RESUMO
BACKGROUND: Initial orthostatic hypotension (IOH) is a clinical syndrome of transient orthostatic hypotension that is defined as a drop in blood pressure of >40â¯mmâ¯Hg systolic and/or >20â¯mmâ¯Hg diastolic within 15â¯s after standing, accompanied by symptoms of cerebral hypoperfusion, but without sustained orthostatic hypotension (blood pressure decrease >20/10â¯mmâ¯Hg after 1-3â¯min of standing). As the etiology of syncope remains unknown in a large proportion of patients, we hypothesized that IOH is highly prevalent among patients with unexplained syncope. METHODS: We studied 250 consecutive outpatients with unexplained syncope that were evaluated in the syncope-unit of our tertiary referral hospital. We measured hemodynamic changes in response to active standing using a beat-to-beat blood pressure measurement device, first after lying supine for >5â¯min and then after squatting for 30â¯s. RESULTS: 11.2% of the patients were diagnosed with syncope due to IOH, with a mean fall in blood pressure of 47.4⯱â¯12.5/29.0⯱â¯10.7â¯mmâ¯Hg within 15â¯s after standing up. Therefore, IOH was the second commonest cause of syncope in our cohort. 46.2% of the patients diagnosed with syncope due to IOH used antihypertensive drugs, mostly betablockers (41.6%) and/or tamsulosin (24.9%). The squatting-to-standing-test in addition to the lying-to-standing-test resulted in only 3 additional patients diagnosed with syncope due to IOH. CONCLUSIONS: IOH is highly prevalent among patients with previously unexplained syncope. Therefore, beat-to-beat blood pressure measurement should be considered in patients with unexplained syncope.
Assuntos
Determinação da Pressão Arterial/métodos , Pressão Sanguínea/fisiologia , Diagnóstico Tardio , Hemodinâmica/fisiologia , Hipotensão Ortostática/diagnóstico , Síncope/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Eletrocardiografia/métodos , Feminino , Humanos , Hipotensão Ortostática/fisiopatologia , Masculino , Pessoa de Meia-Idade , Síncope/fisiopatologiaRESUMO
Incidental cholesterol measurement in a 44-year-old woman revealed 12 mmol/l. She also had orange hand lines and elbow papules, caused by familial dysbetalipoproteinaemia.