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Orthostatic hypotension

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https://www.readbyqxmd.com/read/28721327/two-catastrophes-in-one-patient-drug-reaction-with-eosinophilia-and-systemic-symptoms-and-toxic-shock-syndrome
#1
Moayed Ibrahim, Diana L Nunley
A 70-year-old, immunocompromised patient presented to the emergency room (ER) five weeks after she was started on clopidogrel. She complained of skin eruption, mouth ulcers, fatigue, and myalgia over the past two weeks. Labs showed severe hyponatremia, acute kidney injury, rhabdomyolysis, hyperkalemia, and elevated liver enzymes. She was treated with steroids and discharged after her condition improved. However, a month later, she returned to the ER, complaining of nausea, vomiting, diarrhea, dizziness, chills, and shortness of breath over the past two days...
June 15, 2017: Curēus
https://www.readbyqxmd.com/read/28721322/etiology-and-age-distribution-of-syncope-in-a-predominantly-african-american-population
#2
Ahmad Awan, Hasan Iftikhar, Fasil Tiruneh, Shahabuddin Soherwardi, Daniel Larbi
BACKGROUND: Syncope, the sudden transient loss of consciousness due to multiple etiologies, usually has worse outcomes in African Americans compared with other races because of other comorbidities. This study aims to identify a correlation between the etiologies of syncope and age in a predominantly African-American sample population to facilitate future investigations with potentially improved specificity to address this condition. METHODS: We reviewed the medical records of 155 patients who presented with syncope concerns to the emergency department at our university hospital...
June 14, 2017: Curēus
https://www.readbyqxmd.com/read/28720881/patients-with-orthostatic-intolerance-relationship-to-autonomic-function-tests-results-and-reproducibility-of-symptoms-on-tilt
#3
Hyung Lee, Phillip A Low, Hyun Ah Kim
This study was designed to investigate the frequency and pattern of orthostatic symptoms during head-up tilt (HUT) in patients with orthostatic intolerance during daily life, and to identify the relationship between the orthostatic symptoms during HUT and autonomic parameters. We prospectively collected autonomic data from 464 patients with orthostatic symptoms. Adrenergic and cardiovagal function tests including HUT were performed. Based on HUT results, we divided patients into orthostatic hypotension (OH), postural tachycardia syndrome (POTS), or normal HUT groups...
July 18, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28717991/prolonged-bed-rest-impairs-rapid-cpi-17-phosphorylation-and-contraction-in-rat-mesenteric-resistance-arteries-to-cause-orthostatic-hypotension
#4
Toshio Kitazawa, Kazuyo Kitazawa
Prolonged bed rest (PBR) causes orthostatic hypotension (OH). Rapid constriction of splanchnic resistance arteries in response to a sudden increase in sympathetic tone contributes to the recovery of orthostatic arterial pressure upon standing. However, the molecular mechanism of PBR-induced dysfunction in arterial constriction is not fully understood. Previously, we showed that CPI-17, a regulatory protein for myosin phosphatase, mediates α1A-adrenergic receptor-induced rapid contraction of small mesenteric arteries...
July 17, 2017: Pflügers Archiv: European Journal of Physiology
https://www.readbyqxmd.com/read/28713844/epidemiology-diagnosis-and-management-of-neurogenic-orthostatic-hypotension
#5
Jose-Alberto Palma, Horacio Kaufmann
BACKGROUND: Orthostatic hypotension (OH) is a sustained fall in blood pressure on standing which can cause symptoms of organ hypoperfusion. OH is associated with increased morbidity and mortality and leads to a significant number of hospital admissions particularly in the elderly (233 per 100,000 patients over 75 years of age in the US). OH can be due to volume depletion, blood loss, large varicose veins, medications, or due to defective activation of sympathetic nerves and reduced norepinephrine release upon standing (i...
