Orthostatic dysregulation is the term used to describe a regulatory disorder of blood pressure. It occurs when the affected person adopts an upright posture.
What is orthostatic dysregulation?
Orthostatic dysregulation is also known in medicine as orthostasis syndrome or orthostatic hypotension. It refers to a regulatory disorder of blood pressure when a person changes to an upright body position. The term orthostasis comes from the Greek and means “upright standing”. Orthostatic dysregulation is counted among the forms of arterial hypotension. In this case, there is a malfunction of the orthostasis reaction, which in healthy people ensures that the cardiovascular system works properly even in an upright position. However, orthostatic hypotension results in complaints such as palpitations, feelings of weakness, dizziness and nausea when the person assumes an upright posture. If the affected person sits or lies down again, the symptoms quickly subside. Medicine divides the regulation disorder into three forms:
- The sympathicotonic orthostatic hypotension.
- The asympathicotonic orthostatic hypotension
- The postural orthostatic tachycardia syndrome.
Causes
While the term hypotension refers to low blood pressure, orthostatic hypotension refers to an abrupt drop in blood pressure after standing up. During this process, blood drains from the head toward the feet. As a reaction to this process, the heartbeat is faster and the blood vessels contract, so that the blood pressure rises rapidly. The organism is able to return the blood to the head in a short time. However, if this reaction starts too slowly, this causes an insufficient inflow of blood towards the brain for a short time, making the affected person feel dizzy. Orthostatic dysregulation is not a life-threatening disorder, but it can sometimes lead to a loss of consciousness and even a fall accompanied by injury. It is not uncommon for increased age to be responsible for orthostatic dysregulation. Thus, over the years, the body partially loses the ability to respond to orthostasis. However, certain diseases are also considered a risk factor for orthostasis syndrome. These include, first and foremost, diabetes mellitus and diseases that affect the nerves that are important for blood pressure regulation. Another possible cause of orthostatic dysregulation is the use of certain medications. These are drugs that act against high blood pressure and cause vasodilatation. In addition to blood pressure medications, there are also diuretics, cytostatics, medications for Parkinson’s disease, hypnotics. However, tranquilizers, tricyclic antidepressants, opiates, psychotropic drugs, insulin, muscle relaxants as well as alcohol and drugs such as marijuana are also possible triggers of orthostasis syndrome. Other conceivable causes are cardiovascular diseases such as heart failure or pericarditis. Also, a narrowing of the aorta or disturbances in the heartbeat, infections, hypothyroidism, dysfunction of the anterior pituitary gland and adrenal cortex, permanent lack of exercise, prolonged bed rest, and a lack of fluids.
Symptoms, complaints, and signs
Orthostatic dysregulation is characterized by nonspecific symptoms. They usually become apparent after a sudden change in the body’s position, which primarily affects standing up after lying down. If the affected person stands for a longer period of time, the symptoms can intensify. General symptoms include a feeling of cold, nausea, pallor, sweating and inner restlessness. In addition, there is often palpitations, a feeling of trepidation, dizzy spells, headaches, drowsiness, unsteadiness when walking and standing, ringing in the ears, flickering eyes, and a feeling of emptiness in the head. Because of the discomfort, the patient is forced to sit or lie down again. In this case, the symptoms usually disappear quickly. In some cases, however, brief fainting is also possible, which poses the risk of a serious fall and associated injuries.
Diagnosis and course of the disease
Suspicion of orthostatic dysregulation usually arises from the patient’s medical history alone. To confirm the diagnosis, the treating physician usually performs a tilt table examination or a Schellong test. In the Schellong test, the patient remains on an examination couch for five to ten minutes while his blood pressure and pulse are measured. He is then asked to stand up quickly and remain standing for five to ten minutes. The pulse and blood pressure are also checked during this period. In the tilt table test, the doctor straps the patient to a table that can be tilted. After a rest period of twenty minutes, he tilts the table and thus straightens the patient. After he has been in a standing position for twenty minutes, the table is tilted back again and the procedure is repeated. In most cases, orthostatic dysregulation takes a positive course. Thus, the symptoms improve again in about 80 percent of all patients.
Complications
In most cases, this disease does not result in any particular complications and usually does not result in a life-threatening condition. In this regard, the symptoms and complaints may vary in severity in different patients. However, as a rule, most of the people affected by this disease suffer from pallor and nausea. There is headache and veil vision after changing position. Eye flickering or ringing in the ears may also occur. When walking, there is unsteadiness and the affected person appears dazed and confused. In most cases, the symptoms disappear relatively quickly when the patient lies down or sits up. No particular complications occur. However, in severe cases, the patient may become unconscious and may injure himself. Treatment of the disease is necessary only in severe cases. This is done with the help of medication and does not lead to further complications. If another underlying disease is responsible for these symptoms, it must be treated first. As a rule, the life expectancy of the affected person is not limited due to the disease.
When should one go to the doctor?
