Hypotension

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Hypotension Classification and external resources
ICD-10	I95.
ICD-9	458
DiseasesDB	6539
MedlinePlus	007278
MeSH	D007022

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Cochrane Collaboration on Hypotension Bandolier on Hypotension TRIP on Hypotension
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Definitions of Hypotension
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Hypotension refers to an abnormally low blood pressure. This is best understood as a physiologic state, rather than a disease. It is often associated with shock, though not necessarily indicative of it. Hypotension is not to be confused with hypertension, which is high blood pressure, the opposite of hypotension. Hypotension is a fairly rare problem, hypertension is a much more common problem. Hypotension is almost never a serious problem, although in some very rare cases it can be life threatening.

Normal physiology

Blood pressure is continuously regulated by the autonomic nervous system, using an elaborate network of receptors, nerves, and hormones to balance the effects of the sympathetic nervous system, which tends to raise blood pressure, and the parasympathetic nervous system, which lowers it. The vast and rapid compensation abilities of the autonomic nervous system allow normal individuals to maintain an acceptable blood pressure over a wide range of activities and in many disease states.

Mechanisms and causes

Reduced blood volume, called hypovolemia, is the most common mechanism producing hypotension. This can result from hemorrhage, or blood loss; insufficient fluid intake, as in starvation; or excessive fluid losses from diarrhea or vomiting. Hypovolemia is often induced by excessive use of diuretics. (Other medications can produce hypotension by different mechanisms.)

Decreased cardiac output despite normal blood volume, due to severe congestive heart failure, large myocardial infarction, or bradycardia, often produces hypotension and can rapidly progress to cardiogenic shock. Arrhythmias often result in hypotension by this mechanism. Beta blockers can cause hypotension both by slowing the heart rate and by decreasing the pumping ability of the heart muscle.

Excessive vasodilation, or insufficient constriction of the resistance blood vessels (mostly arterioles), causes hypotension. This can be due to decreased sympathetic nervous system output or to increased parasympathetic activity occurring as a consequence of injury to the brain or spinal cord or of dysautonomia, an intrinsic abnormality in autonomic system functioning. Excessive vasodilation can also result from sepsis, acidosis, or medications, such as nitrate preparations, calcium channel blockers, or ACE inhibitors. Many anesthetic agents and techniques, including spinal anesthesia and most inhalational agents, produce significant vasodilation.

Differential Diagnosis

In alphabetical order ^{[1] [2]}

• Addison's Disease
• Adrenal insufficiency
• Adrenocortical insufficiency
• Adrenogenital syndrome
• Anaphylaxis
• Anemia
• Aortic Arch Syndrome
• Aortic Isthmus Stenosis
• Aortic Stenosis
• Autonomic failure
• Bartter's syndrome
• Cardiac valve defect
• Cardiogenic shock
• Carotid sinus syndrome
• Constrictive pericarditis
• Dehydration
• Diabetes Insipidus
• Diabetic autonomic neuropathy
• Drugs
• During and after infections
• Dysrhythmias
• Ectopic Pregnancy
• Excessive fluid loss through dialysis
• Fatigue
• Fluid loss
• Guillain-Barre Syndrome
• Heart failure
• Heat, Hypothermia
• Hemorrhage - bleeding
• Hemorrhagic shock
• Hepatitis
• Hyponatremia
• Hypothyroidism
• Idiopathic hypotension
• Insufficient fluid intake
• Internal bleeding
• Medications (hypotension secondary)
• Multiple cerebrovascular accidents (CVAs)
• Myocardial infarction
• Myocardial ischemia
• Neurogenic shock
• Orthostatic hypotension
• Overwhelming infection
• Paraplegia
• Parkinson's Disease
• Pericardial effusion
• Perimyocarditis
• Pituitary insufficiency
• Polyneuropathy
• Polyradiculitis
• Postprandial hypotension
• Pregnancy
• Pulmonary Embolism
• Septic shock
• Shy-Drager Syndrome
• Splenic rupture
• Syncope, fainting
• Syringomyelia
• Tabes Dorsalis
• Trauma
• Vagal syncope
• Valsalva maneuver
• Volume depletion

Syndromes

Orthostatic hypotension, also called "postural hypotension", is a common form of low blood pressure. It occurs after a change in body position, typically when a person stands up from either a seated or lying position. It is usually transient and represents a delay in the normal compensatory ability of the autonomic nervous system. It is commonly seen in hypovolemia and as a result of various medications. In addition to the classes of blood pressure-lowering medications listed above, many psychiatric medications, in particular antidepressants, can have this side effect. Simple blood pressure and heart rate measurements while lying, seated, and standing can confirm the presence of orthostatic hypotension.

