vasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, particularly the large arteries, arterioles and veins....
 (baroreceptor reflex), pressing the blood up into the body again. Therefore, a secondary factor that causes a greater than normal fall in blood pressure is often required. Such factors include hypovolemia, diseases, medications, or, very rarely, safety harnesses.

Hypovolemia

Orthostatic hypotension may be caused by hypovolemia
Hypovolemia

In physiology and medicine, hypovolemia is a state of decreased blood volume; more specifically, decrease in volume of blood plasma. Volumetric thirst can be caused by a number of things including bleeding and diarrhea....
 (a decreased amount of blood
Blood

Blood is a specialized bodily fluid that delivers necessary substances to the body's Cell s ? such as nutrients and oxygen ? and transports waste products away from those same cells....
 in the body), resulting from bleeding, the excessive use of diuretic
Diuretic

A diuretic is any drug that elevates the rate of urination and thus provides a means of forced diuresis. There are several categories of diuretics....
s, vasodilators, or other types of drugs, dehydration
Dehydration

Dehydration is the removal of water from an object. In Physiology terms, it entails a relative deficiency of water molecules in relation to other dissolved solutes....
, or prolonged bed rest
Bed rest

Bed rest is a doctor's prescription to spend a longer period of time in bed....
. It also occurs in people with anemia
Anemia

Anemia or an?mia/anaemia is defined as a qualitative or quantitative deficiency of hemoglobin, a protein found inside red blood cells ....
.

Diseases

The disorder may be associated with Addison's disease
Addison's disease

Addison's disease is a rare endocrine disorder in which the adrenal gland doesn't produce enough steroid hormones . It may develop in children and adults, and may occur as the result many underlying causes....
, atherosclerosis
Atherosclerosis

Atherosclerosis is a syndrome affecting artery blood vessels. It is a chronic inflammatory response in the walls of arteries, in large part due to the accumulation of macrophage white blood cells and promoted by low density lipoproteins without adequate removal of fats and cholesterol from the macrophages by functional high density lipoprot...
 (build-up of fatty deposits in the arteries), diabetes, pheochromocytoma
Pheochromocytoma

A phaeochromocytoma is a neuroendocrine tumor of the Adrenal medulla of the adrenal glands , or extra-adrenal chromaffin tissue that failed to involute after birth and secretes excessive amounts of catecholamines, usually epinephrine and norepinephrine....
, and certain neurological
Neurology

Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the Central nervous system, Peripheral nervous system, and autonomic nervous systems, including their coverings, blood vessels, and...
 disorders including Multiple system atrophy
Multiple system atrophy

Multiple system atrophy is a rare disease, degenerative neurological disorder. MSA is associated with the degeneration of nerve cells in specific areas of the brain....
 and other forms of dysautonomia
Dysautonomia

Dysautonomia is a broad term that describes any disease or malfunction of the autonomic nervous system. This includes postural orthostatic tachycardia syndrome , vasovagal syncope, mitral valve prolapse#Mitral valve prolapse syndrome, pure autonomic failure, autonomic instability and a number of lesser-known disorders....
. It is also associated with Ehlers-Danlos Syndrome
Ehlers-Danlos syndrome

Ehlers-Danlos syndrome is a group of rare genetic disorders affecting humans caused by a defect in collagen synthesis. Depending on the individual mutation, the severity of the syndrome can vary from mild to life-threatening....
. It is also present in many patients with Parkinson's Disease
Parkinson's disease

Parkinson's disease is a degenerative disorder of the central nervous system that often impairs the sufferer's motor skills and speech, as well as other functions....
 resulting from sympathetic denervation of the heart or as a side effect of dopaminomimetic therapy. This rarely leads to syncope
Syncope

In phonology, syncope is the loss of one or more sounds from the interior of a word; especially, the loss of an unstressed vowel....
 unless the patient has developed true autonomic failure or has an unrelated cardiac problem.

Another disease is called Dopamine Beta-Hydroxylase Deficiency, that is thought to be underdiagnosed also, that causes loss of sympathetic noradrenergic function and is characterized by a low or extremely low levels of norepinephrine but an excess of dopamine.

It is a symptom that quadriplegics and paraplegics might experience due to multiple systems' inability to maintain a normal blood pressure and blood flow to the upper part of the body.

Recently, a common but underdiagnosed condition that is suspected to be closely related to orthostatic hypotension is spontaneous intracranial hypotension, which results from cerebrospinal fluid
Cerebrospinal fluid

Cerebrospinal fluid , Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space and the ventricular system around and inside the brain....
 leakage. It affects women more than men and peaks at ages between 40 to 50.

