orthostatic hypotension syncope
Introduction
Introduction The position and head position at the time of onset, from the lying position to the standing position, often occurs in orthostatic hypotension. Idiopathic orthostatic hypotention syncope (orthopathic orthostatic hypotension syncope) is an orthostatic hypotension syncope, which refers to syncope caused by excessive blood pressure (typically >20/10mmHg) in the upright position. Orthostatic hypotension is not a special disease, but a manifestation of abnormal blood pressure regulation due to different causes. In the past, it was called primary autonomic dysfunction (PAF), in which simple manifestations were mainly based on orthostatic blood pressure changes, without the manifestations of autonomic nervous system damage such as sweat secretion disorder and pupillary sphincter dysfunction. Acute and subacute, the main manifestations of the episodes are more rapid orthostatic hypotension, but clinically relatively rare.
Cause
Cause
The cause of the disease:
1 systemic disease: dehydration, adrenal insufficiency.
2 simple autonomic nervous function insufficiency.
3 central nervous system diseases: Shy-Drager syndrome, brainstem lesion 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.
Examine
an examination
Related inspection
Dose of dexamethasone inhibited blood pressure in pulse electrocardiogram
1. Middle-aged onset, males are mostly.
2. Insidious onset, the course progresses slowly.
3. Orthostatic hypotension: normal blood pressure in the supine position, systolic blood pressure often decreases above 6.6 kPa (50 mmHg), with dizziness, blurred vision, weakness, and even syncope.
4. Autonomic symptoms: sexual function, bladder rectal sphincter function, sweat dysfunction.
5. Somatic neurological symptoms: signs of nerve damage such as cone system, extrapyramidal system, and cerebellum.
6. Can exclude other diseases that can cause orthostatic hypotension.
7. When standing upright or standing for a long time, there may be aura symptoms such as dizziness, vertigo, dizziness, weakness or upper abdominal discomfort.
8. When the attack occurs, the heart rate is increased and the blood pressure is lowered.
9. Standing position endurance test is positive.
10. 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.
Diagnosis
Differential diagnosis
It should be differentiated from hypotension caused by other causes.
Idiopathic orthostatic hypotension, commonly referred to as Shy-Drager syndrome, is a rare autonomic nervous system dysfunctional degenerative disease of unknown origin, which is more common in middle-aged men. The disease Bradburg and Eggtestoton (1925) first reported that Shy (1961) and Drager (1962) were pathologically described. When the patient is in an upright position, the symptoms of global cerebral insufficiency occur due to a decrease in blood pressure, and are accompanied by cerebellum, pyramidal tract (olivine nucleus, pons, cerebellum), or extrapyramidal (striatum, substantia nigra) degeneration. Clinical manifestations of dizziness, syncope, blurred vision, general malaise or ataxia. Can also be associated with other autonomic and central nervous system symptoms.
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.
