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Y4 Acute Care > Postural Hypotension > Flashcards

Postural Hypotension Flashcards

1
Q

What is important to know about Postural hypotension?

A

It is a CF, not a condition

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2
Q

What is the definition of Postural hypotension? (2 things)

A

One of these when standing up:
1. Fall in Systolic BP of 20+
1. Fall in Diastolic BP of 10+

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3
Q

What are the RF for Post Hypotension? (4 things)

A
  1. Age
  2. Autonomic neuropathy
  3. Anti-HTN meds
  4. Over diuresis (too much peeing)
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4
Q

What are the pathophysiological steps of Post hypotension? (4 steps)

A
  1. Person stands up
  2. Blood pools in lower extremities of body bc of gravity
  3. Venous return compromised –> reduces CO –> reduces arterial pressure
  4. Hypoperfusion of upper body
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5
Q

Why do healthy people not get Post hypotension when they stand up?

A

Baroreceptor reflex triggered

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6
Q

What is the Baroreceptor reflex mediated by?

A

Autonomic NS

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7
Q

What are the different Baroreceptors and what nerves are they innervated by? (2 things)

A
  1. Carotid sinus baroreceptor: CN 9
  2. Aortic arch baroreceptor: CN 10
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8
Q

How do Baroreceptors stop you from having Post Hypotension? (5 things)

A
  1. BP falls
  2. Baroreceptors detect blood vessels are less distended
  3. SNS activated + PNS inhibited
  4. Vasoconstriction + Increased HR
  5. BP elevated
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9
Q

What are the different titles of causes of Post Hypotension? (3 things)

A
  1. Hypovolaemia
  2. Meds
  3. Disease
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10
Q

What are the Hypovolaemia causes of Post Hypotension? (6 things)

A
  1. Dehydration (D+V / fever / heat stroke)
  2. Blood loss
  3. Excessive diuretic use
  4. Vasodilators
  5. Prolonged bed rest
  6. Anaemia
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11
Q

What are the Meds causes of Post Hypotension? (4 things)

A
  1. Beta blockers
  2. Sildenafil (aka Viagra)
  3. Tricyclic antidepressants
  4. Monoamine Oxidase Inhibitors
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12
Q

How do Beta blockers cause Post Hypotension? (3 things)

A

Block B-adrenergic receptors in body –> this prevents 3 things:
1. HR from increasing
1. Heart from contracting strongly
1. Vasodilation

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13
Q

How does Sildenafil cause Post Hypotension?

A

Dilates blood vessels

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14
Q

What are the Diseases that cause of Post Hypotension? (8 things)

A
  1. Addisons
  2. Atherosclerosis
  3. Autonomic neuropathy
  4. DM
  5. Phaeochromocytoma
  6. Parkinsons
  7. CVS
  8. Hypopituitarism (low ACTH)
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15
Q

How does DM cause Post Hypotension? (3 things)

A
  1. Peripheral neuropathy
  2. Affects Autonomic NS
  3. Interferes w Baroreceptor Reflex
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16
Q

What are the CF of Post Hypotension? (6 things)

A

When standing up:
1. Lightheadedness
1. Weakness
1. Blurred vision
1. Syncope / LOC
1. Distortion in hearing
1. Seizures

17
Q

What are the CF of Post Hypotension? (6 things)

A

When standing up:
1. Lightheadedness
1. Weakness
1. Blurred vision
1. Syncope / LOC
1. Distortion in hearing
1. Seizures

18
Q

How do you Dx Post Hypotension? (5 steps)

A
  1. Pt lies down for 5 mins
  2. Take BP
  3. Ask pt to stand
  4. After 3 mins of standing take BP again
  5. If Systolic drops by 20+ / Diastolic by 10+ = Dx
19
Q

What are the CONSERVATIVE Mx options for Post Hypotension? (6 things)

A
  1. Lie down if feeling faint
  2. Stand slowly
  3. Mx Autonomic neuropathy
  4. Increase water + salt ingestion
  5. Reduce carbs + alcohol intake
  6. Head-up tilt of bed @ night
20
Q

How does Head-up tilt of bed @ night help w Post Hypotension Mx? (3 steps)

A
  1. Increases renin release
  2. Decreases fluid loss
  3. Increases standing blood pressure
21
Q

What are the MEDICAL Mx options for Post Hypotension? (2 things)

A
  1. Fludrocortisone
  2. Sympathomimetics (e.g midodrine / ephedrine / pyridostigmine)
22
Q

How does Fludrocortisone work to Tx Post Hypotension?

A

Retains fluid

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