Neurocardiogenic syncope is a form of dysautonomia characterized by an inappropriate drop in blood pressure while in the upright position. Neurocardiogenic syncope is related to vasovagal syncope in that both occur as a result of increased activity of the vagus nerve, the mainstay of the parasympathetic nervous system.

Another, but rarer form, is Postprandial hypotension, which occurs 30–75 minutes after eating substantial meals. When a great deal of blood is diverted to the intestines to facilitate digestion and absorption, the body must increase cardiac output and peripheral vasoconstriction in order to maintain enough blood pressure to perfuse vital organs, such as the brain. It is believed that postprandial hypotension is caused by the autonomic nervous system not compensating appropriately, because of ageing or a specific disorder.

Indicators

For most individuals, a healthy blood pressure lies from 90/50 mmHg to 135/90 mmHg. A small drop in blood pressure, even as little as 20 mmHg, can result in transient hypotension.

Evaluating neurocardiogenic syncope is done with a tilt table test.

Symptoms

The cardinal symptom of hypotension is lightheadedness or dizziness.

If the blood pressure is sufficiently low, fainting and often seizures will occur.

Hypotension, depending on one's own body chemistry and genetics, may often cause mild depression, mostly in regard to taking other medications which do not fit one's personal unique needs.

Low blood pressure is often accompanied by:

(Most of these are related to causes rather than effects of hypotension.)

• Chest pain
• Shortness of breath
• Irregular heartbeat
• Fever higher than 101 °F (38.3 °C)
• Headache
• Stiff neck
• Severe upper back pain
• Cough with phlegm
• Prolonged diarrhea or vomiting
• Inability to eat or drink
• Burning with urination
• Foul-smelling urine
• Adverse effect of medications
• Acute, life-threatening allergic reaction
• Dizziness, or light-headedness, particularly when suddenly standing up from sitting down
• Seizures
• Loss of consciousness
• Profound fatigue

Laboratory Findings

• Complete blood count (CBC)
• Blood urea nitrogen (BUN) / creatinine
• Calcium
• Glucose
• Urinalysis
• Blood culture
• Cortisol level

Electrocardiogram

• ECG

Other Diagnostic Studies

• Swan-Ganz catheterization

Treatment

The treatment for hypotension depends on its cause. Asymptomatic hypotension in healthy people usually does not require treatment. Severe hypotension needs to be aggressively treated because reduced blood flow to critical organs including the brain, heart and kidneys may cause organ failure and can ultimately lead to death. Treatment options include systemic vasoconstrictors and other drugs.

• Increase salt and water intake
• Caffeine
• Fluid replacement
• Remove harmful/offending medications
• Educate patient

Acute Pharmacotherapies

• Fludrocortisone acetate
• Sympathomimetic agents
• Nonsteriodal anti-inflammatory drugs (NSAIDs)
• Erythropoietin
• IV hydrocortisone