May 2017: Movement Disorders Clinical Practice
https://www.readbyqxmd.com/read/28702747/management-of-supine-hypertension-complicating-neurogenic-orthostatic-hypotension
#6
Jacquie Baker, Kurt Kimpinski
Neurogenic orthostatic hypotension (NOH) can be present in a number of disorders, including synucleinopathies, autoimmune disorders, and various genetic disorders. All are characterized by defective norepinephrine release from sympathetic terminals upon standing, resulting in impaired vasoconstriction. NOH is defined as a drop in systolic blood pressure ≥20 mmHg or diastolic blood pressure ≥10 mmHg, or both, within 3 minutes of standing or head up-tilt at a minimum of 60°. However, approximately 50% of patients have associated supine hypertension, which greatly complicates treatment...
July 12, 2017: CNS Drugs
https://www.readbyqxmd.com/read/28699368/impact-of-blood-pressure-lesion-level-and-physical-activity-on-aortic-augmentation-index-in-persons-with-sci
#7
Caitlyn G Katzelnick, Joseph P Weir, Nancy Chiaravalotti, Glenn Wylie, Trevor Dyson-Hudson, William A Bauman, Jill M Wecht
Individuals with chronic spinal cord injury (SCI) are at a heightened risk of cardiovascular disease (CVD) due to autonomic nervous system dysfunction, physical inactivity and increased inflammatory processes. Arterial stiffness (AS) is recognized as an independent risk factor for CVD and, specifically, pulse wave analysis (PWA) has proven to be a useful tool to predict and track structural arterial changes that reflect arteriosclerosis. The augmentation index (AI) can be used to estimate AS and is derived from the amplitude and timing of the blood pressure (BP) wave reflection in a peripheral artery...
July 12, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28687586/a-rash-with-a-heavy-heart
#8
Sergio Barros-Gomes, Niyada Naksuk, Dragan Jevremovic, Hector R Villarraga
Cardiac amyloidosis (CA) is relatively rare and frequently misdiagnosed. Other disorders presenting with increased left ventricular (LV) mass can mimic its diagnosis. This case illustrates unique findings of primary light chain (AL) amyloidosis in a patient with remarkable signs of CA. Here, we report a 49-year-old man with prior diagnosis of hypertrophy cardiomyopathy (HCM) based on an echocardiogram performed 1 year earlier that presented with 8 weeks of periorbital rash. He had numbness in the past 3 years...
July 7, 2017: Echo Research and Practice
https://www.readbyqxmd.com/read/28681408/role-of-peripheral-vascular-resistance-as-an-indicator-of-cardiovascular-abnormalities-in-patients-with-parkinson-s-disease
#9
Monika Zawadka-Kunikowska, Joanna Słomko, Małgorzata Tafil-Klawe, Jacek J Klawe, Agnieszka Cudnoch-Jędrzejewska, Julia L Newton, Paweł Zalewski
The aim of this study was to evaluate cardiovascular autonomic modulation in response to an orthostatic stress in healthy subjects and Parkinson's disease (PD). The study included 47 controls and 56 PD patients divided into groups (vasoconstrictor PD, vasodilator PD, control) according to vasodilation/vasoconstriction response during 70° head up tilt test. Using Impedance cardiography (ICG) and electrocardiography (ECG) we measured stroke volume, cardiac output, left ventricular work index, left ventricular ejection time, acceleration index, index of contractility, Heather index, thoracic fluid content, total peripheral resistance, total arterial compliance...
July 5, 2017: Clinical and Experimental Pharmacology & Physiology
https://www.readbyqxmd.com/read/28681121/indexes-of-cerebral-autoregulation-do-not-reflect-impairment-in-syncope-insights-from-head-up-tilt-test-of-vasovagal-and-autonomic-failure-subjects
#10
Pedro Castro, João Freitas, Rosa Santos, Ronney Panerai, Elsa Azevedo
PURPOSE: The study of dynamic cerebral autoregulation (CA), which adapts cerebral blood flow to arterial blood pressure (ABP) fluctuations, has been limited in orthostatic intolerance syndromes, mainly due to its stationary prerequisites hardly to meet during maneuvers to provoke syncope itself. New techniques of continuous estimates of CA could overcome this pitfall. We aimed to evaluate CA during head-up tilt test in common conditions causing syncope. METHODS: We compared three groups: eight controls; eight patients with autonomic failure due to familial amyloidotic polyneuropathy; eight patients with vasovagal syncope (VVS)...
