Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome

Freeman, Roy; Wieling, Wouter; Axelrod, Felicia B.; Benditt, David G.; Benarroch, Eduardo E.; Biaggioni, Italo; Cheshire, William P.; Chelimsky, Thomas C.; Cortelli, Pietro; Gibbons, Christopher H.; Goldstein, David S.; Hainsworth, R.; Hilz, Max J.; Jacob, Giris; Kaufmann, Horacio; Jordan, Jens; Lipsitz, Lewis A.; Levine, Benjamin D.; Low, Phillip A.; Mathias, Christopher J.; Raj, Satish R.; Robertson, David; Sandroni, Paola; Schatz, Irwin J.; Schondorff, Ron; Stewart, Julian M.; Dijk, J. Gert van

doi:10.1007/s10286-011-0119-5

Cited by 1,378 publications

(1,161 citation statements)

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“…Noteworthy is the large variability in orthostatic HR response in patients with typical syncope (20% demonstrated >30 bpm increase in HR by 3 minutes and 7% a 40 bpm increase). Our findings confirm the recent shift to requiring higher cutoff values of >40 bpm in pediatric and adolescent patients to make a diagnosis of POTS 16, 18. An important practical new finding is the observation that orthostatic blood pressure changes between supine, sitting, and standing were clinically trivial in all syncope groups and therefore deemed not useful in this setting.…”

Section: Discussionsupporting

confidence: 72%

“…The Phase 1 pathway recommended sitting heart rate and blood pressure with formal orthostatic vital signs using the American Autonomic Society guidelines of supine values at 1 and 3 minutes followed by standing values at 1 and 3 minutes 16. Each specific value was recorded in 40% to 76% of patients with typical syncope and in 75% to 94% of patients diagnosed with POTS.…”

Section: Resultsmentioning

confidence: 99%

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Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology

Paris

Toro‐Salazar

Gauthier

et al. 2016

JAHA

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BackgroundPediatric syncope is common. Cardiac causes are rarely found. We describe and assess a pragmatic approach to these patients first seen by a pediatric cardiologist in the New England region, using Standardized Clinical Assessment and Management Plans (SCAMPs).Methods and ResultsAmbulatory patients aged 7 to 21 years initially seen for syncope at participating New England Congenital Cardiology Association practices over a 2.5‐year period were evaluated using a SCAMP. Findings were iteratively analyzed and the care pathway was revised. The vast majority (85%) of the 1254 patients had typical syncope. A minority had exercise‐related or more problematic symptoms. Guideline‐defined testing identified one patient with cardiac syncope. Syncope Severity Scores correlated well between physician and patient perceived symptoms. Orthostatic vital signs were of limited use. Largely incidental findings were seen in 10% of ECGs and 11% of echocardiograms. The 10% returning for follow‐up, by design, reported more significant symptoms, but did not have newly recognized cardiac disease. Iterative analysis helped refine the approach.Conclusions SCAMP methodology confirmed that the vast majority of children referred to the outpatient pediatric cardiology setting had typical low‐severity neurally mediated syncope that could be effectively evaluated in a single visit using minimal resources. A simple scoring system can help triage patients into treatment categories. Prespecified criteria permitted the effective diagnosis of the single patient with a clear cardiac etiology. Patients with higher syncope scores still have a very low risk of cardiac disease, but may warrant attention.

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Section: Discussionsupporting

confidence: 72%

Section: Resultsmentioning

confidence: 99%

Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology

Paris

Toro‐Salazar

Gauthier

et al. 2016

JAHA

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“…Change in SBP or DBP from supine to standing was determined by taking the mean standing measure and subtracting the mean supine measure for either SBP or DBP. OH was defined using thresholds similar to the original consensus definition (ie, a decrease in either SBP or DBP of at least 20 or 10 mm Hg, respectively) 25, 26. We also determined systolic OH (on the basis of a decrease in SBP of at least 20 mm Hg alone) and diastolic OH (on the basis of a decrease in DBP of at least 10 mm Hg alone) as well as a severe OH subgroup meeting both criteria (a decrease in SBP of at least 20 mm Hg and a decrease in DBP of at least 10 mm Hg).…”