Medication

Orthostatic hypotension can be a side effect of certain anti-depressants, such as tricyclics or MAOIs. It is also a side effect of the short-term use of marijuana
Cannabis (drug)

Cannabis, also known as Marijuana or marihuana, or ganja , is a psychoactive drug extracted from the plant Cannabis sativa, or more often, Cannabis sativa subsp....
. Orthostatic hypotension can also be a side effect of alpha1 adrenergic blocking agents. Alpha1 blockers inhibit vasoconstriction normally initiated by the baroreceptor reflex upon postural change and the subsequent drop in pressure.

Harnesses

The use of a safety harness can also contribute to orthostatic hypotension in the event of a fall. While a harness may safely rescue its user from a fall, the leg loops of a standard safety or climbing harness further restrict return blood flow from the legs to the heart, contributing to the decrease in blood pressure.

Other risk factors

Patients who are prone to orthostatic hypotension are the elderly, postpartum mothers, those who have been on bedrest and teenagers because of their large amounts of growth in a short period of time. People suffering from anorexia nervosa and bulimia nervosa often suffer from orthostatic hypotension and it is a common side effect of these mental illnesses. Consuming alcohol may also lead to orthostatic hypotension due to its dehydrating effects on the body.

Treatment and management

There are medications to treat hypotension. In addition there are several lifestyle issues, which however are most often specific to a certain cause of orthostatic hypotension.

Medical management

Some drugs that are used in the treatment of orthostatic hypotension include fludrocortisone
Fludrocortisone

Fludrocortisone is a synthetic corticosteroid with moderate glucocorticoid potency and much greater mineralocorticoid potency.The brand name in the U.S....
 (Florinef) and erythropoietin
Erythropoietin

Erythropoietin, or its alternative erythropoetin or EPO, is a glycoprotein hormone that controls erythropoiesis, or red blood cell production....
 to aid in fluid retention, and vasoconstrictors like midodrine
Midodrine

Midodrine is an alpha-1-sympathomimetic medication. It is used to treat hepatorenal syndrome and orthostatic hypotension. It is not given before bedtime to avoid supine hypertension; the last dose of midodrine should be taken at least 3 to 4 hours before bedtime....
. Pyridostigmine bromide (Mestinon) is also now used to treat the condition. Selective serotonin reuptake inhibitors (SSRI's) and Serotonin-norepinephrine reuptake inhibitor
Serotonin-norepinephrine reuptake inhibitor

Serotonin-norepinephrine reuptake inhibitors are a class of antidepressant used in the treatment of major depressive disorder and other mood disorders....
s (SNRI's) are helpful in many patients. Sometimes stimulant drugs such as Adderall or Ritalin can be of assistance. Benzodiazepines are commonly prescribed as well.

Lifestyle advice

Some suggestions for minimizing the effects include:

  • Standing slowly rather than quickly, as the delay can give the blood vessels more time to constrict properly. This can help avoid incidents of syncope (fainting).
  • Take a deep breath and flex your abdominal muscles while rising to maintain blood and oxygen in the brain. This, however, may be contraindicated in individuals with Stage 2 hypertension
    Hypertension

    Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the blood pressure is chronically elevated....
    . Usually medical personnel have their patients "dangle" before rising from bed to decrease the likelihood of dizziness/falling due to orthostatic hypotension. The dangling is done by having the patient sit on the side of their bed for about a minute so they do not have the sudden dizziness.
  • Maintaining an elevated salt intake, through sodium supplements or electrolyte-enriched drinks. A suggested value is 10 g per day; overuse can lead to hypertension and should be avoided.
  • Maintaining a proper fluid intake to prevent the effects of dehydration.
  • As eating lowers blood pressure, take your food in a larger number of smaller meals. Take extra care when standing after eating.
  • When orthostatic hypotension is caused by hypovolemia due to medications, the disorder may be reversed by adjusting the dosage or by discontinuing the medication.
  • When the condition is caused by prolonged bed rest, improvement may occur by sitting up with increasing frequency each day. In some cases, physical counterpressure such as elastic hose
    Hose (clothing)

    Hose are any of various styles of men's clothing for the legs and lower body, worn from the Middle Ages through the seventeenth century, when the term fell out of use in favor of breeches and stockings....
     (stockings) or whole-body inflatable suits may be required.
  • Many people who experience orthostatic hypotension are able to recognise the symptoms and quickly adopt a "squat position" to avoid falling during an episode. This is because they are usually unable to co-ordinate a return to sitting in a chair, once the episode has commenced.


Prognosis

The prognosis for individuals with orthostatic hypotension depends on the underlying cause of the condition.

See also

  • Orthostatic intolerance
    Orthostatic intolerance

    Orthostatic intolerance is a subcategory of dysautonomia, a disorder of the autonomic nervous system occurring when an individual stands up.OI can also be defined as "the development of symptoms during upright standing relieved by recumbency," or by sitting back down again....


External links

  • DYNA
  • - wrongdiagnosis.com
  • Timothy C. Hain, MD.