Hypotension (low blood pressure)|causes, types, sign & symptoms, treatment

Hypotension 

Content: 

• Definition
• Types
• Causes
• Sign and symptoms
• Treatment

Hypotension definition:

•     Low blood pressure is defined as any blood pressure that is below than the normal level expected for an individual in a given environment.
• Systolic pressure is < 90mm Hg it is considered as hypotension.
• Low blood pressure is called as hypotension

Types:

• primary/essential hypotension
• – secondary hypotension
• - orthostatic hypotension
• – Neurally mediated hypotension

1.Primary and essential hypotension:(unknown cause)

• It is the low BP that develops in the absence of any underlying disease and develops due to some unknown cause . It is also called essential hypotension 
• Frequent fatigue & weakness are common symptoms
• Not susceptible to heart or renal disorder.

2.secondary hypotension:(disease cause)

•  It is the hypotension that occurs due to some underlying diseases . This diseases
• which cause hypotension are:

1. myocardial infarction 
2. hypo activity of pituitary gland 
3. hypo activity of adrenal glands
4. tuberculosis
5. nervous disorder

3.orthostatic hypotension:(when standing up -from a sitting or lying position )

• This type of low BP occurs when standing up from a sitting or lying position.
• it can make feel like dizzy or lightheaded . Or even make you faint .
•  It is occurs if your body isn’t able to adjust BP & blood flow fast enough for the changes in position .
• This type of low blood pressure usually last For only few seconds or minutes after you stand up . You may need to sit or lie down for a short time while you bp returns to normal
• Orthostatic hypotension can occur in all age groups - However its more common in old adults ,especially those who are frail or poor health .

4.neurally mediated hypotension:

•  Neurally mediated hypotension is BP drops after you’ve been standing for a long time . 
• You may feel Dizzy ,faint , or sick to the stomach as a result of this type of low BP also can occur 
• if you have  an upsetting, or scary experience . 
• Stress causes an abnormal autonomic reflex
• Normaly increased sympathetic tone replaced by a increased vagal tone . 
• Variable contribution of vasodilation & bradycardia .
• Example include syncope from : 

1. -pain or fear . 
2. carotid sinus hypersensitivity . 
3. situational ( cough , micturition , defection syncope)

Causes:

Reduced cardiac output: 

• ❖ hypovolemia (haemorrhage , dehydration)
• ❖ Impaired venous return (orthostatic hypotension; gravity)
• ❖ Reduced heart rate (sinus bradycardia ,AV nodal block)
• ❖ Elevated heart rate (tachycardia, fibrillation)
• ❖ Autonomic dysfunction (autonomic neuropathy)

Reduced systemic vascular resistance: 

• ❖ Systemic vasodilation (septic shock , anaphylaxis)
• ❖ Autonomic dysfunction (autonomic neuropathy)

Sign and symptoms:

hypotension s/s

• Dizziness
  Headache
• Fainting
• Seizure
  

• Stiff neck
• Pale skin

• Shortness and shallow of breath
•   Irregular heartbeat

•   Diarrhea
• Vomitting

• Thirst, fatigue, depression 

Investigation:

• Blood pressure diagnostic test like:
• Valsalva maneuver 
• ECG
• Blood samples test
• Urine analysis
• Tilt table test

Treatment:

Drug for bradycardia hypotension

Drug pneumonic is - IDEA

• I-isoproponal
• D-Dopamine
• E-Epinephrine
• A-Atrophine

Patient response (consciousness ) no pulse do -CPR protocols

Low BP with pulse keep the patient in leg raises position, patient not waked up do medication treatment.

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