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*Only for medical professionals to read and reference, everything from diagnostic criteria to classification and treatment.
Since Brad-bury and Eggleston described postural hypotension syndrome in 1925, scholars have been paying close attention to pre-syncope dizziness in patients with autonomic hypotension in the past 100 years.
Orthostatic dizziness/vertigo (HOD/V) is very common in the clinic, and the clinical manifestations of each patient are different, and there is a lack of auxiliary examination methods.
There was no unified diagnostic criteria for many years, until the Barani Vestibule Working Committee formulated the HOD/V diagnostic criteria in 2018 and released it in March 2019.
HOD/V is common in orthostatic hypotension (OH) and postural tachycardia syndrome (POST), as well as hypovolemia, anemia, autonomic nervous disease, bilateral vestibular disease, peripheral neuropathy, and benign paroxysmal positional vertigo , Persistent posture-perceptual dizziness and heart disease, etc.
Epidemiology HOD/V currently has no direct epidemiological data.
Based on community surveys, orthostatic dizziness is 2% to 30% in people over 60.
In a population survey covering all age groups, the one-year prevalence rate was 10.
9%, and the lifetime prevalence rate was 12.
5%.
A few studies have shown that the prevalence of orthostatic dizziness with OH in people over 65 years old is 2% to 20%.
In a large population base study, a standing test was conducted on adults over the age of 20 to observe the incidence of orthostatic dizziness and found that the prevalence of orthostatic dizziness was 4.
8%.
The diagnostic criteria HOD/V refers to dizziness/vertigo during erection.
1.
HOD/V diagnostic criteria (the following conditions must be met) at least one rise process (from lying to sitting/standing or from sitting to standing) or dizziness/vertigo or instability in the standing state, after sitting or lying down The symptoms disappeared.OH, POTS, or syncope were recorded in the standing or tilt test (OH, POTS, and decreased cerebral blood flow were recorded in the upright tilt test).
Can not be better explained by other diseases.
2.
Possible HOD/V diagnostic criteria (the following conditions must be met) at least 5 times of standing up process (from lying to sitting/standing or from sitting to standing) or dizziness/vertigo or instability in standing state, sitting down or The symptoms disappeared after lying down.
There is at least one accompanying symptom: general weakness/fatigue, difficulty thinking or concentrating, blurred vision, tachycardia/palpitations.
Can not be better explained by other diseases.
There is no condition to do the upright tilt test, or the upright tilt test does not record OH or POTS, but the cerebral blood flow changes in the lying position.
OHOH refers to a decrease of 20 mmHg in systolic blood pressure and at least 10 mmHg in diastolic blood pressure within 3 minutes in an upright tilt test.
Three common subtypes of OH: Neurogenic OH (nOH): originates from sympathetic catecholaminergic failure, standing or in a tilt test within 3 minutes of a 30 mmHg drop in systolic blood pressure and 15 mmHg in diastolic blood pressure; late-onset OH: standing Or in the tilt test, after 3 minutes, the systolic blood pressure decreased by at least 20 mmHg, and the diastolic blood pressure decreased by at least 10 mmHg; initial OH: blood pressure decreased briefly within 15 seconds after standing (systolic blood pressure> 30 mmHg, diastolic blood pressure decreased at least 10 mmHg) , It may be a common cause of syncope.
POTSPOTS is a common cause of erectile intolerance.
The prevalence age ranges from 15 to 50 years old.
It is mostly female, and the ratio of male to female is 1:5.
The pathophysiology of POTS is complex and multi-factorial.
The pathogenesis of POTS can be partial denervation of the circulatory system, low blood volume, accumulation of blood in the surrounding pool, or long-term bed rest.
Some blood have positive anti-sympathetic ganglion acetylcholine receptor antibodies, suggesting the existence of autoimmune autonomic peripheral neuropathy.
Hyperventilation and psychological factors can also form POTS.
Although POTS is not accompanied by OH, its standing dizziness/vertigo symptoms are similar to those of OH.
POTS leads to decreased cerebral perfusion and activation of sympathetic nerves.
During the upright tilt test, the heart rate increased at least 30 beats per minute within 10 minutes, or the heart rate exceeded 120 beats/min without OH.
For adolescents aged 12 to 19, the diagnosis of POTS requires a net increase of 40 beats per minute.
HOD/V with loss of consciousness-syncope The main types of syncope are reflex syncope, syncope caused by OH, and cardiogenic syncope.
HOD/V can be a prodromal symptom of reflex syncope and syncope caused by OH.
If HOD/V is immediately accompanied by syncope, hemodynamic causes are directly considered.
The appearance of prodromal symptoms of cardiogenic syncope (dizziness) is not necessarily related to changes in body position.
