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