Orthostatic Hypotension

Orthostatic Hypotension or Postural Hypotension (Coat Hanger Pain) is a form of arterial hypotension in which blood pressure drops sharply when the body position changes from a sitting or lying position to a standing position. The patient experiences dizziness or a feeling of emptiness in the head and may even faint. Sometimes similar conditions occur after trauma to the spinal cord.

When a person stands up abruptly, a large amount of blood enters the vessels of the lower extremities. Its volume can reach one liter. In this case, venous return decreases cardiac output decreases, which causes hypotension. This is a normal physiological process that occurs even in healthy people. The sympathetic nervous system is responsible for normalizing pressure when changing body position. A person’s pulse reflexively increases vascular tone increases. Thanks to this, the pressure immediately returns to normal. When taking an upright position, the pathological signs characteristic of hypotension do not appear or go away almost imperceptibly in healthy people. If a person stays in the supine position for a long time, the production of vasopressin increases due to natural compensation mechanisms. Its effect helps to increase the volume of circulating blood.

This disease is often mild, appears after the transition to an upright position, and persists from several seconds to several minutes. Mild orthostatic hypotension often does not require treatment. Many people occasionally experience vertigo or emptiness after standing up, which is usually not a reason for concern. This disease may indicate more serious problems, so if you often feel dizzy when standing up, you should consult your doctor. If episodes of loss of consciousness appear, even if they last for a few seconds, or if Hanger Pain is present, you should go to the clinic as soon as possible.

Treatment for more severe cases depends on the reason.

Postural Hypotension Signs and Symptoms

When a person stands up abruptly, a large amount of blood enters the vessels of the lower extremities. Its volume can reach one liter. In this case, venous return decreases cardiac output decreases, which causes hypotension. This is a normal physiological process that occurs even in healthy people. 

• The sympathetic nervous system is responsible for normalizing pressure when changing body position. 

• A person’s pulse reflexively increases vascular tone increases. Thanks to this, the pressure immediately returns to normal. 

• When taking an upright position, the pathological signs characteristic of hypotension do not appear or go away almost imperceptibly in healthy people. If a person stays in the supine position for a long time, the production of vasopressin increases due to natural compensation mechanisms. Its effect helps to increase the volume of circulating blood.

The most common symptom of orthostatic hypotension is a feeling of emptiness or vertigo when standing upright from a sitting or lying position. This sensation, like other symptoms, usually occurs immediately after standing up and usually lasts for a few seconds.

Postural hypotension symptoms:

• Feeling empty or dizzy right after getting up
• Blurred vision
• Weakness
• Loss of consciousness (fainting)
• Confusion of consciousness
• Nausea

• With severe symptoms or trauma to the spinal cord, the patient may fall due to loss of balance. 
• In some people, seizures are added to this symptomatology. As a rule, the manifestations of pressure fluctuations are more pronounced after a large meal or exercise. 
• The duration of symptoms depends on the severity of the condition. In some patients, signs of impaired pressure regulation last several minutes; for others, everything goes away in seconds. 
• The patient has to take a horizontal position in severe cases, as he does not feel well when standing.

Orthostatic Hypotension Causes

Depending on the causes of this condition, the following forms of hypotension are distinguished.

• Primary. This is a special form of neurosis-like disease of the vasomotor centers of the brain. The main causes of primary hypotension: severe stress, prolonged emotional stress.

• Secondary. It is often a concomitant pathology in certain thyroid gland diseases, hepatitis, anemia, tumor diseases, gastric ulcer, tuberculosis, rheumatism, cirrhosis of the liver, brain injuries, and taking several medications, etc.

Often, orthostatic hypotension is a sign of vegetative-vascular dystonia of the state of the body, which is characterized by a violation of the activity of the autonomic nervous system, which regulates the work of organs. This can lead to a dysregulation of the cardiovascular system of the nervous and endocrine systems, and, accordingly, to a violation of heart rate, thermoregulation, a decrease in vascular tone, etc. develops due to hormonal disruptions, neuroses, severe stress, and psychological trauma, exposure to harmful occupational factors, alcohol abuse.

Postural hypotension can also develop in healthy people, such as athletes with regular exercise. In this case, low blood pressure acts as a kind of protective reaction of the body. A sudden change in climatic or weather conditions, an increase in humidity, the action of electromagnetic fields, radiation, etc., can also lead to a decrease in pressure. 

Complications of Orthostatic Hypotension

Often, rare cases of hypotension, manifested by weakness, lethargy, nausea, and other no more than unpleasant symptoms, are not accompanied by fatal consequences for the body. They only reason discomfort and reduce performance. However, constant or systematic lowering of blood pressure can negatively affect the work of the heart. Therefore, orthostatic hypotension treatment is required.

• Cardiac manifestations. People with hypotension are at increased risk of serious cardiovascular problems. A fast pulse means that the heart is working intensively. This is a kind of compensatory mechanism to provide tissues with oxygen, which is not enough due to the slow movement of blood through the vessels with low tone. However, a fast pulse is a serious strain on the heart.

