Orthostatic Hypotension (cont.)
When should I call the doctor for orthostatic hypotension?
Feeling faint or lightheaded is not normal. While a rare episode that can be
explained by circumstances, such as working or exercising in the heat, may be
ignored, more frequent occurrences should be investigated.
If a person passes out and is unconscious, even for a short period of time, is never
normal and medical care should be accessed.
How is orthostatic hypotension diagnosed?
The key to the diagnosis is a good history and physical examination. The
health care practitioner will want to know the circumstances that are associated
with the symptoms of lightheadedness or passing out, since the patient is
unlikely to have taken their blood pressure and checked their pulse rate in the
midst of the episode.
The symptoms tend to be transient and resolve quickly.
Should there be concern that the vital signs will change with position, the health care
practitioner
will take the blood pressure in both lying and standing positions and look for
changes.
According to the American Academy of Neurology, the formal diagnosis of
orthostatic hypotension requires a 20mm drop in systolic blood pressure or a
10mm drop in diastolic blood pressure within three minutes of standing. Often
there is an associated increase in the heart rate, especially if dehydration or
bleeding is the cause (if the patient is taking a beta blocker, the heart rate
may not be able to respond with an increase).
Blood tests may be ordered to look for the underlying cause. These may include a
red blood cell count (CBC) to
access for anemia or bleeding. Electrolytes may be
checked, especially if there has been a history of fluid loss through vomiting
or diarrhea, since sodium and potassium abnormalities
may be an issue. Kidney
function may be assessed.
If the physical examination reveals concern about the
heart, an electrocardiogram (EKG) may be done to evaluate electrical conduction
and heart rhythm. An echocardiogram or ultrasound of the heart may be ordered to
evaluate
the heart valves and assess
the function of the heart muscle. A
stress test may
be considered if there is concern about coronary artery disease.
A heads-up tilt table test may be ordered if the symptoms of orthostatic
hypotension continue to recur but it has been difficult to document
abnormalities in blood pressure readings. During the test, the patient is
strapped flat on a table, and as the table gradually is tilted to a 70 or 80
degree angle, continuous blood pressure and heart rate readings are taken. The
patient may be left on the table for more than 10 minutes to look for the
delayed changes seen in postural orthostatic tachycardia syndrome.
For many patients, the diagnosis may be made based upon the history and
physical examination, and no further testing may be needed.
Next: What is the treatment for orthostatic hypotension? »
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