Reflex syncope is the most common, also known as vagal syncope (neurogenic syncope).
It is caused by autonomic reflex, leading to decreased sympathetic blood vessel tone and increased vagus function, decreased blood pressure and/or decreased heart rate, and it is triggered by prolonged standing or specific scene stimulation (such as seeing blood).
The typical vasovagal syncope has prodromal symptoms and signs 60 s before loss of consciousness, such as pale complexion, salivation, nausea, abdominal discomfort, sighing, and hyperventilation.
The classification of syncope 1 nerve-mediated reflex syncope Vasovagal syncope: emotional (fear, pain, instrument operation, and fainting blood) and erection.
Situational syncope: coughing and sneezing; gastrointestinal irritation (after meals, swallowing, defecation, and abdominal pain); urination (fainting after urination); hyperventilation after exercise (such as laughing, playing a brass instrument, lifting weights).
Carotid sinus syncope: mechanical stimulation of the carotid sinus; atypical condition (no obvious predisposing factors and/or atypical performance).
2 Orthostatic syncope.
Primary autonomic disorder: Mainly seen in neurodegenerative diseases, such as idiopathic orthostatic hypotension, multiple system atrophy, Parkinson's disease with autonomic abnormalities, and Lewy body dementia.
Secondary autonomic neuromodulation disorders: diabetes, spinal cord injury, amyloidosis, uremia.
Orthostatic hypotension caused by drugs: alcohol, vasodilators, diuretics, phenothiazines, antidepressants, antiparkinsonian drugs.
Insufficient blood volume: bleeding, diarrhea, vomiting, etc.
3 Cardiogenic syncope Syncope caused by arrhythmia: bradycardia, abnormal sinoatrial node power, atrioventricular junction disease, implantation equipment failure, various tachycardias, drug-induced bradycardia and tachycardia, hereditary Arrhythmia syndrome and so on.
Organic heart disease: valvular disease, myocardial infarction/ischemia, hypertrophic obstructive cardiomyopathy, heart mass (atrial mucus, tumor, etc.
), pericardial disease/packing congenital coronary artery abnormalities, artificial valve abnormalities.
Others: pulmonary embolism, acute aortic dissection, pulmonary hypertension.
Symptoms of HOD/V 1.
Dizziness or dizziness from lying or sitting position to standing or sitting position; or dizziness or dizziness in standing or sitting position without dizziness in lying position, or appearing immediately, or appearing after walking for a period of time.
2.
Accompanying symptoms include fatigue, cognitive impairment, blurred vision, cognitive difficulties are obvious in the elderly, such as interference in thinking and concentration; (more often, dizziness, dizziness, feeling of strangeness or openness, back of the head and neck Swelling and weakness of the shoulders, drowsiness, repeated yawns).
It is worth noting that even for patients with HOD/V with OH who have been identified, the probability of reappearing OH is relatively reduced even if the tilt test is repeated.
Therefore, if OH or POTS cannot be recorded, other accompanying erection symptoms are also helpful in diagnosing HOD/V.
HOD/V treatment 1.
Rehydration, according to climate and temperature, it is recommended to drink 2~3 L of water daily.
2.
Properly adjust the intake of salt, suggesting 2.
3~4.
6 g/d, pay attention to the effect on hypertension and cardiogenic edema.
3.
Appropriate exercise increases muscle strength, but strenuous exercise is not recommended to increase body temperature and increase water loss.
4.
Avoid elevated core body temperature, such as hot baths, saunas and strenuous exercise.
5.
Appropriate use of wedge-shaped mattresses to raise the head during sleep to treat patients with hypertension in the supine position. 6.
Use pressure clothing, such as abdominal compression and long-tube compression stockings.
7.
Eat small and frequent meals to avoid postprandial hypotension and blood accumulation in the gastrointestinal tract, and try not to exercise within 2 hours after a meal.
8.
Coffee and acarbose can reduce the occurrence of postprandial hypotension.
9.
Medication: Midodrine and Dracidopa (certified by FDA) are effective for the treatment of neurogenic hypotension, fluocinolone and pyridostigmine (not certified).
10.
Pay attention to orthostatic hypotension caused by drugs, antihypertensives, antidepressants, anticholinergics, dopamine-like drugs or vasodilators, etc.
Source of this article: Nerve News Content Speaker: Feng Jiachun Review of this article: Li Tuming, Deputy Chief Physician Responsible Editor: Mr.
Lu Li Copyright Statement This article is reproduced and forwarded to the circle of friends-End-Call for contributions welcome to the editor's mailbox: yxjsjbx@yxj.
org.
cn Please note Ming: [Submission] Hospital + department + name Contributions are in the form of word files, and the remuneration is favorable.
