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07-SEPTEMBER-2008 03:17:44 - Hypotension Hypotension Classification and external resources ICD-10 I95. ICD-9 458 DiseasesDB 6539 MedlinePlus 007278 MeSH D007022 In physiology and medicine, hypotension refers to an abnormally low blood pressure. This is best understood as a physiologic state, rather than a disease. It is often associated with shock, though not necessarily indicative of it. Hypotension is the opposite of hypertension, which is high blood pressure. Hypotension can be life-threatening. Contents 1 Normal physiology 2 Mechanisms and causes 3 Syndromes 4 Indicators 5 Symptoms 6 Treatment 7 References Normal physiology Blood pressure is continuously regulated by the autonomic nervous system, using an elaborate network of receptors, nerves, and hormones to balance the effects of the sympathetic nervous system, which tends to raise blood pressure, and the parasympathetic nervous system, which lowers it. The vast and rapid compensation abilities of the autonomic nervous system allow normal individuals to maintain an acceptable blood pressure over a wide range of activities and in many disease states. Mechanisms and causes Reduced blood volume, called hypovolemia, is the most common mechanism producing hypotension. This can result from hemorrhage, or blood loss; insufficient fluid intake, as in starvation; or excessive fluid losses from diarrhea or vomiting. Hypovolemia is often induced by excessive use of diuretics. Other medications can produce hypotension by different mechanisms. Decreased cardiac output despite normal blood volume, due to severe congestive heart failure, large myocardial infarction, or bradycardia, often produces hypotension and can rapidly progress to cardiogenic shock. Arrhythmias often result in hypotension by this mechanism. Beta blockers can cause hypotension both by slowing the heart rate and by decreasing the pumping ability of the heart muscle. Varieties of mation and/or other mental-physiological disciplines can create temporary hypotension effects, as well, and should not be considered unusual. Excessive vasodilation, or insufficient constriction of the resistance blood vessels mostly arterioles, causes hypotension. This can be due to decreased sympathetic nervous system output or to increased parasympathetic activity occurring as a consequence of injury to the brain or spinal cord or of dysautonomia, an intrinsic abnormality in autonomic system functioning. Excessive vasodilation can also result from sepsis, acidosis, or medications, such as nitrate preparations, calcium channel blockers, angiotensin II receptor inhibitors or ACE inhibitors. Many anesthetic agents and techniques, including spinal anesthesia and most inhalational agents, produce significant vasodilation. Syndromes Orthostatic hypotension, also called postural hypotension, is a common form of low blood pressure. It occurs after a change in body position, typically when a person stands up from either a seated or lying position. It is usually transient and represents a delay in the normal compensatory ability of the autonomic nervous system. It is commonly seen in hypovolemia and as a result of various medications. In addition to blood pressure-lowering medications, many psychiatric medications, in particular antidepressants, can have this side effect. Simple blood pressure and heart rate measurements while lying, seated, and standing with a two-minute delay in between each position change can confirm the presence of orthostatic hypotension. Orthostatic hypotension is indicated if there is a drop in 20 mmHg of systolic pressure and a 10 mmHg drop in diastolic pressure in some facilities and a 20 bpm increase in heart rate. Neurocardiogenic syncope is a form of dysautonomia characterized by an inappropriate drop in blood pressure while in the upright position. Neurocardiogenic syncope is related to vasovagal syncope in that both occur as a result of increased activity of the vagus nerve, the mainstay of the parasympathetic nervous system. Another, but rarer form, is postprandial hypotension, which occurs 30-75 minutes after eating substantial meals. When a great deal of blood is diverted to the intestines to facilitate digestion and