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Postural (Orthostatic) Hypotension, sympathetic and parasympathetic are…
Postural (Orthostatic) Hypotension
Normal Physiology of Gravity Effect
Stands
blood gets pulled to legs
VR and BP decreases
baroreceptor activated
venoconstriction and vasoconstriction
(+) SNS & (-) PSNS
(+) BP
baroreceptor reflex
BP stays low
(-) cerebral perfusion
fainting
Causes
Hypovolemia
dehydration
(+) in BUN, creatinine, and low urinary Na+
haemorrhage
overdialysis
Autonomic dysfunction
prolonged bed rest
central neurological disorders: parkinson
(+) age
(-) baroreceptor activity
peripheral neurological disorders: diabetes
impaired baroreceptor
Cardiovascular and endocrine problems
Medications
alpha and beta blockers
diuretics
vasodilators
ACE inhibitors and ARBs
mental illnesses drugs
phosphodiesterase inhibitors + nitrates
alcohol, opioids, hypnotic sedatives
Classifications
Classical OH
within 3 minutes
systolic decrease >20
diastolic decrease >10
pulse increase >30 bpm
Delayed OH
more than 3 minutes
commonly at least 10 mins
causes
neurologic disorders
diabetes
parkinson's
multiple system atrophy
diagnosis: Tilt-table testing
Postprandial hypotension
dizziness within 2 hours after eating a meal
Presentation
asymptomatic
presyncope
light headedness
syncope
transient loss of consciousness (TLOC)
Treatment
Pharmacological
Fludrocortisone
synthetic mineralcorticoid
salt and water retention
First-line therapy
Midodrine
alpha 1 adrenergic agonist
vasoconstriction
Pyridostigmine
cholinesterase inhibitor
prevent ACh breakdown
promotes ANS activity
Non-pharmalogical
binders
arise slowly
increase salt intake
Treat reasoning behind OH
sympathetic and parasympathetic are not necessarily opposites to eachother!
not first option due to adverse effects