Related Experiment Video
Updated: Sep 26, 2026

Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients
Published on: April 18, 2025
Abnormal Cardiovascular Responses During Orthostatic Hypotension in Cardiac Amyloidosis Revealed by
Mai Iwataki1, Hajime Miki1, Takeshi Onoue1
1Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
Background:
Mechanisms of orthostatic hypotension (OH) in cardiac amyloidosis (CA) patients remain largely unclarified.
Case Summary:
We performed semi-sitting/standing stress echocardiography in 6 healthy volunteers, 5 patients with CA but without OH [CA/OH(-)], and 4 with CA and OH [CA/OH(+)]. Semi-sitting/standing stress echocardiography revealed broad abnormal responses during semi-sitting/standing in CA/OH(+) patients, including reduced increase in heart rate, reduction in blood pressure, lack of reduction in left ventricular end-systolic dimension (contractile reserve), severely reduced stroke volume/cardiac output, paradoxical reduction in systemic vascular resistance, and paradoxical dilation of inferior vena cava dimension, compared to the group oh healthy volun.
Discussion:
These findings may suggest a combined and broad abnormal compensations of all chronotropy, left ventricle, arteries, and veins during semi-sitting/standing, leading to severe OH with CA.
Take-Home Messages:
Broad cardiovascular abnormalities were observed in 4 patients with CA and OH. Semi-sitting/standing stress echocardiography may hold potential for exploring the underlying pathophysiological mechanisms.
Related Concept Videos
Cardiomyopathy III: Hypertrophic Cardiomyopathy
Heart Failure II: Pathophysiology
Cardiovascular System Abnormal Findings I: Inspection and Palpation
Abnormal findings observed during an inspection
Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
Acute Coronary Syndrome III: Diagnostic Studies
Dysrhythmias V: Evaluating Dysrhythmias