July 5, 2017: European Journal of Applied Physiology
https://www.readbyqxmd.com/read/28674628/syndromes-of-orthostatic-intolerance-and-syncope-in-young-adults
#11
Viktor Hamrefors, Jasmina Medic Spahic, David Nilsson, Martin Senneby, Richard Sutton, Olle Melander, Artur Fedorowski
OBJECTIVE: To explore the clinical and neuroendocrine characteristics of syndromes of orthostatic intolerance and syncope in young adults. METHODS: Two hundred and thirty-six patients aged 18-40 years with orthostatic intolerance and/or syncope were examined by head-up tilt test (HUT). Plasma levels of epinephrine, norepinephrine, renin, C-terminal-pro-arginine-vasopressin (CT-proAVP), C-terminal-endothelin-1 and mid-regional-fragment of pro-atrial-natriuretic-peptide (MR-proANP) were analysed...
2017: Open Heart
https://www.readbyqxmd.com/read/28673219/the-effect-of-oral-intake-during-the-immediate-pre-colonoscopy-time-period-on-volume-depletion-in-patients-who-receive-sodium-picosulfate
#12
G S Labuschagne, R W Morris
Sodium picosulfate, used in combination with magnesium oxide and citric acid for bowel cleansing, can result in dehydration. We investigated whether enhanced carbohydrate fluid intake pre-colonoscopy could mitigate this effect. We enrolled 398 elective colonoscopy patients in a prospective, controlled, single-blinded study. The control group (n=194) fasted routinely (minimum seven hours) whilst the treatment group (n=197) drank 1,200 ml carbohydrate solution leading up to admission (up until two hours pre-colonoscopy)...
July 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/28666000/dynamic-wheelchair-seating-positions-impact-cardiovascular-function-after-spinal-cord-injury
#13
Jessica A Inskip, Henrike Rianne J C Ravensbergen, Inderjeet S Sahota, Christine Zawadzki, Lowell T McPhail, Jaimie F Borisoff, Victoria E Claydon
BACKGROUND: Innovative wheelchairs allow individuals to change position easily for comfort and social situations. While these wheelchairs are beneficial in multiple ways, the effects of position changes on blood pressure might exacerbate hypotension and cerebral hypoperfusion, particularly in those with spinal cord injury (SCI) who can have injury to autonomic nerves that regulate cardiovascular control. Conversely, cardiovascular benefits may be obtained with lowered seating. Here we investigate the effect of moderate changes in wheelchair position on orthostatic cardiovascular and cerebrovascular reflex control...
2017: PloS One
https://www.readbyqxmd.com/read/28658309/microstructural-integrity-of-white-matter-tracts-amongst-older-fallers-a-dti-study
#14
Yoke Queen Wong, Li Kuo Tan, Pohchoo Seow, Maw Pin Tan, Khairul Azmi Abd Kadir, Anushya Vijayananthan, Norlisah Ramli
OBJECTIVES: This study assesses the whole brain microstructural integrity of white matter tracts (WMT) among older individuals with a history of falls compared to non-fallers. METHODS: 85 participants (43 fallers, 42 non-fallers) were evaluated with conventional MRI and diffusion tensor imaging (DTI) sequences of the brain. DTI metrics were obtained from selected WMT using tract-based spatial statistics (TBSS) method. This was followed by binary logistic regression to investigate the clinical variables that could act as confounding elements on the outcomes...
2017: PloS One
https://www.readbyqxmd.com/read/28655059/association-of-autonomic-dysfunction-with-disease-progression-and-survival-in-parkinson-disease
#15
Eduardo De Pablo-Fernandez, Carmen Tur, Tamas Revesz, Andrew J Lees, Janice L Holton, Thomas T Warner
Importance: Evidence suggests that development of autonomic dysfunction (AutD) may negatively affect disease course and survival in patients with synucleinopathies. However, the few available studies on Parkinson disease (PD) have conflicting results, comprise a small number of patients, have short follow-up periods, and lack pathologic confirmation of the diagnosis. Objective: To examine the association of time of onset of AutD with disease progression and survival in PD...
