Orthostatic Hypotension: Circulatory Dynamics and Clinical Spectrum

To enhance the clinical evaluation of patients suffering from recurrent syncope of unknown origin, the integrity of mechanisms controlling blood pressure was examined in 151 patients utilizing a screening tilt test. Ninety-eight patients had an abnormal blood pressure and/or heart rate response to tilt testing, including provoked syncopal attacks in 63 patients. Whenever indicated, the screening tilt test was followed by blood volume and hemodynamic determinations, as well as autonomic nervous system testing to identify contributing pathophysiological abnormalities (hypovolemia, venous pooling, autonomic dysfunction). Detailed analysis of this battery of tests allowed us to conclude that: (1) The tilt test is commonly a provocative tool in the workup of patients with recurrent syncope due to vasovagal - vasodepressor reactions and other abnormalities of blood pressure regulation; (2) Its usefulness is augmented by associated hemodynamic and blood volume evaluations; (3) The identification of contributory pathophysiological mechanisms of blood pressure control facilitates specific therapeutic interventions.

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The Usefulness of Head‐Up Tilt Testing and Hemodynamic Investigations in the Workup of Syncope of Unknown Origin

Abi‐Samra

Maloney

Fouad‐Tarazi

et al. 1988

Pacing Clinical Electrophis

295

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Geometry of the Carotid Arteries and Tilt-up Hypotension in Subjects with Essential Arterial Hypertension

et al. 1996

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Dysfunction of the baroreceptor structures located in the carotid bulb is considered responsible for hypotensive responses to orthostatic posture in hypertensive subjects. Because of a recurrent vascular impairment in essential hypertensives, the authors hypothesized that in these cases the baroreceptive dysfunction could be related to some peculiar vascular disarrangement of the carotid arteries, at the level of the bulb. To test this, they compared two groups of mild essential hypertensives, divided into group A--15 subjects considered hyporeacting because of a decrease in mean blood pressure > or = 10 mmHg at the first minute of a passive orthostatic stress--and group B--15 subjects considered normoreacting because of an increase in mean blood pressure > or = 5 mmHg. They evaluated by high definition echo Doppler ultrasonography: (1) an arterial compliance index, (2) the volume of the carotid bulb, and (3) a score expressing the degree of arteriopathy at the level of the carotid arteries. In group A, results demonstrated a significant impairment of the carotid artery structure, expressed by an increase in volume of the carotid bulb (389.4 +/- 134.7 vs 233.2 +/- 116.5 mm3, P < 0.05) and a higher vascular score (2.7 vs 1, P < 0.001), while the index of arterial compliance was similar in the two groups. In conclusion, in mild essential hypertension a baroreceptor dysfunction could be strictly linked to a derangement of the carotid artery structure, while arterial compliance does not seem to involve the baroreceptor function.

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Malignant vasovagal syncope: prolonged asystole provoked by head-up tilt: Case report and review of diagnosis, pathophysiology, and therapy

Maloney

Jaeger

Fouad‐Tarazi

et al. 1988

Cleveland Clinic Journal of Medicine

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is a common clinical disorder that often escapes diagnosis; if the syncope is recurrent and severe (malignant vasovagal syncope), it can be a source of morbidity and possibly mortality. The authors report a 39-year-old patient with recurrent, unexplained syncope who underwent provocative head-up tilt testing that resulted in asystole for 73 seconds. In addition to vasovagal syncope, head-up tilt test also aids in the diagnosis and management of disorders of blood pressure and heart rate regulation. Management of recurrent vasovagal syncope is based upon the underlying pathophysiology and includes transdermal scopolamine, volume expansion, biofeedback, support stockings, and pacemakers (preferably AV sequential).

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Orthostatic Hypotension: Circulatory Dynamics and Clinical Spectrum

Cited by 4 publications

References 50 publications

The Usefulness of Head‐Up Tilt Testing and Hemodynamic Investigations in the Workup of Syncope of Unknown Origin

The Usefulness of Head‐Up Tilt Testing and Hemodynamic Investigations in the Workup of Syncope of Unknown Origin

Geometry of the Carotid Arteries and Tilt-up Hypotension in Subjects with Essential Arterial Hypertension

Malignant vasovagal syncope: prolonged asystole provoked by head-up tilt: Case report and review of diagnosis, pathophysiology, and therapy

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