32 years
I have orthostatic intolerance, can't stay idle on my feet for more than 10 min without feeling lightheaded & feeling needles in my heart. Same prob when sitting down & leaning forward, ecg is normal
Oct 31, 2014
Orthostatic hypotension is defined as a decrease in systolic (top value) blood pressure of 20 mm Hg or a decrease in diastolic (lower value) blood pressure of 10 mm Hg within three minutes of standing when compared with blood pressure from the sitting or supine (lying down) position. It results from an inadequate physiologic response to postural changes in blood pressure. Normally, upon rising from a supine or sitting position, the heart rate increase along with an increase in systolic blood pressure to counteract the blood pooling in the legs and maintain adequate blood supply to the brain; in people with orthostatic hypotension, this reflex is weak or sometimes absent.
Postural orthostatic tachycardia syndrome (POTS), also called postural autonomic tachycardia or chronic or idiopathic (of unknown cause) orthostatic intolerance, is a syndrome of orthostatic intolerance in younger patients. Various symptoms (eg, fatigue, light-headedness, exercise intolerance, cognitive impairment) and tachycardia occur with standing; however, there is little or no fall in blood pressure. The reason for symptoms is unclear.
Orthostatic hypotension may be acute or chronic, as well as symptomatic or asymptomatic. Common symptoms include dizziness, lightheadedness, blurred vision, weakness, fatigue, nausea, palpitations, and headache. Less common symptoms include syncope, dyspnea, chest pain, and neck and shoulder pain. Causes include dehydration or blood loss; disorders of the neurologic, cardiovascular, or endocrine systems; and several classes of medications.
Evaluation of suspected orthostatic hypotension begins by identifying reversible causes and underlying associated medical conditions.
ECG, serum electrolytes (sodium, potassium, chloride, calcium etc.) and glucose are routinely checked. However, these and other tests are usually of little benefit unless suggested by specific symptoms.
Autonomic function can be evaluated with 24 hour monitoring of pulse and blood pressure (Holter monitor) to check if there is actual significant drop in blood pressure and the concomitant variations in pulse.
Tilt table testing may be done; it can aid in confirming a diagnosis of suspected orthostatic hypotension when standard orthostatic vital signs do not reveal any diagnosis; it also can aid in assessing treatment response in patients with an autonomic disorder (the autonomic nervous system is the branch of the nervous system responsible for the non-voluntary functions like heartbeat, respiration, blood vessel contraction/dilation etc.). During a tilt table test, the patient lies down on a table that moves from a horizontal to a vertical position. Heart rate and blood pressure are monitored and recorded throughout the tilt table test.
Treatment aims to improve hypotension, relieve orthostatic symptoms, and improve standing time. Treatment includes correcting reversible causes (if present) and discontinuing responsible medications, when possible.
Non-pharmacologic treatment:
Patients are advised to avoid large carbohydrate-rich meals (to prevent postprandial hypotension), limit alcohol intake, and ensure adequate hydration. Keep a symptom diary to record and avoid identified precipitating factors is a useful practice. Sodium consumption should be increased by adding extra salt to food. Lower-extremity and abdominal binders may be beneficial.
Special exercises can improve conditioning and teach physical maneuvers to avoid orthostatic hypotension. Patients are instructed to actively stand with legs crossed, with or without leaning forward. Squatting has been used to alleviate symptomatic orthostatic hypotension. Other maneuvers include isometric exercises involving the arms, legs, and abdominal muscles during positional changes or prolonged standing. Toe raises, thigh contractions, and bending over at the waist are recommended.
For patients who do not respond adequately to non-pharmacologic treatment, fludrocortisone (a steroid), midodrine (a vasopressor/antihypotensive agent), and pyridostigmine are pharmacologic therapies proven to be beneficial.
Postural orthostatic tachycardia syndrome (POTS), also called postural autonomic tachycardia or chronic or idiopathic (of unknown cause) orthostatic intolerance, is a syndrome of orthostatic intolerance in younger patients. Various symptoms (eg, fatigue, light-headedness, exercise intolerance, cognitive impairment) and tachycardia occur with standing; however, there is little or no fall in blood pressure. The reason for symptoms is unclear.
Orthostatic hypotension may be acute or chronic, as well as symptomatic or asymptomatic. Common symptoms include dizziness, lightheadedness, blurred vision, weakness, fatigue, nausea, palpitations, and headache. Less common symptoms include syncope, dyspnea, chest pain, and neck and shoulder pain. Causes include dehydration or blood loss; disorders of the neurologic, cardiovascular, or endocrine systems; and several classes of medications.
Evaluation of suspected orthostatic hypotension begins by identifying reversible causes and underlying associated medical conditions.
ECG, serum electrolytes (sodium, potassium, chloride, calcium etc.) and glucose are routinely checked. However, these and other tests are usually of little benefit unless suggested by specific symptoms.
Autonomic function can be evaluated with 24 hour monitoring of pulse and blood pressure (Holter monitor) to check if there is actual significant drop in blood pressure and the concomitant variations in pulse.
Tilt table testing may be done; it can aid in confirming a diagnosis of suspected orthostatic hypotension when standard orthostatic vital signs do not reveal any diagnosis; it also can aid in assessing treatment response in patients with an autonomic disorder (the autonomic nervous system is the branch of the nervous system responsible for the non-voluntary functions like heartbeat, respiration, blood vessel contraction/dilation etc.). During a tilt table test, the patient lies down on a table that moves from a horizontal to a vertical position. Heart rate and blood pressure are monitored and recorded throughout the tilt table test.
Treatment aims to improve hypotension, relieve orthostatic symptoms, and improve standing time. Treatment includes correcting reversible causes (if present) and discontinuing responsible medications, when possible.
Non-pharmacologic treatment:
Patients are advised to avoid large carbohydrate-rich meals (to prevent postprandial hypotension), limit alcohol intake, and ensure adequate hydration. Keep a symptom diary to record and avoid identified precipitating factors is a useful practice. Sodium consumption should be increased by adding extra salt to food. Lower-extremity and abdominal binders may be beneficial.
Special exercises can improve conditioning and teach physical maneuvers to avoid orthostatic hypotension. Patients are instructed to actively stand with legs crossed, with or without leaning forward. Squatting has been used to alleviate symptomatic orthostatic hypotension. Other maneuvers include isometric exercises involving the arms, legs, and abdominal muscles during positional changes or prolonged standing. Toe raises, thigh contractions, and bending over at the waist are recommended.
For patients who do not respond adequately to non-pharmacologic treatment, fludrocortisone (a steroid), midodrine (a vasopressor/antihypotensive agent), and pyridostigmine are pharmacologic therapies proven to be beneficial.
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