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Orthostatic hypotension
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==Signs and symptoms== Orthostatic hypotension is characterized by symptoms that occur after standing (from lying or sitting), particularly when done rapidly. Many report [[presyncope|lightheadedness]] (a feeling that one might be about to faint), sometimes [[Presyncope|severe]], or even actual [[syncope (medicine)|fainting]] with associated [[Falling (accident)|fall]] risk.<ref>{{cite journal | vauthors = Shaw BH, Borrel D, Sabbaghan K, Kum C, Yang Y, Robinovitch SN, Claydon VE | title = Relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residents | journal = BMC Geriatrics | volume = 19 | issue = 1 | pages = 80 | date = March 2019 | pmid = 30866845 | pmc = 6415493 | doi = 10.1186/s12877-019-1082-6 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Mol A, Bui Hoang PT, Sharmin S, Reijnierse EM, van Wezel RJ, Meskers CG, Maier AB | title = Orthostatic Hypotension and Falls in Older Adults: A Systematic Review and Meta-analysis | journal = Journal of the American Medical Directors Association | volume = 20 | issue = 5 | pages = 589โ597.e5 | date = May 2019 | pmid = 30583909 | doi = 10.1016/j.jamda.2018.11.003 | hdl = 1871.1/3c04fc8f-8520-4a7e-bf5c-8ba541a61acb | s2cid = 57898094 | url = https://research.vu.nl/ws/files/101284496/Orthostatic_Hypotension_and_Falls_in_Older_Adults.pdf }}</ref><ref name="pmid21438868"/> With chronic orthostatic hypotension, the condition and its effects may worsen even as fainting and many other symptoms become less frequent. Generalized weakness or tiredness may also occur. Some also report difficulty concentrating, [[blurred vision]], tremulousness, [[vertigo]], [[anxiety]], [[palpitations]] (awareness of the heartbeat), [[ataxia|unsteadiness]], feeling sweaty or clammy, and sometimes [[nausea]]. A person may look [[Pallor|pale]].<ref>{{cite book |vauthors=Kasper DL, Fauci AS, Hauser SL, Longo DL, James JL, Loscalzo J |title=Harrison's principles of internal medicine |publisher=McGraw-Hill Medical Publishing Division |location=New York |year=2015 |edition=19th |isbn=978-0-07-180215-4 | volume=2 | page=2639}}</ref> Some people may experience severe orthostatic hypotension with the only symptoms being confusion or extreme fatigue. Chronic severe orthostatic hypotension may present as fluctuating cognition/[[delirium]]. {{citation needed|date=October 2021}} Women who are pregnant are also susceptible to orthostatic hypotension.<ref>{{cite journal | vauthors = Miyake Y, Ohnishi M, Fujii TK, Yamamoto T, Yoneda C, Takahashi S, Ichimaru Y | title = The effects of postural changes of baroreflex gain in normal and hypertensive pregnancies | journal = Clinical and Experimental Hypertension | volume = 24 | issue = 1โ2 | pages = 23โ31 | date = 2002-01-01 | pmid = 11848166 | doi = 10.1081/CEH-100108712 | s2cid = 777855 }}</ref><ref>{{cite journal | vauthors = Lucini D, Mela GS, Malliani A, Pagani M | title = Impairment in cardiac autonomic regulation preceding arterial hypertension in humans: insights from spectral analysis of beat-by-beat cardiovascular variability | journal = Circulation | volume = 106 | issue = 21 | pages = 2673โ2679 | date = November 2002 | pmid = 12438292 | doi = 10.1161/01.CIR.0000039106.89299.AB | s2cid = 9826957 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Easterling TR, Schmucker BC, Benedetti TJ | title = The hemodynamic effects of orthostatic stress during pregnancy | journal = Obstetrics and Gynecology | volume = 72 | issue = 4 | pages = 550โ552 | date = October 1988 | pmid = 3419734 | url = https://pubmed.ncbi.nlm.nih.gov/3419734 }}</ref><ref>{{cite journal | vauthors = Brooks VL, Dampney RA, Heesch CM | title = Pregnancy and the endocrine regulation of the baroreceptor reflex | journal = American Journal of Physiology. Regulatory, Integrative and Comparative Physiology | volume = 299 | issue = 2 | pages = R439โR451 | date = August 2010 | pmid = 20504907 | pmc = 2928618 | doi = 10.1152/ajpregu.00059.2010 }}</ref> ===Associated diseases=== The disorder may be associated with [[Addison's disease]], [[atherosclerosis]] (build-up of fatty deposits in the arteries), [[diabetes]], [[pheochromocytoma]], [[porphyria]],<ref name=pmid497968>{{cite journal | vauthors = Sim M, Hudon R | title = Acute intermittent porphyria associated with postural hypotension | journal = Canadian Medical Association Journal | volume = 121 | issue = 7 | pages = 845โ846 | date = October 1979 | pmid = 497968 | pmc = 1704473 }}</ref> [[long COVID]],<ref>{{Cite journal |last=Lee |first=Cassie |last2=Greenwood |first2=Darren C. |last3=Master |first3=Harsha |last4=Balasundaram |first4=Kumaran |last5=Williams |first5=Paul |last6=Scott |first6=Janet T. |last7=Wood |first7=Conor |last8=Cooper |first8=Rowena |last9=Darbyshire |first9=Julie L. |last10=Gonzalez |first10=Ana Espinosa |last11=Davies |first11=Helen E. |last12=Osborne |first12=Thomas |last13=Corrado |first13=Joanna |last14=Iftekhar |first14=Nafi |last15=Rogers |first15=Natalie |date=1 March 2024 |title=Prevalence of orthostatic intolerance in long covid clinic patients and healthy volunteers: A multicenter study |url=https://onlinelibrary.wiley.com/doi/10.1002/jmv.29486 |journal=Journal of Medical Virology |language=en |volume=96 |issue=3 |doi=10.1002/jmv.29486 |issn=0146-6615}}</ref><ref>{{Cite journal |date=24 September 2024 |title=Is long COVID linked with orthostatic intolerance? |url=https://evidence.nihr.ac.uk/alert/is-long-covid-linked-with-orthostatic-intolerance/ |journal=NIHR Evidence}}</ref> and certain [[neurology|neurological]] disorders, including [[autoimmune autonomic ganglionopathy]], [[multiple system atrophy]], and other forms of [[dysautonomia]]. It is also associated with [[EhlersโDanlos syndrome]] and [[anorexia nervosa]]. It is also present in many patients with [[Parkinson's disease]] or [[Lewy body dementias]] resulting from sympathetic denervation of the heart or as a side effect of dopaminomimetic therapy. This rarely leads to [[Syncope (medicine)|fainting]] unless the person has developed true [[autonomic nervous system|autonomic]] failure or has an unrelated heart problem.{{citation needed|date=October 2016}} Another disease, [[dopamine beta hydroxylase deficiency]], also thought to be underdiagnosed, causes loss of sympathetic noradrenergic function and is characterized by low or extremely low levels of norepinephrine, but an excess of dopamine.<ref>{{cite book | vauthors = Robertson D, Garland EM | chapter = Dopamine Beta-Hydroxylase Deficiency | date = September 2003 | pmid = 20301647 | chapter-url = https://www.ncbi.nlm.nih.gov/books/NBK1474/ | publisher = University of Washington, Seattle | veditors = Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJ, Stephens K, Amemiya A | title = GeneReviews | via = NCBI Bookshelf }}</ref> Quadriplegics and paraplegics also might experience these symptoms due to multiple systems' inability to maintain normal blood pressure and blood flow to the upper part of the body.{{citation needed|date=October 2016}}
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