A nurse notifies you that a patient of yours has a blood pressure of 90/65. The day before his BP was 110/75.
- What is your differential diagnosis for this acute drop in BP?
The differential diagnosis for acute hypotension includes:
- Hypovolemia 20 to decreased fluid intake
- Acute bleed
- Hypovolemic (typically acute bleed)
- Cardiogenic – MI, arrhythmia, cardiac tamponade, pulmonary embolism
- Anaphylactic (i.e. medication, environment, food)
- Vasodilators – hydralazine, nitroglycerine, calcium channel blockers
- Antihypertensives – alpha blockers, beta blockers, calcium channel blockers
- What is the definition of orthostatic hypotension?
Orthostatic hypotension is defined as:
- Systolic BP drop ≥20mmHg from lying to standing
- Diastolic BP drop ≥10mmHg from lying to standing
These postural changes are often accompanied by an increase in heart rate increase ≥30bpm from lying to standing
- How would you assess this patient?
Initial assessment of this patient includes the following:
- Stabilize ABCs
- History – chest pain, palpitations, dyspnea, light-headedness, presyncope/syncope, blood in stool/melena, hemoptysis
- Repeat vitals with orthostatic vitals
- Physical exam – cardiac, JVP, respiratory, abdominal, skin
- Assess volume status and daily Ins/OUTs
- Review patient’s MAR for medications:
- New mediations?
- Doubling medications?
- If suspicious for ACS/MI – ECG, troponin, CK
Lanier JB, Mote MB and Clay EC. Evaluation and Management of Orthostatic Hypotension. Am Fam Physician. 2011, 84:527-536.