References

External Links

• hypotension WebMD
• hypotension Medterms

v • d • e Circulatory system pathology (I, 390-459)
Hypertension	Hypertensive heart disease - Hypertensive nephropathy - Secondary hypertension (Renovascular hypertension)
Ischaemic heart disease	Angina pectoris (Prinzmetal's angina) - Myocardial infarction (heart attack) - Dressler's syndrome
Pulmonary circulation	Pulmonary embolism - Cor pulmonale
Pericardium	Pericarditis - Pericardial effusion - Cardiac tamponade
Endocardium/heart valves	Endocarditis - mitral valve (regurgitation, prolapse, stenosis) - aortic valve (stenosis, insufficiency) - pulmonary valve (stenosis, insufficiency) - tricuspid valve (stenosis, insufficiency)
Myocardium	Myocarditis - Cardiomyopathy (Dilated cardiomyopathy, Hypertrophic cardiomyopathy, Loeffler endocarditis, Restrictive cardiomyopathy) - Arrhythmogenic right ventricular dysplasia
Electrical conduction system of the heart	Heart block: AV block (First degree, Second degree, Third degree) - Bundle branch block (Left, Right) - Bifascicular block - Trifascicular block Pre-excitation syndrome (Wolff-Parkinson-White, Lown-Ganong-Levine) - Long QT syndrome - Adams-Stokes syndrome - Cardiac arrest - Sudden cardiac death Arrhythmia: Paroxysmal tachycardia (Supraventricular, AV nodal reentrant, Ventricular) - Atrial flutter - Atrial fibrillation (Familial) - Ventricular fibrillation - Premature contraction (Atrial, Ventricular) - Ectopic pacemaker - Sick sinus syndrome
Other heart conditions	Heart failure - Cardiovascular disease - Cardiomegaly - Ventricular hypertrophy (Left, Right)
Cerebrovascular diseases	Stroke - Transient ischemic attack - Intracranial hemorrhage/cerebral hemorrhage: Extra-axial hemorrhage (Epidural hemorrhage, Subdural hemorrhage, Subarachnoid hemorrhage) Intra-axial hematoma (Intraventricular hemorrhages, Intraparenchymal hemorrhage) - Anterior spinal artery syndrome - Binswanger's disease - Moyamoya disease
Arteries, arterioles and capillaries	Atherosclerosis (Renal artery stenosis) - Aortic dissection/Aortic aneurysm (Abdominal aortic aneurysm) - Aneurysm - Raynaud's phenomenon/Raynaud's disease - Buerger's disease - Vasculitis/Arteritis (Aortitis) - Intermittent claudication - Arteriovenous fistula - Hereditary hemorrhagic telangiectasia - Spider angioma - Dissection (Carotid artery, Vertebral artery)
Veins, lymphatic vessels and lymph nodes	Thrombosis/Phlebitis/Thrombophlebitis (Deep vein thrombosis, May-Thurner syndrome, Portal vein thrombosis, Venous thrombosis, Budd-Chiari syndrome, Renal vein thrombosis, Paget-Schroetter disease) - Varicose veins / Portacaval anastomosis (Hemorrhoid, Esophageal varices, Varicocele, Gastric varices, Caput medusae) - Superior vena cava syndrome - Lymph (Lymphadenitis, Lymphedema, Lymphangitis)
Other	Hypotension (Orthostatic hypotension) - Rheumatic fever
See also congenital (Q20-Q28, 745-747)

v • d • e WikiDoc Research Resources for Hypotension (Click show to right to view)
Articles on Hypotension	Most recent articles on Hypotension • Most cited articles on Hypotension • Review articles on Hypotension • Articles on Hypotension in N Eng J Med, Lancet, BMJ
Media (Slides, Video, Images, MP3) on Hypotension	Powerpoint slides on Hypotension • Images of Hypotension • Photos of Hypotension • Podcasts & MP3s on Hypotension • Videos on Hypotension
Evidence Based Medicine Regarding Hypotension	Cochrane Collaboration on Hypotension • Bandolier on Hypotension • TRIP on Hypotension
Cost Effectiveness of Hypotension	Cost Effectiveness of Hypotension
Clinical Trials Involving Hypotension	Ongoing Trials on Hypotension at Clinical Trials.gov • Trial results on Hypotension • Clinical Trials on Hypotension at Google
Guidelines / Policies / Government Resources (FDA/CDC) Regarding Hypotension	US National Guidelines Clearinghouse on Hypotension • NICE Guidance on Hypotension • NHS PRODIGY Guidance • FDA on Hypotension • CDC on Hypotension
Textbook Information on Hypotension	Books and Textbook Information on Hypotension
Pharmacology Resources on Hypotension	Dosing of Hypotension • Drug interactions with Hypotension • Side effects of Hypotension • Allergic reactions to Hypotension • Overdose information on Hypotension • Carcinogenicity information on Hypotension • Hypotension in pregnancy • Pharmacokinetics of Hypotension •
Genetics, Pharmacogenomics, and Proteinomics of Hypotension	Genetics of Hypotension • Pharmacogenomics of Hypotension • Proteomics of Hypotension
Newstories on Hypotension	Hypotension in the news • Be alerted to news on Hypotension • News trends on Hypotension
Commentary on Hypotension	Blogs on Hypotension
Patient Resources on Hypotension	Patient resources on Hypotension • Discussion groups on Hypotension • Patient Handouts on Hypotension • Directions to Hospitals Treating Hypotension • Risk calculators and risk factors for Hypotension
Healthcare Provider Resources on Hypotension	Symptoms of Hypotension • Causes & Risk Factors for Hypotension • Diagnostic studies for Hypotension • Treatment of Hypotension
Continuing Medical Education (CME) Programs on Hypotension	CME Programs on Hypotension
International Resources on Hypotension	Hypotension en Espanol • Hypotension en Francais
Business Resources on Hypotension	Hypotension in the Marketplace • Patents on Hypotension
Informatics Resources on Hypotension	List of terms related to Hypotension

cs:Hypotenze

de:Hypotoniefr:Hypotension artérielle it:Ipotensione nl:Hypotensie no:Hypotensjonsq:Hipotensioni sv:Hypotension

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Acknowledgement and Attribution Regarding Sources of Content

Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .