scholarly journals Classical and Delayed Orthostatic Hypotension in Patients With Unexplained Syncope and Severe Orthostatic Intolerance

2020 ◽  
Vol 7 ◽  
Author(s):  
Parisa Torabi ◽  
Fabrizio Ricci ◽  
Viktor Hamrefors ◽  
Richard Sutton ◽  
Artur Fedorowski
Keyword(s):  
Orthostatic Hypotension ◽  
Orthostatic Intolerance ◽  
Unexplained Syncope

Orthostatic intolerance: orthostatic hypotension and postural orthostatic tachycardia syndrome

ESC CardioMed ◽  
2018 ◽  
pp. 2032-2037
Author(s):  
Artur Fedorowski
Keyword(s):  
Orthostatic Hypotension ◽  
Orthostatic Intolerance ◽  
Wide Spectrum ◽  
Standing Position ◽  
Diagnostic Methods ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Unexplained Syncope ◽  
Clinical Variants ◽  
Age Range ◽  
Specific Symptoms

The impairment of adaptive mechanisms during orthostatic challenge may evoke orthostatic intolerance, a heterogeneous condition, in which the standing position elicits a fall in blood pressure and/or excessive tachycardia, accompanied by a wide spectrum of subjective symptoms such as dizziness, discomfort, nausea, and palpitations. Apart from chronic and potentially debilitating symptoms, orthostatic intolerance may occasionally lead to sudden loss of consciousness and fall injuries. Consequently, orthostatic intolerance should be considered as a possible cause of unexplained syncope. Two main forms of orthostatic intolerance are orthostatic hypotension (OH) and postural orthostatic tachycardia syndrome (POTS). Clinical variants of OH include initial, classical, and delayed forms. The prevalence of OH increases with age, ranging from less than 5% under 40 years to about 20% above 70 years of age, and is higher in chronic diseases, such as hypertension and diabetes, reaching above 35% in Parkinson’s disease and advanced kidney failure. The presence of OH is associated with a higher mortality and an increased incidence of cardiovascular disease, with the majority of patients being asymptomatic in normal conditions. In contrast, POTS affects predominantly young women (70–80%) within an age range of 15–40 years and is usually accompanied by non-specific symptoms: deconditioning, headache, cognitive impairment, and gastrointestinal dysfunction. Management of orthostatic intolerance includes both non-pharmacological and pharmacological methods with limited efficacy in the severe cases. Empirical treatment with vasoactive and volume expanding drugs for OH and POTS, and rhythm controlling therapy for POTS are recommended. Future studies on syndromes of orthostatic intolerance should focus on mechanisms leading to OH and POTS, novel diagnostic methods, and more effective therapeutic options.

Orthostatic intolerance: orthostatic hypotension and postural orthostatic tachycardia syndrome

ESC CardioMed ◽  
2018 ◽  
pp. 2032-2037
Author(s):  
Artur Fedorowski
Keyword(s):  
Orthostatic Hypotension ◽  
Orthostatic Intolerance ◽  
Wide Spectrum ◽  
Standing Position ◽  
Diagnostic Methods ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Unexplained Syncope ◽  
Clinical Variants ◽  
Age Range ◽  
Specific Symptoms

The impairment of adaptive mechanisms during orthostatic challenge may evoke orthostatic intolerance, a heterogeneous condition, in which the standing position elicits a fall in blood pressure and/or excessive tachycardia, accompanied by a wide spectrum of subjective symptoms such as dizziness, discomfort, nausea, and palpitations. Apart from chronic and potentially debilitating symptoms, orthostatic intolerance may occasionally lead to sudden loss of consciousness and fall injuries. Consequently, orthostatic intolerance should be considered as a possible cause of unexplained syncope. Two main forms of orthostatic intolerance are orthostatic hypotension (OH) and postural orthostatic tachycardia syndrome (POTS). Clinical variants of OH include initial, classical, and delayed forms. The prevalence of OH increases with age, ranging from less than 5% under 40 years to about 20% above 70 years of age, and is higher in chronic diseases, such as hypertension and diabetes, reaching above 35% in Parkinson’s disease and advanced kidney failure. The presence of OH is associated with a higher mortality and an increased incidence of cardiovascular disease, with the majority of patients being asymptomatic in normal conditions. In contrast, POTS affects predominantly young women (70–80%) within an age range of 15–40 years and is usually accompanied by non-specific symptoms: deconditioning, headache, cognitive impairment, and gastrointestinal dysfunction. Management of orthostatic intolerance includes both non-pharmacological and pharmacological methods with limited efficacy in the severe cases. Empirical treatment with vasoactive and volume expanding drugs for OH and POTS, and rhythm controlling therapy for POTS are recommended. Future studies on syndromes of orthostatic intolerance should focus on mechanisms leading to OH and POTS, novel diagnostic methods, and more effective therapeutic options.

scholarly journals Severe orthostatic hypotension in otherwise uncomplicated Plasmodium vivax infection

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Chaisith Sivakorn ◽  
Polrat Wilairatana ◽  
Srivicha Krudsood ◽  
Marcus J. Schultz ◽  
Tachpon Techarang ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Orthostatic Hypotension ◽  
Plasmodium Vivax ◽  
Falciparum Malaria ◽  
Fluid Resuscitation ◽  
Orthostatic Intolerance ◽  
Parasite Clearance ◽  
Chain Reaction ◽  
Thai Woman ◽  
Polymerase Chain

AbstractImpaired autonomic control of postural homeostasis resulting in orthostatic hypotension has been described in falciparum malaria. However, severe orthostatic intolerance in Plasmodium vivax has been rarely reported. A case of non-immune previously healthy Thai woman presenting with P. vivax infection with well-documented orthostatic hypotension is described. In addition to oral chloroquine and intravenous artesunate, the patient was treated with fluid resuscitation and norepinephrine. During hospitalization, her haemodynamic profile revealed orthostatic hypotension persisting for another three days after microscopic and polymerase chain reaction confirmed parasite clearance. Potential causes are discussed.

scholarly journals Initial orthostatic hypotension and orthostatic intolerance symptom prevalence in older adults: A systematic review

2021 ◽  
Vol 8 ◽  
pp. 100071
Author(s):  
Elena M. Christopoulos ◽  
Jennifer Tran ◽  
Sarah L. Hillebrand ◽  
Peter W. Lange ◽  
Rebecca K. Iseli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Orthostatic Hypotension ◽  
Orthostatic Intolerance ◽  
Symptom Prevalence ◽  
Initial Orthostatic Hypotension

scholarly journals Cardiovascular risk after hospitalisation for unexplained syncope and orthostatic hypotension

Heart ◽  
2017 ◽  
Vol 104 (6) ◽  
pp. 487-493 ◽  
Author(s):  
Ekrem Yasa ◽  
Fabrizio Ricci ◽  
Martin Magnusson ◽  
Richard Sutton ◽  
Sabina Gallina ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Orthostatic Hypotension ◽  
Cardiovascular Events ◽  
Hospital Admissions ◽  
Cox Regression ◽  
All Cause Mortality ◽  
Unexplained Syncope ◽  
The Impact

ObjectiveTo investigate the relationship of hospital admissions due to unexplained syncope and orthostatic hypotension (OH) with subsequent cardiovascular events and mortality.MethodsWe analysed a population-based prospective cohort of 30 528 middle-aged individuals (age 58±8 years; males, 40%). Adjusted Cox regression models were applied to assess the impact of unexplained syncope/OH hospitalisations on cardiovascular events and mortality, excluding subjects with prevalent cardiovascular disease.ResultsAfter a median follow-up of 15±4 years, 524 (1.7%) and 504 (1.7%) participants were hospitalised for syncope or OH, respectively, yielding 1.2 hospital admissions per 1000 person-years for each diagnosis. Syncope hospitalisations increased with age (HR, per 1 year: 1.07, 95% CI 1.05 to 1.09), higher systolic blood pressure (HR, per 10 mm Hg: 1.06, 95% CI 1.01 to 1.12), antihypertensive treatment (HR: 1.26, 95% CI 1.00 to 1.59), use of diuretics (HR: 1.77, 95% CI 1.31 to 2.38) and prevalent cardiovascular disease (HR: 1.59, 95% CI 1.14 to 2.23), whereas OH hospitalisations increased with age (HR: 1.11, 95% CI 1.08 to 1.12) and prevalent diabetes (HR: 1.82, 95% CI 1.23 to 2.70). After exclusion of 1399 patients with prevalent cardiovascular disease, a total of 473/464 patients were hospitalised for unexplained syncope/OH before any cardiovascular event. Hospitalisation for unexplained syncope predicted coronary events (HR: 1.85, 95% CI 1.49 to 2.30), heart failure (HR: 2.24, 95% CI 1.65 to 3.04), atrial fibrillation (HR: 1.84, 95% CI 1.50 to 2.26), aortic valve stenosis (HR: 2.06, 95% CI 1.28 to 3.32), all-cause mortality (HR: 1.22, 95% CI 1.09 to 1.37) and cardiovascular death (HR: 1.72, 95% CI 1.23 to 2.42). OH-hospitalisation predicted stroke (HR: 1.66, 95% CI 1.24 to 2.23), heart failure (HR: 1.78, 95% CI 1.21 to 2.62), atrial fibrillation (HR: 1.89, 95% CI 1.48 to 2.41) and all-cause mortality (HR: 1.14, 95% CI 1.01 to 1.30).ConclusionsPatients discharged with the diagnosis of unexplained syncope or OH show higher incidence of cardiovascular disease and mortality with only partial overlap between these two conditions.

Orthostatic Hypotension and Orthostatic Intolerance

Endocrinology ◽  
2010 ◽  
pp. 2063-2082
Author(s):  
Christopher J. Mathias ◽  
Gianluigi Galizia
Keyword(s):  
Orthostatic Hypotension ◽  
Orthostatic Intolerance

scholarly journals Mechanisms of sympathetic regulation in orthostatic intolerance

2012 ◽  
Vol 113 (10) ◽  
pp. 1659-1668 ◽  
Author(s):  
Julian M. Stewart
Keyword(s):  
Quality Of Life ◽  
Orthostatic Hypotension ◽  
Blood Volume ◽  
Orthostatic Intolerance ◽  
Daily Life ◽  
Bipedal Stance ◽  
Sympathetic Regulation ◽  
Circulatory Control ◽  
Regional Blood Volume

Sympathetic circulatory control is key to the rapid cardiovascular adjustments that occur within seconds of standing upright (orthostasis) and which are required for bipedal stance. Indeed, patients with ineffective sympathetic adrenergic vasoconstriction rapidly develop orthostatic hypotension, prohibiting effective upright activities. One speaks of orthostatic intolerance (OI) when signs, such as hypotension, and symptoms, such as lightheadedness, occur when upright and are relieved by recumbence. The experience of transient mild OI is part of daily life. However, many people experience episodic acute OI as postural faint or chronic OI in the form of orthostatic tachycardia and orthostatic hypotension that significantly reduce the quality of life. Potential mechanisms for OI are discussed including forms of sympathetic hypofunction, forms of sympathetic hyperfunction, and OI that results from regional blood volume redistribution attributable to regional adrenergic hypofunction.

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