June 26, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28648106/pressure-autoregulation-measurement-techniques-in-adult-tbi-part-i-a-scoping-review-of-intermittent-semi-intermittent-methods
#16
Frederick Adam Zeiler, Joseph Donnelly, Leanne Calviello, David Menon, Peter Smieleweski, Marek Czosnyka
To perform a systematic, scoping review of commonly described intermittent/semi-intermittent autoregulation measurement techniques in adult TBI. Nine separate systematic reviews were conducted for each intermittent technique: Computed tomographic perfusion (CTP)/Xenon-CT (Xe-CT), positron emission tomography (PET), magnetic resonance imaging (MRI), arterio-venous difference in oxygen (AVDO2) technique, thigh cuff deflation technique (TCDT), transient hyperemic response test (THRT), orthostatic hypotension test (OHT), mean flow index (Mx) and transfer function ARI (TF-ARI)...
June 24, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28647615/prevalence-and-associative-factors-of-orthostatic-hypotension-in-older-adults-results-from-the-well-being-of-the-singapore-elderly-wise-study
#17
Hui Lin Ong, Edimansyah Abdin, Esmond Seow, Shirlene Pang, Vathsala Sagayadevan, Sherilyn Chang, Janhavi Ajit Vaingankar, Siow Ann Chong, Mythily Subramaniam
BACKGROUND: Orthostatic hypotension (OH) is commonly reported among older adults and is associated with an increased risk of mortality. This study aimed to describe the prevalence and investigate the possible associations between OH with sociodemographic variables, chronic medical conditions, health service utilisation, dementia and cognitive status among older adults residing in Singapore. METHODS: Data was collected from 2266 participants aged 60 years and older who participated in the Well-being of the Singapore Elderly (WiSE) study in 2013...
June 15, 2017: Archives of Gerontology and Geriatrics
https://www.readbyqxmd.com/read/28644253/spectrum-of-autonomic-nervous-system-impairment-in-sj%C3%A3-gren-syndrome
#18
Brent P Goodman, Amy Crepeau, Priya S Dhawan, Julie A Khoury, Lucinda A Harris
OBJECTIVE: To describe the spectrum of autonomic dysfunction in a uniformly evaluated cohort of patients with Sjögren syndrome. METHODS: A series of 13 patients underwent a comprehensive evaluation for suspected autonomic impairment, including a neurological examination, autonomic testing, and laboratory studies. A diagnosis of Sjögren syndrome was established as the cause of autonomic dysfunction in all. Clinical features, findings on autonomic testing, and laboratory results are described...
July 2017: Neurologist
https://www.readbyqxmd.com/read/28643170/predictors-and-incidence-of-orthostatic-headache-associated-with-lumbar-drain-placement-following-endoscopic-endonasal-skull-base-surgery
#19
Buqing Liang, Sathwik R Shetty, Sacit Bulent Omay, Joao Paulo Almeida, Shilei Ni, Yu-Ning Chen, Armando S Ruiz-Treviño, Vijay K Anand, Theodore H Schwartz
BACKGROUND: Orthostatic headache (OH) is a potential complication of lumbar drainage (LD) usage. The incidence and risk factors for OH with the use of lumbar drainage during endoscopic endonasal procedures have not been documented. OBJECTIVE: To investigate the incidence of post-procedure OHs associated with placement of LD in patients undergoing endoscopic endonasal procedures. METHODS: We prospectively noted the placement of LDs in a consecutive series of endoscopic endonasal skull base surgeries...
August 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28626427/distinctive-steady-state-heart-rate-and-blood-pressure-responses-to-passive-robotic-leg-exercise-during-head-up-tilt-a-pilot-study-in-neurological-patients
#20
Amirehsan Sarabadani Tafreshi, Robert Riener, Verena Klamroth-Marganska
Introduction: Robot-assisted tilt table therapy was proposed for early rehabilitation and mobilization of patients after diseases such as stroke. A robot-assisted tilt table with integrated passive robotic leg exercise (PE) mechanism has the potential to prevent orthostatic hypotension usually provoked by verticalization. In a previous study with rather young healthy subjects [average age: 25.1 ± 2.6 years (standard deviation)], we found that PE effect on the cardiovascular system depends on the verticalization angle of the robot-assisted tilt table...
2017: Frontiers in Physiology
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