Podcast
Questions and Answers
A patient experiences a sudden drop in blood pressure and fainting due to intense emotion. Which physiological mechanism is most likely the primary cause of this vasovagal response?
A patient experiences a sudden drop in blood pressure and fainting due to intense emotion. Which physiological mechanism is most likely the primary cause of this vasovagal response?
- Decreased parasympathetic outflow, causing vasodilation and bradycardia.
- Transient increase in parasympathetic outflow and sympathoinhibition, leading to bradycardia and vasodilation. (correct)
- Increased sympathetic outflow leading to vasoconstriction and increased heart rate.
- Activation of the renin-angiotensin-aldosterone system, resulting in fluid retention and hypertension.
A patient with orthostatic hypotension is prescribed a beta-blocker for an unrelated condition. What is the most critical consideration regarding this medication in the context of their hypotension?
A patient with orthostatic hypotension is prescribed a beta-blocker for an unrelated condition. What is the most critical consideration regarding this medication in the context of their hypotension?
- Beta-blockers will improve venous return and increase central blood volume.
- Beta-blockers have no significant impact on patients with orthostatic hypotension.
- Beta-blockers will stimulate the sympathetic nervous system, increasing vasoconstriction.
- Beta-blockers can exacerbate orthostatic hypotension by impairing the heart rate response to postural changes. (correct)
In managing orthostatic hypotension, why is exercise on a recumbent bike or in a pool preferred over upright exercises?
In managing orthostatic hypotension, why is exercise on a recumbent bike or in a pool preferred over upright exercises?
- Recumbent and aquatic exercises reduce venous pooling compared to upright exercises. (correct)
- Recumbent and aquatic exercises require less energy expenditure.
- Upright exercises are more effective at building muscle tone.
- Upright exercises are less likely to cause injuries.
A patient with suspected vasovagal syncope is undergoing evaluation. Which historical factor would most strongly suggest a vasovagal etiology over other causes of syncope?
A patient with suspected vasovagal syncope is undergoing evaluation. Which historical factor would most strongly suggest a vasovagal etiology over other causes of syncope?
A patient diagnosed with Postural Orthostatic Tachycardia Syndrome (POTS) and orthostatic hypotension is being considered for pharmacological management. What is the rationale for using Ivabradine in this specific scenario?
A patient diagnosed with Postural Orthostatic Tachycardia Syndrome (POTS) and orthostatic hypotension is being considered for pharmacological management. What is the rationale for using Ivabradine in this specific scenario?
What is the most critical pathophysiological difference between orthostatic hypotension due to autonomic failure and that due to volume depletion?
What is the most critical pathophysiological difference between orthostatic hypotension due to autonomic failure and that due to volume depletion?
A patient prescribed Fludrocortisone for orthostatic hypotension reports increased peripheral edema and new-onset hypertension. What is the most appropriate next step in managing this patient?
A patient prescribed Fludrocortisone for orthostatic hypotension reports increased peripheral edema and new-onset hypertension. What is the most appropriate next step in managing this patient?
Why might a patient with orthostatic hypotension be advised to increase their sodium intake despite general health recommendations to limit sodium consumption?
Why might a patient with orthostatic hypotension be advised to increase their sodium intake despite general health recommendations to limit sodium consumption?
A patient with orthostatic hypotension is being evaluated using a tilt table test. What is the primary diagnostic criterion used to confirm the diagnosis during this test?
A patient with orthostatic hypotension is being evaluated using a tilt table test. What is the primary diagnostic criterion used to confirm the diagnosis during this test?
Which of the following medications would be most likely to cause orthostatic hypotension as a side effect?
Which of the following medications would be most likely to cause orthostatic hypotension as a side effect?
Flashcards
Orthostatic Hypotension Definition
Orthostatic Hypotension Definition
A reduction in systolic blood pressure of at least 20 mmHg or diastolic blood pressure of at least 10 mmHg after 3 minutes of standing.
Orthostatic Hypotension Pathophysiology
Orthostatic Hypotension Pathophysiology
Failure of sympathetic vasoconstrictor response, inadequate intravascular volume, or decreased venous return.
Common Causes of Orthostatic Hypotension
Common Causes of Orthostatic Hypotension
Volume depletion, vasodilator drugs, or postural orthostatic tachycardia syndrome (POTS).
Vasovagal Hypotension Definition
Vasovagal Hypotension Definition
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Causes of Vasovagal Hypotension
Causes of Vasovagal Hypotension
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Vasovagal Hypotension Pathophysiology
Vasovagal Hypotension Pathophysiology
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Orthostatic Hypotension Management
Orthostatic Hypotension Management
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Orthostatic Hypotension Management
Orthostatic Hypotension Management
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Study Notes
- Hypotension includes orthostatic hypotension and vasovagal hypotension
Orthostatic Hypotension
- Definition: Systolic blood pressure decreases by at least 20 mmHg or diastolic blood pressure decreases by at least 10 mmHg after standing for 3 minutes or during a head-up tilt on a tilt table.
- Affects about 30% of ambulatory patients.
- Symptoms: Syncope, lightheadedness/dizziness, weakness/fatigue, shortness of breath, blurred vision, palpitations or chest pain.
- Diagnostic tests: Electrocardiogram (ECG) and a tilt table test.
- Pathophysiology involves the failure of sympathetic vasoconstrictor response, inadequate intravascular volume, decreased venous return, or inability to increase cardiac output due to postural changes.
Common Causes of Orthostatic Hypotension
- Volume depletion
- Vasodilator drugs
- Postural orthostatic tachycardia syndrome (POTS), incidence is increased 5%–20% in post-COVID patients and sedentary patients.
- Use of a negative chronotropic drug (e.g., beta-blocker, verapamil, diltiazem, ivabradine)
- Presence of a cardiac conduction defect (easily identified by an electrocardiogram and often requiring a pacemaker for effective management)
- Autonomic failure (neurogenic)
Orthostatic Hypotension Management
- Managed with non-pharmacological measures
- Identifying and stopping blood pressure lowering drugs
- Muscle tone exercise to reduce venous pooling, done either recumbent (e.g., on recumbent bike or rowing machine) or aquatic (swimming or pool-walking)
- Compression stockings
- High sodium intake (>150 mEq/day) and fluid intake (at least 2 L/day)
- Pharmacologic agents include:
- Beta blockers (e.g., Ivabradine) for POTS patients with hyperadrenergic subtype and sinus tachycardia > 120 bpm on standing
- Synthetic mineralocorticoid: Fludrocortisone
- Short acting vasoconstrictors: midodrine or droxidopa
Vasovagal Hypotension
- Sudden decreased heart rate and blood pressure leading to fainting.
- Causes - Usually from a reaction to motionless upright posture, warm ambient temperature, intravascular volume depletion, alcohol ingestion, hypoxemia, anemia, pain, the sight of blood, venipuncture, and intense emotion.
- Symptoms include dizziness, light-headedness, blurred or tunnel vision, sweating, turning pale, feeling warm, nausea, cold and clammy skin, and ringing in ears.
- Pathophysiology: Transient change in autonomic efferent activity with increased parasympathetic outflow plus sympathoinhibition, resulting in bradycardia, vasodilation, reduced vasoconstrictor tone, and reduced cardiac output
- Management
- Reassurance
- Avoidance of provocative stimuli
- Plasma volume expansion with fluid and salt
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