Hypotension: Causes & Reasons

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Possible Causes for Hypotension

Orthostatic Hypotension

Evaluation of Orthostatic Hypotension FIGURE 1. Algorithm for the evaluation of orthostatic hypotension. [aafp.org]

"Orthostatic Hypotension". [en.wikipedia.org]

Convert to ICD-10-CM : 458.0 converts directly to: 2015/16 ICD-10-CM I95.1 Orthostatic hypotension Approximate Synonyms Hypotension, orthostatic Orthostatic hypotension (low [icd9data.com]

Acute Kidney Injury

[…] by hypotension was similar in the two groups. [ncbi.nlm.nih.gov]

The cause is usually ischemic (from prolonged hypotension) or nephrotoxic (from an agent that is toxic to the tubular cells). [aafp.org]

and 0 point for not having hypotension; 0 point for ATN-ISI score Table 5 Prognostic score of 90-day mortality in hospitalized patients with acute kidney injury. [doi.org]

Vasovagal Syncope

POTS has recently been conflated with VVS when excessive tachycardia is succeeded by hypotension during tilt testing. [ncbi.nlm.nih.gov]

In these cases additional measures should be used to counteract hypotension. [ncbi.nlm.nih.gov]

Neurocardiogenic (vasovagal) syncope is characterized by hypotension and bradycardia. [ncbi.nlm.nih.gov]

Sepsis

Abstract Purpose of review Norepinephrine is the first-line agent recommended during resuscitation of septic shock to correct hypotension due to depressed vascular tone. [doi.org]

Septic shock is defined as hypotension with a mean arterial pressure less than 65 mm Hg, requiring vasopressors despite adequate fluid resuscitation and/or lactic acid levels [ncbi.nlm.nih.gov]

The cardinal symptoms of sepsis include: Fever, chills or hypothermia Hypotension and oliguria Hyperventilation Mental status changes Skin manifestations These features may [symptoma.com]

Syncope

Syncope suspected of orthostatic hypotension (OH) can be mediated by neurogenic conditions, dehydration, or drugs. [acc.org]

In this article, we review POTS, orthostatic hypotension, and NMS with an emphasis on NMS. [ncbi.nlm.nih.gov]

Orthostatic Hypotension In orthostatic hypotension (postural hypotension), patients tend to faint on standing. [courses.washington.edu]

Diabetic Autonomic Neuropathy

Abstract Postural hypotension is uncommon in diabetes but can occur secondary to autonomic neuropathy. [ncbi.nlm.nih.gov]

CONCLUSION: Ergotamine may be considered in refractory cases of postural hypotension. [ncbi.nlm.nih.gov]

[…] and cimetidine (H1 and H2 histamine antagonists, respectively) markedly improved the hypotension and diarrhea and led to better blood glucose control. [ncbi.nlm.nih.gov]

Hypovolemia

KEYWORDS: Blood donation; Blood pressure variability; Heart rate; Heart rate variability; Non-hypotensive hypovolemia [ncbi.nlm.nih.gov]

The correlation of our findings with the results of an independent hypotensive CQI study will be presented. [ncbi.nlm.nih.gov]

Hypotension Hypovolemia causes hypotension when the blood volume loss is greater than 30%; this is called decompensated hypovolemic shock 7. [ehealthstar.com]

Acute Coronary Syndrome

Patients present with hypotension and distended neck veins, but without signs of pulmonary odema. [rcemlearning.co.uk]

S3/S4, APO, edema, distended tender liver) Look for any evidence of cardiogenic shock (altered mental state, poor skin perfusion +/- hypotension) Clinical Risk Stratification [litfl.com]

This can be due to acute thrombosis and plaque rupture, or to increased supply and demand from comorbid disease presentations (e.g., tachycardia, hypotension or anemia). [ncbi.nlm.nih.gov]

Autonomic Neuropathy

We present a unique case of orthostatic hypotension as the sole feature of a CRMP-5 paraneoplastic autonomic neuropathy in a patient with small cell lung cancer. [ncbi.nlm.nih.gov]

People with orthostatic hypotension are advised to avoid sitting up or standing up suddenly; wear compression stockings; avoid medications that aggravate orthostatic hypotension [diabetesselfmanagement.com]

The bladder problems tend to improve earlier than orthostatic hypotension. [ncbi.nlm.nih.gov]

Hypotension

Postprandial hypotension (a type of orthostatic hypotension) mostly affects older adults. Postprandial hypotension is a sudden drop in blood pressure after a meal. [nhlbi.nih.gov]

This kind of low blood pressure is known as postural hypotension or orthostatic hypotension. [webmd.com]

Severe Hypotension Linked to Shock Many factors and conditions can cause severe hypotension linked to shock. [nhlbi.nih.gov]

Pulmonary Embolism

Ultimately, insufficient cardiac output from the RV causes left ventricular under-filling which results in systemic hypotension and cardiovascular collapse. [ncbi.nlm.nih.gov]