Edit WeChat: chenaFF0911
Since Brad-bury and Eggleston described postural hypotension syndrome in 1925, scholars have been paying close attention to pre-syncope dizziness in patients with autonomic hypotension in the past 100 years.
Orthostatic dizziness/vertigo (HOD/V) is very common in the clinic, and the clinical manifestations of each patient are different, and there is a lack of auxiliary examination methods.
There was no unified diagnostic criteria for many years, until the Barani Vestibule Working Committee formulated the HOD/V diagnostic criteria in 2018 and released it in March 2019.
HOD/V is common in orthostatic hypotension (OH) and postural tachycardia syndrome (POST), as well as hypovolemia, anemia, autonomic nervous disease, bilateral vestibular disease, peripheral neuropathy, and benign paroxysmal positional vertigo , Persistent posture-perceptual dizziness and heart disease, etc.
Epidemiology HOD/V currently has no direct epidemiological data.
Based on community surveys, orthostatic dizziness is 2% to 30% in people over 60.
In a population survey covering all age groups, the one-year prevalence rate was 10.
9%, and the lifetime prevalence rate was 12.
5%.
A few studies have shown that the prevalence of orthostatic dizziness with OH in people over 65 years old is 2% to 20%.
In a large population base study, a standing test was conducted on adults over the age of 20 to observe the incidence of orthostatic dizziness and found that the prevalence of orthostatic dizziness was 4.
8%.
The diagnostic criteria HOD/V refers to dizziness/vertigo during erection.
1.
HOD/V diagnostic criteria (the following conditions must be met) at least one rise process (from lying to sitting/standing or from sitting to standing) or dizziness/vertigo or instability in the standing state, after sitting or lying down The symptoms disappeared.OH, POTS, or syncope were recorded in the standing or tilt test (OH, POTS, and decreased cerebral blood flow were recorded in the upright tilt test).
Can not be better explained by other diseases.
2.
Possible HOD/V diagnostic criteria (the following conditions must be met) at least 5 times of standing up process (from lying to sitting/standing or from sitting to standing) or dizziness/vertigo or instability in standing state, sitting down or The symptoms disappeared after lying down.
There is at least one accompanying symptom: general weakness/fatigue, difficulty thinking or concentrating, blurred vision, tachycardia/palpitations.
Can not be better explained by other diseases.
There is no condition to do the upright tilt test, or the upright tilt test does not record OH or POTS, but the cerebral blood flow changes in the lying position.
OHOH refers to a decrease of 20 mmHg in systolic blood pressure and at least 10 mmHg in diastolic blood pressure within 3 minutes in an upright tilt test.
Three common subtypes of OH: Neurogenic OH (nOH): originates from sympathetic catecholaminergic failure, standing or in a tilt test within 3 minutes of a 30 mmHg drop in systolic blood pressure and 15 mmHg in diastolic blood pressure; late-onset OH: standing Or in the tilt test, after 3 minutes, the systolic blood pressure decreased by at least 20 mmHg, and the diastolic blood pressure decreased by at least 10 mmHg; initial OH: blood pressure decreased briefly within 15 seconds after standing (systolic blood pressure> 30 mmHg, diastolic blood pressure decreased at least 10 mmHg) , It may be a common cause of syncope.
POTSPOTS is a common cause of erectile intolerance.
The prevalence age ranges from 15 to 50 years old.
It is mostly female, and the ratio of male to female is 1:5.
The pathophysiology of POTS is complex and multi-factorial.
The pathogenesis of POTS can be partial denervation of the circulatory system, low blood volume, accumulation of blood in the surrounding pool, or long-term bed rest.
Some blood have positive anti-sympathetic ganglion acetylcholine receptor antibodies, suggesting the existence of autoimmune autonomic peripheral neuropathy.
Hyperventilation and psychological factors can also form POTS.
Although POTS is not accompanied by OH, its standing dizziness/vertigo symptoms are similar to those of OH.
POTS leads to decreased cerebral perfusion and activation of sympathetic nerves.
During the upright tilt test, the heart rate increased at least 30 beats per minute within 10 minutes, or the heart rate exceeded 120 beats/min without OH.
For adolescents aged 12 to 19, the diagnosis of POTS requires a net increase of 40 beats per minute.
HOD/V with loss of consciousness-syncope The main types of syncope are reflex syncope, syncope caused by OH, and cardiogenic syncope.
HOD/V can be a prodromal symptom of reflex syncope and syncope caused by OH.
If HOD/V is immediately accompanied by syncope, hemodynamic causes are directly considered.
The appearance of prodromal symptoms of cardiogenic syncope (dizziness) is not necessarily related to changes in body position.
Reflex syncope is the most common, also known as vagal syncope (neurogenic syncope).
