Orthostatic hypotension - Revision history

Aidan at 18:12, 5 April 2026

2026-04-05T18:12:29Z

← Older revision		Revision as of 18:12, 5 April 2026
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	== ~~Definition~~ ==		== Background ==

	* A decrease in blood pressure when changing from sitting to standing of more than 20mmHg systolic or 10mmHg diastolic		* A decrease in blood pressure when changing from sitting to standing of more than 20mmHg systolic or 10mmHg diastolic
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	== Etiologies ==		== Etiologies ==

		⚫	* About 1/3 of patients will have no identifiable cause for chronic orthostatic hypotension
	* Primary autonomic failure (neurodegenerative diseases) (30%)		* Primary autonomic failure (neurodegenerative diseases) (30%)
	** Parkinson disease		** [[Parkinson disease]]
	** Dementia with Lewy bodies		** [[Dementia with Lewy bodies]]
	** Multiple system atrophy		** [[Multiple system atrophy]]
	** Pure autonomic failure		** Pure autonomic failure
	* Secondary autonomic failure (neuropathies) (35%)		* Secondary autonomic failure (neuropathies) (35%)
	** Small fiber neuropathies		** Small fiber neuropathies
	*** Diabetes (most common cause)		*** [[Diabetes mellitus]] '''(most common cause)'''
	*** Amyloidosis		*** [[Amyloidosis]]
	*** ~~Sjogren~~ syndrome		*** [[Sjögren syndrome]]
	*** Sarcoidosis		*** [[Sarcoidosis]]
	*** Other connective tissue disorders		*** Other [[connective tissue disorders]]
			*** [[Chronic kidney disease]]
	*** Renal failure
	*** Vitamin B12 deficiency		*** [[Vitamin B12 deficiency]]
	*** Toxins		*** Toxins
	*** Infections: syphilis, Lyme, HIV, Chagas		*** Infections: [[syphilis]], [[Lyme disease\|Lyme]], [[HIV]], [[Chagas]]
	*** Porphyria		*** [[Porphyria]]
	** Autoimmune autonomic gangionopathy		** [[Autoimmune autonomic gangionopathy]]
	** Paraneoplastic autonomic neuropathy: small cell lung cancer		** Paraneoplastic autonomic neuropathy: [[small cell lung cancer]]
	** Familial dysautonomic (Rile Day syndrome)		** Familial dysautonomic (Rile Day syndrome)
	* No generalized autonomic dysfunction (40%)		* No generalized autonomic dysfunction (40%)
	** Volume depletion		** Volume depletion
	** Medications and drugs: alcohol, alpha blockers (terazosin), SSRIs/TCAs/MAOIs/trazodone, antihypertensives, antiparkinsonism drugs, antipsychotics, beta-blockers, diuretics, muscle relaxants, opioids, phosphodiesterase inhibitors, sedatives, vasodilators		** Medications and drugs: alcohol, alpha blockers ([[terazosin]]), [[SSRIs]]/[[TCAs]]/[[MAOIs]]/[[trazodone]], [[antihypertensives]], antiparkinsonism drugs, [[antipsychotics]], beta-blockers, [[diuretics]], muscle relaxants, [[opioids]], [[phosphodiesterase inhibitors]], sedatives, vasodilators
	*** Antidepressants are major overlooked cause		*** Antidepressants are major overlooked cause
	** Aging (decreased baroreceptor sensitivity)		** Aging (decreased baroreceptor sensitivity)
	** Other		** Other
	*** Aortic stenosis		*** [[Aortic stenosis]]
	*** Pericarditis/myocarditis		*** [[Pericarditis]]/[[myocarditis]]
	*** Arrhythmias		*** Arrhythmias
⚫	* About 1/3 of patients will have no identifiable cause for chronic orthostatic hypotension

⚫	== Differential Diagnosis ==

⚫	* Postprandial hypotension
⚫	* Reflex syncope
⚫	* Postural tachycardia syndrome and chronic orthostatic intolerance (COI)

	== Clinical Manifestations ==		== Clinical Manifestations ==
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	** Change at 1min most associated with falls		** Change at 1min most associated with falls
	** Isolated increase in heart rate of more than 30bpm suggests postural tachycardia syndrome (not orthostatic hypotension)		** Isolated increase in heart rate of more than 30bpm suggests postural tachycardia syndrome (not orthostatic hypotension)

		⚫	== Differential Diagnosis ==

		⚫	* Postprandial hypotension
		⚫	* Reflex syncope
		⚫	* Postural tachycardia syndrome and chronic orthostatic intolerance (COI)

	== Investigations ==		== Investigations ==

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-22T01:59:21Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 01:59, 22 July 2020
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	* Postural tachycardia syndrome and chronic orthostatic intolerance (COI)		* Postural tachycardia syndrome and chronic orthostatic intolerance (COI)

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	* History		* History

Maintenance script: Imported from text file

2020-07-04T01:17:48Z

Imported from text file

New page

== Definition ==

* A decrease in blood pressure when changing from sitting to standing of more than 20mmHg systolic or 10mmHg diastolic

== Etiologies ==

* Primary autonomic failure (neurodegenerative diseases) (30%)
** Parkinson disease
** Dementia with Lewy bodies
** Multiple system atrophy
** Pure autonomic failure
* Secondary autonomic failure (neuropathies) (35%)
** Small fiber neuropathies
*** Diabetes (most common cause)
*** Amyloidosis
*** Sjogren syndrome
*** Sarcoidosis
*** Other connective tissue disorders
*** Renal failure
*** Vitamin B12 deficiency
*** Toxins
*** Infections: syphilis, Lyme, HIV, Chagas
*** Porphyria
** Autoimmune autonomic gangionopathy
** Paraneoplastic autonomic neuropathy: small cell lung cancer
** Familial dysautonomic (Rile Day syndrome)
* No generalized autonomic dysfunction (40%)
** Volume depletion
** Medications and drugs: alcohol, alpha blockers (terazosin), SSRIs/TCAs/MAOIs/trazodone, antihypertensives, antiparkinsonism drugs, antipsychotics, beta-blockers, diuretics, muscle relaxants, opioids, phosphodiesterase inhibitors, sedatives, vasodilators
*** Antidepressants are major overlooked cause
** Aging (decreased baroreceptor sensitivity)
** Other
*** Aortic stenosis
*** Pericarditis/myocarditis
*** Arrhythmias
* About 1/3 of patients will have no identifiable cause for chronic orthostatic hypotension

== Differential Diagnosis ==

* Postprandial hypotension
* Reflex syncope
* Postural tachycardia syndrome and chronic orthostatic intolerance (COI)

== Clinical Presentation ==

* History
** Any recent volume loss?
** Rule out CHF, malignancy, diabetes, and alcohol abuse
** Evaluate for parkinsonism, ataxia, peripheral neuropathy or dysautonomia
*** Abnormal pupillary response
*** Chronic constipation
*** Erectile dysfunction
** Rule out postprandial hypotension
* Physical exam
** Lying 5min, then measure supine BP
** Standing 1-5min, then measure standing BP
** Change at 1min most associated with falls
** Isolated increase in heart rate of more than 30bpm suggests postural tachycardia syndrome (not orthostatic hypotension)

== Investigations ==

* Laboratory
** CBC
** Lytes, creatinine for renal disease, dehydration
** Glucose, A1c for diabetes control
** Consider syphilis screening, SPEP, or other investigations for polyneuropathy
* Other
** EKG
** Consider EMG studies if abnormal neurological exam

== Management ==

* Review medications for offenders (including antidepressants)

[[Category:Cardiology]]