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Syndromes of orthostatic intolerance: a hidden danger
Author(s) -
Fedorowski A.,
Melander O.
Publication year - 2013
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/joim.12021
Subject(s) - medicine , orthostatic intolerance , orthostatic vital signs , asymptomatic , disease , risk factor , exercise intolerance , intensive care medicine , postural orthostatic tachycardia syndrome , tachycardia , cardiology , blood pressure , heart failure
Orthostatic hypotension ( OH ) is a relatively common heterogenous and multifactorial disorder, traditionally classified as neurogenic (less common but often more severe) or nonneurogenic (more common, with no direct signs of autonomic nervous system disease). The different clinical variants of orthostatic intolerance include initial, classical and delayed OH as well as postural tachycardia syndrome. Orthostatic instability may induce syncopal attacks either alone or in combination with other mechanisms, and is often dismissed as a precipitating factor. Moreover, prevalent OH is an independent risk factor for all‐cause mortality and cardiovascular morbidity, and the majority of patients with OH are asymptomatic or have few nonspecific symptoms. Management of symptomatic orthostatic intolerance includes both nonpharmacological and pharmacological methods, but it is not always successful and may lead to complications. Future studies of OH should focus on mechanisms that lead to neurogenic and nonneurogenic OH , novel diagnostic methods and more effective therapeutic modalities.