During admission, the patient developed sudden, severe hypotension that was refractory to treatment. [ncbi.nlm.nih.gov]

KEYWORDS: Cardiopulmonary arrest; Hypotension; Surgical embolectomy; Thrombolysis [Indexed for MEDLINE] Free full text [ncbi.nlm.nih.gov]

Hyponatremia

After several weeks of suffering from gastroenteritis with vomiting, she presented with disturbance of consciousness, hypotension, dehydration, and severe hyponatremia (108 [ncbi.nlm.nih.gov]

Hypovolemia or Hypotension: For patients who develop hypovolemia or hypotension while receiving VAPRISOL, VAPRISOL should be discontinued, and volume status and vital signs [vaprisol.com]

He was in poor general condition, hypotensive, and he had dry mucous membranes and skin as well as mucosa hyperpigmentation. [ncbi.nlm.nih.gov]

Low-Cardiac-Output Syndrome

[…] supraventricular arrhythmias, development of LCOS, acute kidney injury (AKI), duration of mechanical ventilation, intensive care unit and hospital lengths of stay, and incidence of hypotension [ncbi.nlm.nih.gov]

Etiology Syndrome ass. with CV instability and hypotension. • Sepsis ( Hypotension with ed SVR) • Anaphylactic reaction (blood products, drugs) • Adrenal insufficiency (primary [slideshare.net]

[…] whereas 94% of those surveyed sometimes or always administer corticosteroids to patients with severe low cardiac output syndrome (two or more vasoactive agents and persistent hypotension [ncbi.nlm.nih.gov]

Septicemia

Septic shock• Sepsis with– Hypotension, for at least 1 h, despite adequate fluidresuscitation– Need for vesopressor9 10. [slideshare.net]

Abstract Purpose of review Norepinephrine is the first-line agent recommended during resuscitation of septic shock to correct hypotension due to depressed vascular tone. [doi.org]

Hypotension (low blood pressure) is an unfavorable sign. [healthcentral.com]

Adrenal Insufficiency

Unexplained hypotension may be a manifestation of an adrenal insufficient state in patients with a history of corticosteroid therapy on hemodialysis. [ncbi.nlm.nih.gov]

It should be part of the differential diagnosis in cases of hypotensive patient who is unresponsive to vasoactive agents. [ncbi.nlm.nih.gov]

A 78-year-old Japanese man with fatigue, appetite loss, skin hyperpigmentation, hypotension and hypoglycemia, visited our hospital to evaluate an abnormal chest X-ray and [ncbi.nlm.nih.gov]

Ascending Cholangitis

[…] stones (28%-70%) • Recent cholecystectomy • Endoscopic manipulation or ERCP, cholangiogram • History of cholangitis • Immunocompromised • Malignancy (10-57%) • Sepsis • Hypotension [slideshare.net]

Furthermore, some authors add hypotension and altered mental status to the Charcot triad's to form the Reynold's pentad, another diagnostic tool used to identify patients [symptoma.com]

[…] the more severe, life-threatening form, known as toxic cholangitis or cholangitis with sepsis, patients have purulent biliary tree contents, as well as evidence of sepsis, hypotension [bestpractice.bmj.com]

Benzodiazepine Overdose

Although rare, this may result in hypotension, cardiac dysrhythmias, lactic acidosis, seizures, or coma. [emedicine.medscape.com]

Coma, life-threatening hypotension, bradycardia and clinically significant respiratory depression are rare if only a benzodiazepine has been taken. [mhra.gov.uk]

Nystagmus Hallucinations Slurred speech Ataxia Coma Hypotonia Weakness Altered mental status, impairment of cognition Amnesia Paradoxical agitation Respiratory depression Hypotension [emedicine.medscape.com]

Upper Gastrointestinal Bleeding

Worrisome signs are tachycardia, hypotension (systolic blood pressure < 90 mm Hg), orthostatic hypotension, and findings indicative of poor perfusion such as cool extremities [symptoma.com]

[…] malaise/weakness fever dizziness Physical exam positive stool guiaic hypotension tachycardia fever Evaluation CBC recall that hematocrit is not an accurate measure of blood [medbullets.com]

[…] and need for endoscopic intervention advanced age > 60 years severe comorbidity active bleeding witnessed hematemesis, red blood per NG tube, bright red blood per rectum hypotension [medbullets.com]

Addison Disease

[…] of hypotension in these individuals. [ncbi.nlm.nih.gov]

During admission for evaluation of hypotension, she was also detected to have hyponatremia. Hyponatremia and hypotension failed to improve despite fluid resuscitation. [ncbi.nlm.nih.gov]

She was hyperpigmented, hypotensive and hyponatraemic despite rehydration. [ncbi.nlm.nih.gov]

Kounis Syndrome

Emergency medicine team with the doctor was sent to an 87 year old woman who had an altered mental state, hypotension and urticaria. [eusem.org]