People who experience discomfort after a sudden or rapid change in body position should consult a doctor. If there is a pale complexion, malaise or nausea immediately after the performed movement, there is cause for concern. If there is flickering of the eyes, dizziness, or loss of balance, a physician should be consulted to avoid secondary symptoms or other problems. Ringing in the ears, headaches or a feeling of emptiness should be investigated. If disturbances of the heart rhythm develop, a racing heart develops, or loud palpitations occur, a physician is needed. In case of drowsiness after standing up or bending down, clarification of the symptoms is necessary. A brief loss of consciousness should be reported to a physician immediately. If possible, the ambulance service should be alerted so that the health of the affected person can be stabilized as quickly as possible. A feeling of cold, unsteadiness of gait or an increased risk of accidents should be presented to a physician. If anxiety, withdrawal behavior or almost complete avoidance of movement develops, the affected person needs help. If the complaints increase or new symptoms appear, a visit to the doctor is urgently recommended. Often, the existing discomfort intensifies as soon as the affected person stands for a certain time and then changes the body position.
Treatment and therapy
As far as possible, therapy for orthostatic dysregulation should be carried out without the administration of drugs. Only in severe cases does the patient receive alpha-adrenoceptor agonists. To counteract hypotension, which mostly occurs in the morning hours, it is recommended to perform exercises for the circulation when getting up. In this way, venous return can be stimulated by activating the lower leg muscles while the patient is still lying down. Before standing up, the patient can also remain seated for two minutes. A cool environment is also considered helpful, since cold also increases venous return. Often, even a strong cup of coffee provides relief.
Outlook and prognosis
In orthostatic dysregulation, the prognosis varies. Sympathicotonic orthostatic hypotension has a positive prognosis. They are readily treatable.In contrast, the asympathicotonic form of this disease is a serious condition with a worse prognosis. In the case of sympathicotonic orthostatic dysregulation, the affected person can lead a relatively normal life. However, he should take care of his health maintenance by various measures. It cannot be excluded that otherwise a deterioration, or a cardiovascular disease will occur. The extent to which orthostatic dysregulation is merely a nuisance, or the harbinger of later cardiovascular disease, is a matter of disagreement among physicians. In general, low blood pressure is not conspicuous because it damages the blood vessels. It can cause discomfort, but it can also provide freedom from discomfort. Measures that improve the prognosis are helpful. For example, patients should drink more fluids and saline. They should discontinue medications that promote orthostatic hypotension. Everyone can do a lot to keep the vessels healthy, for example, through exercise, Kneipp applications or brush massages. Those with orthostatic dysregulation can do much to positively influence the prognosis. Drug therapies only become necessary if the patient’s own measures are not sufficient. The asympathicotonic variant of orthostatic dysregulation is a chronic progressive form. This is difficult to control with therapeutic measures.
Prevention
To prevent discomfort from orthostatic dysregulation, getting up slowly and not too quickly is recommended. Sleeping with the upper body elevated is also considered useful.
Aftercare
Orthostatic dysregulation is a clinical picture that often depends on the patient’s behavior. Aftercare is thus prevention at the same time, so that the disorder occurs as rarely as possible in those affected. There is a whole bundle of measures that are used in aftercare and can be discussed in advance with the attending physician, for example the family doctor. Exercise is an important factor in stabilizing the circulation in the long term. Here, the individual aftercare around orthostatic dysregulation offers two efficient building blocks: On the one hand, it is important to move briefly again and again during the day to activate the circulation, for example, to get up from the PC at the desk and do a few gymnastic exercises. Consistent physical training is also important. Strength training and fitness courses are just as possible as swimming or playing sports. The only thing that is important is regular circulation activation. Drinking habits are also important in the follow-up of orthostatic dysregulation. Not drinking enough can lead to fluid deficiency, which can promote circulatory problems. Water and teas are particularly suitable as regular beverages. Alcohol, on the other hand, should be avoided, especially in large quantities. Nicotine can also have an unfavorable effect. At meals, care can be taken not to burden the organism with only lavish portions, but rather to eat light food more often during the day.
This is what you can do yourself
Self-help for the disease, after medical clarification and treatment, is primarily about reducing symptoms and improving the quality of life. This increase is possible by paying attention to a few aspects of everyday life. Since standing for long periods of time can be problematic, but this cannot always be avoided, compression stockings are a great help in such situations. Due to the pressure on the veins and the muscles in the legs, the blood cannot pool so quickly in the legs. This reduces the risk of a sudden drop in blood pressure. Furthermore, in the case of orthostatic dysregulation, it is advisable to change position slowly. After sleeping, it is advisable to remain seated for a moment. It is also helpful to stand up very slowly after sitting for a long time. This also reduces the risk of blood pooling in the legs and the symptoms of orthostatic dysregulation. It is particularly critical to stay in very warm rooms or even when bathing. In these cases, care should also be taken to avoid standing for long periods of time or standing up quickly. To reduce the sensitivity of the nervous system somewhat, alternating showers can help. This means that when showering, the water temperature should be alternated between hot and cold.It is most effective if the phase with cold water lasts about 30 seconds and preferably the leg region is showered off. Exercise and diet also have a significant impact. Eating high-salt foods can generally raise blood pressure somewhat, and building good leg muscles helps the body function naturally.
