Introduction to orthostatic hypotension Orthostatic hypotension is a common clinical manifestation of impaired internal environment, seen in 15% to 20% of the elderly. Its prevalence increases with age, cardiovascular disease and basal blood pressure. Many elderly people have a wide range of changes in blood pressure when their position changes, and are closely related to the level of systolic blood pressure in their basal position. That is, when the systolic blood pressure is the highest in the basal position, the orthostatic systolic blood pressure drops the most, and the systolic blood pressure drops 320 mmHg (2.7 kPa) when the erect hypotension is standing. Orthostatic hypotension is an important risk factor for syncope and fainting in the elderly, even in those without evidence of other autonomic nervous system dysfunction. basic knowledge The proportion of illness: 15%-20% Susceptible people: no specific population Mode of infection: non-infectious Complications: urinary incontinence
Common causes of orthostatic hypotension are:
1. Systemic diseases: dehydration, adrenal insufficiency;
2. Simple autonomic nervous function insufficiency;
3. Central nervous system diseases: Shy-Drager syndrome, brainstem lesions Parkinson disease, myelopathy, multiple cerebral infarction;
4. Peripheral and autonomic neuropathy: diabetes, amyloidosis, bone marrow spasm, tumor-like syndrome, alcohol and nutritional diseases;
5. Drugs: phenothiazine and other antipsychotics, monoamine oxidase inhibitors, tricyclic antidepressants, antihypertensives, levodopa, vasodilators, beta-blockers, calcium channel blockers.
Orthostatic hypotension prevention
1. Adjusting the body posture early is effective, such as raising the head properly when lying down; wearing elastic tights and elastic stockings can reduce the accumulation of venous return when the patient is upright; the movement should be slow when getting up or down, both lower limbs After a few moments of activity, slowly stand up, can reduce the onset; avoid drinking or too high room temperature, or bath soaking, sauna and other induced low blood pressure; use drugs that affect blood pressure with caution.
2, high salt diet.
3, symptomatic patients should not take blood pressure drugs before meals, should be supine after meals, reduce the dose of antihypertensive drugs and eat with less food and more meals may also help, recent information suggests walking in some patients after eating Can help to restore normal circulation, but this treatment should only be carried out under close monitoring.
Orthostatic hypotension complications Complications, urinary incontinence
Common complications of the disease: fixed heart rate, urinary incontinence, constipation, no sweating, no heat, impotence and fatigue.
Orthostatic hypotension symptoms Common symptoms Hypotension, flustered, cold sweat, squatting, black pacing frequency, dizziness, dizziness, dizziness, erect, erectile decompression, low oxygen partial pressure
First, clinical manifestations
Dizziness and confusion are common clinical manifestations of orthostatic hypotension.
If the elderly complain of orthostatic dizziness and mild confusion, the clinician cannot think that he is suffering from orthostatic hypotension. The patient should be placed in a supine position for at least 5 minutes to measure blood pressure and pulse rate, then stand for 1 minute and then measure blood pressure and pulse rate. After standing for 3 minutes, measure blood pressure and pulse rate. The hypotensive response may occur immediately or after a delay. In order to find a hypotensive response to the show, it may be necessary to extend the standing time or perform a tilt test. Blood pressure should be measured multiple times to confirm the persistence of orthostatic hypotension before starting treatment.
Orthostatic hypotension check
1, 12 lead ECG
Can indicate arrhythmia, conduction abnormalities, ventricular hypertrophy, pre-excitation syndrome, QT prolongation, pacemaker failure, or myocardial ischemia and myocardial infarction. If there is no clinical evidence, at least 24-hour ambulatory electrocardiography should be performed. Any arrhythmia that can be captured may be the cause of the change in consciousness, but most patients do not experience repeated syncope during the monitoring. Recorder playback is valuable if there are aura symptoms before syncope.
2. Average signal electrocardiogram
Can help find ventricular arrhythmias. Invasive electrophysiological examination may be considered if the noninvasive method fails to diagnose suspected recurrent arrhythmia syncope. The role of electrophysiological tests is controversial unless it is used for unexplained recurrent syncope; its objection is that most syncopes are recoverable and belong to low-risk subgroups. The value of exercise testing is small unless the patient is suddenly fainting under physiological activity. Tilt tests can help diagnose vasopressor syncope or other reflex-induced syncope. Echocardiography can also identify suspicious heart disease or abnormalities in artificial heart valves. Image-enhanced fluoroscopy also has some value for the latter. Transesophageal echocardiography can help diagnose if transthoracic ultrasound fails to determine dysfunction of the prosthetic heart valve. Echocardiography can also diagnose pericardial effusion and suggest pericardial tamponade.
3, routine laboratory inspection
The value of routine laboratory tests is small, and it is necessary to have a general direction to add inspections. Fasting blood glucose measurements can confirm hypoglycemia. Hematocrit can determine anemia, hypokalemia, and hypomagnesemia can be identified as a causative factor of arrhythmia. A small number of syncope patients with elevated serum troponin or phosphocreatine kinase should be considered for acute myocardial infarction. If the aerobic partial pressure is reduced and the ECG has evidence of acute pulmonary heart disease with pulmonary embolism, monitoring of lung perfusion and ventilation scans is an excellent screening technique. If you suspect a seizure, you should do an EEG. When the diagnosis is not clear, such as suspected intracranial lesions or focal neuropathy, head and brain CT and magnetic resonance are performed as differential diagnosis.
Diagnosis of orthostatic hypotension
Most patients with orthostatic hypotension often experience symptoms such as syncope, dizziness, dizziness, disturbance of consciousness, and blurred vision when they suddenly wake up or stand up for a long time. Fatigue, exercise, alcohol or a full meal can aggravate symptoms. A severe reduction in blood supply to the brain can lead to syncope and even coma.
The doctor can make a diagnosis based on the symptoms. If the patient's blood pressure drops significantly and the blood pressure returns to normal after lying down, the diagnosis of orthostatic hypotension can be determined. Of course, the cause of orthostatic hypotension should be further sought.
If the elderly complain of orthostatic dizziness and mild confusion, the clinician cannot think that he is suffering from orthostatic hypotension. He should first let the patient sit flat for at least 5 minutes, then measure blood pressure and pulse rate, then stand for 1 minute and then measure blood pressure. And pulse rate, continue to stand for 3 minutes, then measure blood pressure and pulse rate, hypotension reaction may occur immediately or delayed after standing, in order to find the hypotensive response of the show may extend the standing time or tilt test, before starting treatment Blood pressure should be measured multiple times to confirm the persistence of orthostatic hypotension.
This disease should be differentiated from hypotension caused by other causes.