HYPOTENSION, CHRONIC
Ask the Following Questions:
- Is the hypotension found only on standing? The finding of hypotension on standing suggests orthostatic hypotension, which may be due to several causes, including hypopituitarism, diabetic neuropathy, anemia, and various cardiovascular disorders.
- Is there a history of drug ingestion? Many drugs induce hypotension, including nitroglycerin and its analogues, vasodilators, quinidine, and tricyclic drugs.
- Is there cardiomegaly or a heart murmur? These findings suggest mitral valvular disease, aortic stenosis, and congestive heart failure.
- Is there pallor? The finding of pallor suggests anemia.
- Is there hyperpigmentation? The presence of hyperpigmentation suggests Addison's disease.
DIAGNOSTIC WORKUP
Routine studies include a CBC, sedimentation rate, chemistry panel, urinalysis, thyroid panel, EKG, and chest x-ray. Blood volume and arterial blood gas studies may be useful. If there is cardiomegaly or a murmur, echocardiography and venous pressure and circulation time should be done. A cardiologist should also be consulted.
If there is hyperpigmentation, a serum cortisol and ACTH stimulation test should be done. A skull x-ray can be done to rule out pituitary tumors. A visual field examination by a qualified ophthalmologist may be helpful in this regard also. Twenty-four-hr blood pressure monitoring may be useful in the workup also.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
Other Book Chapters Related to Orthostatic hypotension
Read excerpts from these other book chapters related to Orthostatic hypotension:
Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.
More About Causes of Orthostatic hypotension
» Next page: Hypotension (In a Page: Signs and Symptoms)
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