It is caused by autonomic reflex, leading to decreased sympathetic blood vessel tone and increased vagus function, decreased blood pressure and/or decreased heart rate, and it is triggered by prolonged standing or specific scene stimulation (such as seeing blood).
The typical vasovagal syncope has prodromal symptoms and signs 60 s before loss of consciousness, such as pale complexion, salivation, nausea, abdominal discomfort, sighing, and hyperventilation.
The classification of syncope 1 nerve-mediated reflex syncope Vasovagal syncope: emotional (fear, pain, instrument operation, and fainting blood) and erection.
Situational syncope: coughing and sneezing; gastrointestinal irritation (after meals, swallowing, defecation, and abdominal pain); urination (fainting after urination); hyperventilation after exercise (such as laughing, playing a brass instrument, lifting weights).
Carotid sinus syncope: mechanical stimulation of the carotid sinus; atypical condition (no obvious predisposing factors and/or atypical performance).
2 Orthostatic syncope.
Primary autonomic disorder: Mainly seen in neurodegenerative diseases, such as idiopathic orthostatic hypotension, multiple system atrophy, Parkinson's disease with autonomic abnormalities, and Lewy body dementia.
Secondary autonomic neuromodulation disorders: diabetes, spinal cord injury, amyloidosis, uremia.
Orthostatic hypotension caused by drugs: alcohol, vasodilators, diuretics, phenothiazines, antidepressants, antiparkinsonian drugs.
Insufficient blood volume: bleeding, diarrhea, vomiting, etc.
3 Cardiogenic syncope Syncope caused by arrhythmia: bradycardia, abnormal sinoatrial node power, atrioventricular junction disease, implantation equipment failure, various tachycardias, drug-induced bradycardia and tachycardia, hereditary Arrhythmia syndrome and so on.
Organic heart disease: valvular disease, myocardial infarction/ischemia, hypertrophic obstructive cardiomyopathy, heart mass (atrial mucus, tumor, etc.
), pericardial disease/packing congenital coronary artery abnormalities, artificial valve abnormalities.
Others: pulmonary embolism, acute aortic dissection, pulmonary hypertension.
Symptoms of HOD/V 1.
Dizziness or dizziness from lying or sitting position to standing or sitting position; or dizziness or dizziness in standing or sitting position without dizziness in lying position, or appearing immediately, or appearing after walking for a period of time.
2.
Accompanying symptoms include fatigue, cognitive impairment, blurred vision, cognitive difficulties are obvious in the elderly, such as interference in thinking and concentration; (more often, dizziness, dizziness, feeling of strangeness or openness, back of the head and neck Swelling and weakness of the shoulders, drowsiness, repeated yawns).
It is worth noting that even for patients with HOD/V with OH who have been identified, the probability of reappearing OH is relatively reduced even if the tilt test is repeated.
Therefore, if OH or POTS cannot be recorded, other accompanying erection symptoms are also helpful in diagnosing HOD/V.
HOD/V treatment 1.
Rehydration, according to climate and temperature, it is recommended to drink 2~3 L of water daily.
2.
Properly adjust the intake of salt, suggesting 2.
3~4.
6 g/d, pay attention to the effect on hypertension and cardiogenic edema.
3.
Appropriate exercise increases muscle strength, but strenuous exercise is not recommended to increase body temperature and increase water loss.
4.
Avoid elevated core body temperature, such as hot baths, saunas and strenuous exercise.
5.
Appropriate use of wedge-shaped mattresses to raise the head during sleep to treat patients with hypertension in the supine position. 6.
Use pressure clothing, such as abdominal compression and long-tube compression stockings.
7.
Eat small and frequent meals to avoid postprandial hypotension and blood accumulation in the gastrointestinal tract, and try not to exercise within 2 hours after a meal.
8.
Coffee and acarbose can reduce the occurrence of postprandial hypotension.
9.
Medication: Midodrine and Dracidopa (certified by FDA) are effective for the treatment of neurogenic hypotension, fluocinolone and pyridostigmine (not certified).
10.
Pay attention to orthostatic hypotension caused by drugs, antihypertensives, antidepressants, anticholinergics, dopamine-like drugs or vasodilators, etc.
Source of this article: Nerve News Content Speaker: Feng Jiachun Review of this article: Li Tuming, Deputy Chief Physician Responsible Editor: Mr.
Lu Li Copyright Statement This article is reproduced and forwarded to the circle of friends-End-Call for contributions welcome to the editor's mailbox: yxjsjbx@yxj.
org.
cn Please note Ming: [Submission] Hospital + department + name Contributions are in the form of word files, and the remuneration is favorable.
Edit WeChat: chenaFF0911
