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[Differential orthostatic dysregulation disorders diagnosis]
1Autonomes Labor, Neurologische Klinik mit Klinischer Neurophysiologie, Krupp Krankenhaus, Essen.
Der Nervenarzt
|January 19, 2000
Summary
Orthostatic circulatory disorders cause intolerance and falls. Differentiating these conditions using active standing or tilt-table tests guides effective therapies like fludrocortisone, midodrine, or beta-blockers.
Area of Science:
- Cardiovascular Physiology
- Autonomic Nervous System Disorders
- Clinical Diagnostics
Context:
- Orthostatic circulatory disorders frequently lead to orthostatic intolerance, syncope, and falls.
- Accurate diagnosis is crucial for effective treatment.
- Active standing tests and tilt-table tests are key diagnostic tools.
Purpose:
- To differentiate between three common pathological reactions causing orthostatic intolerance.
- To outline the diagnostic criteria for hypoadrenergic orthostatic hypotension, postural tachycardia syndrome, and neurocardiogenic syncope.
- To identify evidence-based therapies for each condition.
Summary:
- Hypoadrenergic orthostatic hypotension involves a rapid blood pressure drop due to sympathetic dysfunction.
- Postural tachycardia syndrome is characterized by increased heart rate without significant blood pressure drop, linked to venous pooling.
- Neurocardiogenic syncope results from a reflex mechanism involving sympathetic inhibition and vagal activation.
Impact:
- Provides a framework for differential diagnosis of orthostatic intolerance.
- Identifies specific pharmacological treatments for distinct orthostatic disorders.
- Aims to reduce the incidence of syncope and falls in affected individuals.