Orthostatic Hypotension

Etiology

  • Hyovolemia to extent that unable to compensate with elevated HR and increased peripheral tone to maintain BP when change from lying/sitting to standing
  • Neuropathy (e.g. from DM) resulting in impaired ability to raise HR or peripheral tone w/standing
  • Autonomic dz (e.g. multi-system atrophy/Shy-Drager) that results in impaired ability to raise HR or peripheral tone w/standing
  • Medications that blunt heart rate response (e.g. beta-blockers, clonidine) and/or decrease peripheral tone (e.g. alpha-blockers, calcium channel blockers)

Risk Factors

  • Hypovolemia for any reason
  • Diabetes or other toxic/metabolic process leading to peripheral neuropathy
  • Multiple processes can contribute simultaneously (e.g. diabetic neuropathy + hypovolemia)
  • Meds that affect HR and BP

Symptoms

  • Lightheaded/dizzy sensation when move from lying/sitting to standing
  • More commonly causes presyncope rather than syncope
  • May have numbness, weakness, other symptoms associated w/neuropathy if that's the root cause

Physical Exam Findings

  • Orthostatic blood pressure and heart rate changes
  • Symptoms provoked with change in position
  • Impaired distal sensation, reflexes other findings associated w/neuropathy if that is the root cause

Links