absorption, the body must increase cardiac output and peripheral vasoconstriction in order to maintain enough blood pressure to perfuse vital organs, such as the brain. It is believed that postprandial hypotension is caused by the autonomic nervous system not compensating appropriately, because of ageing or a specific disorder. Indicators For most individuals, a healthy blood pressure ranges from 90/60 mmHg to 120/80 mmHg. A small drop in blood pressure, even as little as 20 mmHg, can result in transient hypotension.citation needed Evaluating neurocardiogenic syncope is done with a tilt table test. Symptoms The cardinal symptom of hypotension is lightheadedness or dizziness. If the blood pressure is sufficiently low, fainting and often seizures will occur. Low blood pressure is sometimes associated with certain symptoms, many of which are related to causes rather than effects of hypotension: Chest pain Shortness of breath Irregular heartbeat Fever higher than 101 °F 38.3 °C Headache Stiff neck Severe upper back pain Cough with phlegm Prolonged diarrhea or vomiting Dysphagia Dysuria Foul-smelling urine Adverse effect of medications Acute, life-threatening allergic reaction Seizures Loss of consciousness Profound fatigue Treatment The treatment for hypotension depends on its cause. Asymptomatic hypotension in healthy people usually does not require treatment. Severe hypotension needs to be aggressively treated because reduced blood flow to critical organs including the brain, heart and kidneys may cause organ failure and can ultimately lead to death. Treatment options include systemic vasoconstrictors and other drugs. Adding sodium to a diet can also relieve symptoms of mild hypotension. In mild cases, where the patient is still responsible, laying the person in dorsal decubitus laying over the back position and lifting the legs will increase venous return, thus making more blood available to critical organs at chest and head. References Hypotension details hypotension WebMD hypotension Medterms v d e Cardiovascular disease: vascular disease - Circulatory system pathology I70-I99, 440-459 Arteries, arterioles and capillaries Arterial occlusive disease/ peripheral vascular disease Arteriosclerosis: Atherosclerosis - Intermittent claudication - Atheroma - Monckeberg's arteriosclerosis Stenosis Renal artery stenosis, Carotid artery stenosis - Fibromuscular dysplasia - Degos disease - Aortoiliac occlusive disease Raynaud's phenomenon/Raynaud's disease - Erythromelalgia Aneurysm Aortic aneurysm/Abdominal aortic aneurysm - Cerebral aneurysm - Coronary artery aneurysm - Intracranial berry aneurysm - Dissection Aortic, Carotid, Vertebral - Pseudoaneurysm Other Arteritis Aortitis - Buerger's disease Arteriovenous fistula - Herary hemorrhagic telangiectasia Nevus Spider angioma, Halo nevus, Cherry angioma Veins Venous thrombosis/ Phlebitis/ Thrombophlebitis primarily lower limb Deep vein thrombosis abdomen May-Thurner syndrome, Portal vein thrombosis, Budd-Chiari syndrome, Renal vein thrombosis upper limb/torso Paget-Schroetter disease, Mondor's disease head Cerebral venous sinus thrombosis Post-thrombotic syndrome Varicose veins Varicocele - Gastric varices - Portacaval anastomosis Hemorrhoid, Esophageal varices, Caput medusae Other Superior vena cava syndrome - Inferior vena cava syndrome - Venous ulcer Arteries or veins Vasculitis - Thrombosis - Embolism Pulmonary embolism, Cholesterol embolism - Angiopathy Macroangiopathy, Microangiopathy Lymphatic disease Lymphadenitis - Lymphedema - Lymphangitis Blood pressure Hypertension Hypertensive heart disease - Hypertensive nephropathy - Secondary hypertension Renovascular hypertension - Pulmonary hypertension Hypotension Orthostatic hypotension See also congenital, neoplasia Retrieved from http://en..org/wiki/Hypotension Categories: Cardiology | Blood pressureHidden categories: All articles with statements | Articles with statements since May 2008 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Bosanski ÄŒesky Deutsch Español Français í•œêµì–´ Italiano Nederlands 日本語 ‪Norsk bokmÃ¥l‬ Polski Português РуÑ?Ñ?кий Shqip Svenska Türkçe ä¸æ–‡ This page was last modified on 5 August 2008, at 16:58
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