12 – Neuro – Orthostatic Hypotension
08.18.2018 - By Jimmy McKay, PT, DPT
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Episode 12: Orthostatic Hypotension NPTE Studycast
Featured Expert Bridget Ripa, PT, DPT, NCS, CBIS, CSRS
Notes by Alexis Lancaster, SPT
What is it
* A decrease in blood pressure by ≥20mmHg systolic and ≥10mmHg diastolic when moving from a supine to upright position
Causes
* Cardiovascular system, BP, blood supply to the brain
Signs & Symptoms:
* Physical signs: pallor, diaphoresis, loss of consciousness (potentially)
* Symptoms pt will report: dizziness, light-headedness, faintness, nausea
Differential Diagnosis:
* Autonomic dysreflexia
* Look at the blood pressure: AD will have ↑ in BP, OH will have ↓ in BP
* Vertigo, BPPV: b/c of dizziness and light-headedness symptoms
* Generalized nausea from infection, etc.
Special tests
* Orthostatic testing: monitor BP with position changes
Treatment examples:
* Immediately: lay the person down, elevate legs to prevent loss of consciousness
* After: talk to the team about BP treatment medications
* Encourage fluids with pt
* Progress upright tolerance with a hospital bed, tilt table to decrease the number of OH episodes/frequency & duration of OH episodes
* Abdominal binders, ace wraps on legs to keep BP up
How can it look on the test?
* The important part: recognizing OH and manage it
* Emergent scenario: decide that it’s OH and what you would do about it
* May need to differentiate between OH and more emergent conditions, such as AD
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