Orthostatic hypotension: the collapse of the symptoms, causes, treatment, emergency care, arterial

Orthostatic hypotension - a drop in blood pressure (upper and lower) by changing the vertical position of the body. This diagnosis is made in the event that a person standing at the pressure lower than sitting or lying down. Such a violation of the pressure regulation does not apply to an independent disease, and is the result of various causes. At risk - the elderly and the young girls.

Causes

Normally, the human cardiovascular system provides the relative constancy of blood pressure when changing posture. Compensatory mechanism triggered a healthy body so that a change in body position from horizontal to a vertical frequency of heart beats increases and the lower extremities vessels spazmiruyutsya slightly, forcing blood upstairs.

Orthostatic (postural) hypotension, orthostatic or collapse occurs due to untimely reaction of the cardiovascular apparatus for changes in body condition in space that causes a decrease in pressure in the blood vessels, poor blood flow to the brain and, as a consequence, its oxygen starvation.

Orthostatic hypotension, the causes of which can be covered in numerous pathologies, most often caused by:

• a decrease in circulating blood volume - this state has a medical name, and hypovolemia is the result of inadequate intake in body fluids, abundant blood loss, receiving diuretics or preparations of relaxing the smooth muscles of the walls of blood vessels;
• side effects from prolonged treatments antihypertensive agents or antidepressants, including monoamine oxidase inhibitors and tricyclics;
• diseases that are accompanied by vascular lesion of the device, the narrowing of the lumen of the arteries, endocrine diseases such as chronic adrenocortical insufficiency, adrenal tumor, diabetes diabetes;
• conditions associated with a sharp decrease in body mass (anorexia, bulimia, nervous exhaustion);
• neurological disorders (dystonia, parkinsonism, multiple system atrophy caused by degeneration of the nerve cells of certain parts of the brain).

The disorder can occur in anyone after a long stay in a horizontal position, especially for the elderly and pregnant women, as well as any persons with impaired vascular tone. Often the phenomenon of orthostatic hypotension observed in adolescent girls and young women, due to the uneven growth of the heart and blood vessels during this period.

Tight bandaging of the lower extremities, which is produced for insurance climbers, jumping fans at the "bungee", builders and other persons whose work is associated with height, can impede blood flow in the direction of the heart and cause symptoms of orthostatic hypotension. For the same reason, can interfere with blood flow tight corset.

symptoms

Orthostatic hypotension should be suspected if a change in body position on the vertical for 2-5 minutes a man dark eyes, dizziness occurs. In severe cases syncope. Orthostatic hypotension, whose symptoms can manifest themselves in various combinations, is diagnosed in the event of at least one of the following features:

• drop index upper or systolic pressure, at least 20 units;
• drop index lower, or diastolic blood pressure by 10 or more units;
• dizziness, loss of consciousness or other phenomena (excessive sweating, cramps, weakness) insufficiency of cerebral blood flow with a sharp rising.

Depending on the severity of symptoms distinguish 3 degrees of severity of the disorder:

• easy - infrequent dizziness without loss of consciousness;
• average - episodic loss of consciousness as a result of getting up or prolonged standing;
• heavy - frequent fainting when changing position on the vertical, including the transition from a lying position to a sitting position or half-sitting.

Postural hypotension mild to moderate severity develops gradually over several seconds. Because of this man has time to adequately respond to the deterioration of health: sit down, break his fall with his hands.

In severe disease, loss of consciousness can occur suddenly, accompanied by jerking, injuries from falling. Fainting may last up to several minutes.

Urgent Care

When it orthostatic collapse, emergency aid consists of the following steps:

1. Gently pull the patient's head back.
2. Assist to stop bleeding, if it was the cause of the collapse.
3. Call the ambulance staff.
4. Open the windows in the room to provide fresh air.
5. Use warm water bottle, and overlaid their victim.
6. Release the patient from tight garments that hamper his breathing.
7. The face and the affected breast can be moisten with tepid water.
8. If a person does not come to consciousness, dip a cotton swab in alcohol and ammonia, previously lightly press it gently bring to a patient's nostrils.
9. Rub hands and feet of the patient with a stiff brush or cloth.
10. Who came into the consciousness of the victim asked to drink a cup of sweet black tea or coffee.

If possible, the patient subcutaneously injected caffeine (10%) of 1 ml or 1.2 ml kordiamina.

For suspected orthostatic hypotension patient forbidden to take medications for vasodilatation (Valocordin, papaverine, no-silos, etc.), And others are not recommended to attempt to bring the victim to life, striking at cheeks.

Treatment

The therapeutic strategy physician individually selected only after careful examination of the patient and determination of the underlying disease. Orthostatic hypotension, which treatment for mild to moderate severity outpatient may require hospitalization in severe pathology flow.

non-drug therapies include:

• Abolition of drugs that can cause disturbances pressure regulation.
• The development of the optimum mode of physical activity and recreation.
• Therapeutic exercises: exercises to study and bring to tone the abdomen and leg muscles, thereby increasing and vascular tone.
• Production of skill smooth change in standing posture (without abrupt motions).
• Maintaining optimum temperature and humidity in the room.
• Adjustment of diet: increasing the number of products rich in potassium salts and the use of sufficient volume (within the age norm). Sodium salt contained in the food keeps the fluid in the body, resulting in increased blood pressure.
• Sleep on a cushion with a high head elevated, which prevents an excessive pressure rise in a horizontal position.
• The use of compression stockings and lingerie. They do not leave the chance of blood unnecessarily deposited (stagnate) in venous leg system.

If these methods do not bring sustainable positive effect in orthostatic hypotension, the treatment is continued administration of drug therapy, which may include the following groups preparations:

• adrenomimetics - have a tapering effect on peripheral vessels to prevent pressure shocks during the change of body position;
• Beta-blockers - regulate water-salt balance and blood pressure by enhancing the action adrenocortical hormones have a positive effect on blood vessels and autonomic nervous tone system;
• mineralokortikosteroidy - hold blood, sodium ions, to enhance the ability of peripheral vascular spasms, which makes blood pressure to decrease sharply when rising;
• NSAIDs - inhibit the synthesis of prostaglandins, including the kidney, has vasodilatory effect;
• adaptogens - act on the central nervous system, stimulating the sympathetic nervous system, which regulates, in particular, the work of the circulatory system.

By the indications for surgery include:

• Some diseases which were the main cause orthostatic collapse (adrenal tumor, narrowing or occlusion of the arteries);
• the need for pacemaker implantation for heart rate recovery (operation still does not guarantee the complete disappearance of the effects of orthostatic collapse).

Orthostatic hypotension is not only significantly reduces the quality of life, but also is associated with risk of serious complications for the patient, including stroke. If you suspect that this pathology is shown passing comprehensive medical examination that allows time to identify and treat the underlying cause of the regulation of blood disorders pressure.