Section: Methodsmentioning

confidence: 99%

Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle‐Aged Adults

Juraschek

Daya

Appel

et al. 2018

JAHA

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BackgroundAlthough orthostatic hypotension (OH) is a well‐recognized manifestation of neuropathy and hypovolemia, its contribution to cardiovascular disease (CVD) risk is controversial.Methods and ResultsParticipants with OH, defined as a decrease in blood pressure (systolic ≥20 mm Hg or diastolic ≥10 mm Hg) from the supine to standing position, were identified during the first visit of the ARIC (Atherosclerosis Risk in Communities) Study (1987–1989) within 2 minutes of standing. All participants were followed up for the development of myocardial infarction, heart failure, stroke, fatal coronary heart disease (CHD), any CHD (combination of silent, nonfatal, and fatal CHD or cardiac procedures), and all‐cause mortality. Participants were assessed for carotid intimal thickness and plaque during the first visit. Detectable high‐sensitivity troponin T (≥5 ng/L) and elevated NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide; ≥100 pg/mL) were determined in blood collected during the second visit (1990–1992). All associations were adjusted for known CVD risk factors. In 9139 participants (57% women; 23% black; mean age, 54±5.7 years), 3% had OH. During follow‐up (median, 26 years), OH was associated with myocardial infarction (hazard ratio [HR], 1.88; 95% confidence interval [CI], 1.44–2.46), congestive heart failure (HR, 1.65; 95% CI, 1.34–2.04), stroke (HR, 1.83; 95% CI, 1.35–2.48), fatal CHD (HR, 2.77; 95% CI, 1.93–3.98), any CHD (HR, 2.00; 95% CI, 1.64–2.44), and all‐cause mortality (HR, 1.68; 95% CI, 1.45–1.95). OH was also associated with carotid intimal thickness (β, 0.05 mm; 95% CI, 0.04–0.07 mm), carotid plaque (odds ratio, 1.51; 95% CI, 1.18–1.93), detectable high‐sensitivity troponin T (odds ratio, 1.49; 95% CI, 1.16–1.93), and elevated NT‐proBNP (odds ratio, 1.92; 95% CI, 1.48–2.49).Conclusions OH identified in community‐dwelling middle‐aged adults was associated with future CVD events and subclinical CVD. Further research is necessary to establish a causal role for OH in the pathogenesis of CVD.

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“…и/или диастоличе-ского -не менее чем на 10 мм рт.ст. свидетельствует о наличии ОГ [19]. У пациентов с ДТЛ падение АД при стоянии сохраняется в течение длительного пе-риода времени [20].…”

Section: диагностика ог при дтлunclassified

“…ОГ диагностируется при сни-жении систолического АД на 20 мм рт.ст., диастоли-ческого -на 10 мм рт.ст. при смене положения тела из горизонтального в вертикальное [19]. Распро-страненность ее в общей популяции среди лиц стар-ше 50 лет составляет 5%, среди лиц старше 70 лет -30%.…”

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Orthostatic hypotension in dementia with Lewy bodies

Чимагомедова¹,

Левин²

2016

Z. nevrol. psikhiatr. im. S.S. Korsakova

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ГБОУ ДПО «Российская медицинская академия последипломного образования», Москва, Россия В обзоре рассматриваются особенности проявления ортостатической гипотензии при деменции с тельцами Леви и методы ее диагностики. Ранняя диагностика данных нарушений позволит предотвратить такие нежелательные последствия, как падения и обмороки, улучшить повседневную деятельность и повысить качество жизни пациентов. анализируются современные подходы к коррекции данного состояния. The features of orthostatic hypotension in patients with dementia with Lewy bodies are considered. The early diagnosis of these disorders could prevent adverse conditions (falls and syncopes), improve activities of daily living and quality-of-life. Current approaches to treatment of orthostatic hypotension are analyzed.

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Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome

Cited by 1,378 publications

References 0 publications

Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology

Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology

Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle‐Aged Adults

Orthostatic hypotension in dementia with Lewy bodies

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