• Hypotension and pregnancy. Postural hypotension during pregnancy is a reason to see your doctor. If the expectant mother has systematic low blood pressure, this can lead to oxygen starvation of the fetus due to poor oxygen supply to the placenta. This, in turn, threatens disruptions in the unborn baby’s development. It was found that pregnant women with low blood pressure more often and more severely experience toxicosis and gestosis. Changes in pressure during pregnancy are often difficult to detect. Fatigue, weakness, nausea, and other signs of hypotension are often confused with the characteristic symptoms of pregnancy provoked by hormonal imbalance.

It is important to say that a sharp and sudden drop in pressure with a deterioration in well-being may indicate intense internal bleeding, heart attack, and other internal problems that threaten a person’s life. In such cases, you should immediately consult a doctor.

When Should You See a Doctor for Coat Hanger Pain?

Occasional dizziness or a feeling of emptiness in the head may be relatively mild and may result from mild dehydration, low blood sugar, prolonged exposure to the sun, or, for example, a hot bath. Dizziness or emptiness in the head may also occur when standing up after sitting for a long time, such as at a lecture, concert, or church service. If these symptoms are episodic, they usually do not represent a cause for concern.

• If symptoms of orthostatic hypotension are frequent, it is important to consult a doctor. They may indicate a more serious disorder in some cases, especially if Hanger Pain is present. It is useful to keep a special diary to record the time of the onset of symptoms, their duration, and their actions when they appeared. 

• If symptoms occur frequently enough to be dangerous for you and those around you, you should consult your doctor.

Patients may experience a significant increase in heart rate. This phenomenon is called postural tachycardia. The heart rate increases to 120 or more beats per minute. If in a person, when changing the body’s position, the pulse accelerates by more than 30 beats, then this is also postural tachycardia. In some patients, an increase in heart rate is accompanied by dizziness and weakness, but the pressure is reduced slightly or remains normal. Experts have not yet figured out what caused this condition.

Orthostatic Hypotension Diagnosis     

To diagnose hypotension, a general practitioner performs several steps:

• carefully collects complaints, analyzes the description of each of the symptoms of hypotension;
• finds out if there is a hereditary predisposition, negative factors, etc.
• examines the patient and listens to the heart and lungs;
• performs a thorough three-time pressure measurement, and, if necessary, sets pressure monitoring for a week or more, daily pressure monitoring;
• gives a referral to a cardiologist, neurologist or endocrinologist;
• analyzes the conclusion on the composition of blood and urine, which includes a general and biochemical analysis, a blood test for glucose levels, protein spectrum, ionic composition;
• determines the level of catecholamines in the urine and blood, the endocrine profile;
• directs to ultrasound of the heart, electrocardiography;
• conducts stress tests.

In some cases, additional CT or MRI of the head, ultrasound of the kidneys, adrenal glands, and thyroid gland are performed before treatment.

Treatment of the Orthostatic Hypotension

To eliminate the pressure drop when changing the body’s position, you need to act on the disease that led to a similar condition. Treatment of pathology is divided into medication and non-medication. The patient will have to reconsider their habits.

• First of all, it is necessary to normalize the drinking regimen, provide moderate physical activity, and give up alcohol.

• Physical activity improves vascular health and has a positive effect on blood circulation.

• If the patient had to constantly adhere to bed rest, it is undesirable to spend all the time lying down. It is necessary to get up periodically or just sit down.

• For older patients, it is recommended to sleep with a raised headboard. It is important to provide the body with the right amount of sodium, increasing fluid volume inside the vessels. To do this, you need to take sodium supplements or increase the amount of salt in the diet. This option has contraindications if the patient has heart or kidney problems. Excess sodium in the diet leads to edema.

• People who have orthostatic hypotension caused by excessive carbohydrate or heavy food intake should reconsider their diet. It is essential to reduce the number of foods high in carbohydrates and food in general. After eating, you need to get up smoothly, avoid sudden movements.

• It is also recommended to wear elastic stockings, due to which venous return is increased.

If non-drug treatment has failed, the doctor will prescribe medication. Drug therapy is possible only as directed by a doctor since drugs have contraindications and can cause side reactions.

FAQ    

• What is orthostatic hypotension?

Orthostatic hypotension manifests itself when the position of the body changes, which causes a sharp drop in blood pressure. The frequent manifestation of such conditions is not the norm.

• How to detect orthostatic hypotension?

In order to determine the presence of orthostatic hypotension, you need to measure the pressure. A strong decrease in blood pressure when standing up is an indication of abnormal body behavior.

• Who Treats Orthostatic Hypotension?

This type of disorder in the human body is treated by a therapist and a cardiologist. If your blood pressure fluctuates frequently, see your doctor.

• What is the pressure with arterial hypotension?

Hypotension is low blood pressure in a person. Some people may have low blood pressure from birth.

• Which disease can cause weakness, pale skin, and dizziness?

These are symptoms of orthostatic hypotension, but in order to find out for sure, consult a doctor. Only a qualified doctor can make the correct diagnosis and prescribe treatment.