It can cause hypersensitivity reactions, leading to hypotension, rash, pulmonary edema, and, very rarely, Kounis syndrome (KS). [cureus.com]

He developed constricting chest discomfort associated with dyspnea, sweating and hypotension. [revportcardiol.org]

Cinchonism

[…] irreversible tunnel vision and very severe visual impairment.Patients treated with quinine may also suffer from low blood sugar, especially if it is administered intravenously, and hypotension [en.wikipedia.org]

Patients treated with quinine may also suffer from hypoglycemia (especially if administered intravenously ) and hypotension (low blood pressure ). [academickids.com]

Jarisch Herxheimer Reaction

Penicillin given on the first day and tetracycline on subsequent days to avoid severe Jarisch-Herxheimer reactions, has the disadvantage of a longer period of spirochetemia and hypotension [ncbi.nlm.nih.gov]

Shortly afterward, she became hypotensive and required fluid resuscitation. [ncbi.nlm.nih.gov]

She became tachycardic and hypotensive after her first dose of antibiotic, and she developed disseminated intravascular coagulation. [scholars.northwestern.edu]

Anaphylaxis

Use of vasopressors should be considered if hypotension persists. [ncbi.nlm.nih.gov]

The hypotensive state was refractory to large amount of crystalloid infusion and a series of examinations were performed to determine the shock etiology. [ncbi.nlm.nih.gov]

Hypotension often resolves after epinephrine is given. [merckmanuals.com]

Hemothorax

Marked blood loss produces hypotension and shock. [symptoma.com]

Positive pressure ventilation - +/- intubation and ventilation Cardiac Tamponade - penetrating wound (usually) - Beck's triad (hypotension, distended neck veins, muffled [fprmed.com]

Risks and benefits of hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis. [ncbi.nlm.nih.gov]

Pericardial Effusion

[…] physicians must maintain vigilance in suspecting pericardial effusion and tamponade in patients with known or suspected malignancy who present with tachycardia, dyspnea, and hypotension [ncbi.nlm.nih.gov]

Pericardial effusion is initially asymptomatic, but cardiac tamponade has a distinct clinical presentation, including hypotension, tachycardia, jugular venous congestion, [amboss.com]

Recall Beck's triad of distended neck veins, distant heart sounds, and HYPOtension. [em.emory.edu]

Lower Gastrointestinal Hemorrhage

The patient re-presented to the emergency room with recurrent bleeding, anemia, and hypotension. [ncbi.nlm.nih.gov]

A history of prior gastrointestinal bleeding, transfusions, orthostatic hypotension, or tachycardia were not predictors for a positive angiogram. [ncbi.nlm.nih.gov]

The inclusion criteria were hematochezia or melena and hypotension refractory to conservative treatment and requiring blood transfusion. [ncbi.nlm.nih.gov]

Pneumothorax

The classic presentation will be a patient in distress with tachycardia, tachypnea, hypotension and hypoxia. [cdemcurriculum.com]

Tension Pneumothorax is 2 Diseases rather than 1 Awake/Spontaneously Breathing Patients Purely hypoxemic No hypotension until just before collapse May have long periods of [emcrit.org]

Vital signs frequently demonstrate tachycardia, tachypnea and, depending on the severity, hypoxia and hypotension. [cdemcurriculum.com]

Cardiogenic Shock

He is profoundly hypotensive with low O2 sats and obvious CHF. The patient’s blood pressure will transiently respond to fluid resuscitation. [emsimcases.com]

Signs and symptoms of hypotension are present: Weak or absent peripheral pulses; mottled extremities from low flow states; diaphoresis; and pallor. [cathlabdigest.com]

The characteristic features are: poor tissue perfusion: poor cerebral function cool extremeties oliguria hypotension poor cardiac output Cardiogenic shock is most commonly [gpnotebook.co.uk]

Shy-Drager Syndrome

Hypotension, Dysautonomic — Dysautonomic Orthostatic Hypotension — Dysautonomic Orthostatic Hypotensions — Hypotension, Dysautonomic Orthostatic — Hypotensions, Dysautonomic [mesh.kib.ki.se]

Progressive Autonomic Hypotension Syndrome, Dysautonomia-Orthostatic Hypotension Syndromes, Dysautonomia-Orthostatic Hypotension, Dysautonomic Orthostatic Hypotensions, [online-medical-dictionary.org]

Their conclusion that orthostatic hypotension and central nervous system dysfunction were probably related is obvious today but at the time seemed prescient. [doi.org]

Hypovolemic Shock

CONCLUSION: The shock bowel sign and the CT hypotension complex are frequently associated with hypotension from causes other than trauma-induced hypovolemic shock, such as [ncbi.nlm.nih.gov]

Severe bleeding and hypovolemic shock causing hypotension are most often associated with tachycardia. [ncbi.nlm.nih.gov]

Shock is characterised by systemic hypotension due either to reduced cardiac output or to reduced effective circulating blood volume. [symptoma.com]