Hemodynamics in Shy-Drager syndrome and treatment with indomethacin

Hemodynamic studies were performed in a case of Shy-Drager syndrome with severe orthostatic hypotension. Marked depression of blood pressure was recognized immediately after the tilt-up, wherein decrease in cardiac output was detected (65 leads to 35 ml; stroke volume) during measurements by echocardiography. In association with the depression of blood pressure and decrease in cardiac output, Doppler sonograms showed the overall blood flow reduction in the brain-supplying arteries, suggesting some breakdown of autoregulation of the cerebral blood flow. Medication with indomethacin obviously limited the depression of blood pressure during the standing exercise. The pressor mechanism of indomethacin might be regarded as a result of increased vasoconstrictivity by inhibiting the synthesis of prostaglandins.