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Symptoms and Signs - Differential Diagnosis of Orthostatic Hypotension
COMMON
• Medications: antihypertensives, antidepressants (tricyclics), antipsychotics (phenothiazines), alcohol, narcotics, barbiturates, insulin, nitrates
• Reduced intravascular volume (hemorrhage, dehydration, hyperglycemia, hypoalbuminemia)
• Postprandial effect (especially in the elderly)
• Vasovagal syncope
• Deconditioning
• Peripheral autonomic dysfunction (diabetes mellitus, Guillain- Barré syndrome)
UNCOMMON
• Central autonomic dysfunction (Shy-Drager syndrome)
• Postganglionic autonomic dysfunction: impaired norepinephrine release
• Autoimmune autonomic dysfunction: nicotinic acetylcholine receptor autoantibodies
• Paraneoplastic autonomic dysfunction: anti-Hu antibodies (in small cell lung cancer)
• Postural tachycardia syndrome (POTS): usually occurs in young women; an abnormally large increase in heart rate is observed in the upright position caused by increased venous pooling from autonomic dysfunction of the lower extremities, but blood pressure is not affected because of an excess of plasma norepinephrine.
• Impaired cardiac output
• Cerebrovascular accident
• Adrenal insufficiency
• Deconditioning
• Carotid sinus hypersensitivity
• Anxiety, panic attacks
• Seizures
• Idiopathic
COMMON
• Medications: antihypertensives, antidepressants (tricyclics), antipsychotics (phenothiazines), alcohol, narcotics, barbiturates, insulin, nitrates
• Reduced intravascular volume (hemorrhage, dehydration, hyperglycemia, hypoalbuminemia)
• Postprandial effect (especially in the elderly)
• Vasovagal syncope
• Deconditioning
• Peripheral autonomic dysfunction (diabetes mellitus, Guillain- Barré syndrome)
UNCOMMON
• Central autonomic dysfunction (Shy-Drager syndrome)
• Postganglionic autonomic dysfunction: impaired norepinephrine release
• Autoimmune autonomic dysfunction: nicotinic acetylcholine receptor autoantibodies
• Paraneoplastic autonomic dysfunction: anti-Hu antibodies (in small cell lung cancer)
• Postural tachycardia syndrome (POTS): usually occurs in young women; an abnormally large increase in heart rate is observed in the upright position caused by increased venous pooling from autonomic dysfunction of the lower extremities, but blood pressure is not affected because of an excess of plasma norepinephrine.
• Impaired cardiac output
• Cerebrovascular accident
• Adrenal insufficiency
• Deconditioning
• Carotid sinus hypersensitivity
• Anxiety, panic attacks
• Seizures
• Idiopathic
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