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Orthostatic blood pressure recovery patterns in suspected syncope in the emergency department
- Source :
- Emergency Medicine Journal : EMJ, Emergency medicine journal, 35, 226-230. BMJ PUBLISHING GROUP
- Publication Year :
- 2018
- Publisher :
- BMJ Publishing Group, 2018.
-
Abstract
- IntroductionOrthostasis is a frequent trigger for (pre)syncope but some forms of orthostatic (pre)syncope have a worse prognosis than others. Routine assessment of orthostatic BP in the ED can detect classic orthostatic hypotension, but often misses these other forms of orthostatic (pre)syncope. This study aimed to determine the frequency of abnormal orthostatic BP recovery patterns in patients with (pre)syncope by using continuous non-invasive BP monitoring.MethodsWe performed a prospective cohort study in suspected patients with (pre)syncope in the ED of a tertiary care teaching hospital between January and August 2014. Orthostatic BP was measured during the active lying-to-standing test with Nexfin, a continuous non-invasive finger arterial pressure measurement device. Orthostatic BP recovery patterns were defined as normal BP recovery, initial orthostatic hypotension, delayed BP recovery, classic orthostatic hypotension and reflex-mediated hypotension.ResultsOf 116 patients recruited, measurements in 111 patients (age 63 years, 51% male) were suitable for analysis. Classic orthostatic hypotension was the most prevalent abnormal BP pattern (19%), but only half of the patients received a final diagnosis of orthostatic hypotension. Initial orthostatic hypotension and delayed BP recovery were present in 20% of the patients with (pre)syncope of whom 45% were diagnosed as unexplained syncope. Reflex-mediated hypotension was present in 4% of the patients.ConclusionContinuous non-invasive BP measurement can potentially identify more specific and concerning causes of orthostatic (pre)syncope. Correct classification is important because of different short-term and long-term clinical implications.
- Subjects :
- Adult
Male
medicine.medical_specialty
emergency department
Posture
Short Report
Blood Pressure
030204 cardiovascular system & hematology
Critical Care and Intensive Care Medicine
Tertiary care
non invasive
Syncope
Cohort Studies
03 medical and health sciences
Orthostatic vital signs
Hypotension, Orthostatic
0302 clinical medicine
Heart Rate
Internal medicine
Journal Article
Medicine
Humans
In patient
Prospective Studies
Prospective cohort study
Aged
Aged, 80 and over
Academic Medical Centers
biology
business.industry
Syncope (genus)
030208 emergency & critical care medicine
Blood Pressure Determination
General Medicine
Emergency department
Middle Aged
biology.organism_classification
Blood pressure
Emergency Medicine
Cardiology
vascular-arterial
Orthostatic blood pressure
Female
business
Emergency Service, Hospital
Subjects
Details
- Language :
- English
- ISSN :
- 14720213 and 14720205
- Volume :
- 35
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Emergency Medicine Journal : EMJ
- Accession number :
- edsair.doi.dedup.....ad658c0bc5028c3755f75abac802c35d