What are signs and symptoms of Hypotension?

Signs and symptoms of Hypotension include: - Lightheadedness or dizziness - Fainting (in cases of extremely low pressure) - Chest pain - Shortness of breath - Irregular heartbeat - Fever higher than 101 degrees Fahrenheit - Headache - Stiff neck - Severe upper back pain - Cough with sputum - Diarrhea - Vomiting - Issues with urination - Acute allergic reactions - Fatigue - Vision changes

How do you get Hypotension?

Hypotension can be caused by various factors, including illnesses or conditions that affect the heart's pumping or the resistance in the arteries, certain medications, severe blood loss, dehydration, orthostatic hypotension, and different types of shock.

What else can Hypotension be?

A doctor needs to rule out the following conditions when diagnosing Hypotension: - Benign hypotension - Distributive shock - Cardiogenic shock - Hypovolemic shock - Obstructive shock - Combined-type hypotensive shock

How is Hypotension treated?

Hypotension, or low blood pressure, is treated based on the underlying cause and the presence of symptoms. If low blood pressure does not cause any symptoms, it usually does not require serious treatment. However, if symptoms are present, it is important to identify the cause and try to reverse it. Tests and procedures such as electrocardiograms, echocardiograms, chest X-rays, and ultrasounds can provide helpful clues to determine the cause of low blood pressure. Monitoring urine production, maintaining electrolyte balance, and adjusting medications may also be necessary. In serious cases, replenishing fluid levels, stopping bleeding, and using vasopressor medications may be crucial. Infections may require blood testing and antibiotics, while allergic reactions may be treated with epinephrine. Steroids can be used in cases where low blood pressure is due to widened blood vessels and other treatments are not effective.

What are the side effects when treating Hypotension?

When treating hypotension, there can be side effects such as death, shock, multiple organ failure, and serious infection if the low blood pressure is left untreated.

Are there long term effects of Hypotension?

The prognosis for benign, or harmless, low blood pressure is generally very good. However, the prognosis for low blood pressure that comes with symptoms can vary depending on the cause and severity of the condition.

What type of doctor should I see for Hypotension?

You should see a doctor specializing in cardiology or internal medicine for hypotension.

Hypotension

What is Hypotension?

Hypotension is a medical term for low blood pressure, which is generally when values fall below 90/60. Though there isn’t a universally accepted value for low blood pressure, it’s usually seen as a fairly harmless condition primarily because it often doesn’t cause any symptoms. However, it can be a problem when the pressure isn’t strong enough to supply important organs with blood that carries oxygen. When this happens, it can impact a person’s quality of life with various symptoms.

Hypotension is categorized based on the particular measurements of your blood pressure. There are different degrees to which blood pressure can drop. It could be a drop in systolic blood pressure (the top number) to less than 90 mm Hg, or mean arterial pressure (the average blood pressure over a full heartbeat cycle) becoming less than 65 mm Hg. It could also be a drop in diastolic blood pressure (the bottom number) to less than 40 mm Hg. Another form is orthostatic hypotension, defined by a drop in systolic pressure by more than 20 mm Hg or a drop in diastolic pressure by more than 10 mm Hg when you stand up from lying down. Some people rely on medication to manage low blood pressure, which is known as profound hypotension. In extreme cases, a rapid drop in blood pressure, known as hypotensive shock, may happen and can threaten a person’s life.

To put it simply, your blood pressure is determined by how much blood your heart pumps and how much resistance there is to the flow of blood in your blood vessels. It is represented as a simple equation:

Blood Pressure = Cardiac output (the amount of blood your heart pumps) x Total peripheral vascular resistance (the resistance to blood flow in the blood vessels)

And, the mean arterial pressure, which is the average blood pressure over one complete heartbeat cycle, calculated roughly as:

Mean arterial pressure = 2/3 diastolic pressure (the bottom number) + 1/3 systolic pressure (the top number)

What Causes Hypotension?

Blood pressure is controlled by two main aspects: the amount of blood your heart pumps, and the resistance to this blood flow in your arteries. Any illness or condition that affects either the heart’s pumping or the resistance in your arteries can cause low blood pressure.

Think of your heart as a pump system. It produces a pressure difference to circulate blood all over your body. This pumping capacity is known as the cardiac output. If you want to calculate your cardiac output, you multiply the amount of blood your heart pumps with each beat (stroke volume) by the number of times your heart beats per minute (heart rate).

If an illness reduces your stroke volume or heart rate, your cardiac output will decrease too. This means your heart’s pumping ability decreases, which can lower your blood pressure. Certain medications can also lower blood pressure by affecting these parameters. These include beta-blockers and calcium channel blockers – known for reducing heart rate – and diuretics, which can lower the stroke volume. Conditions that can affect these include heart irregularities, issues with your heart valves, heart failure, severe blood loss, and a condition where fluid builds up around the heart, called cardiac tamponade.

Peripheral vascular resistance refers to the resistance the blood encounters when flowing through small arteries in different parts of your body. This resistance is mainly determined by the size of your arteries. If the arteries get narrower, the resistance to the blood flow increases, thus raising blood pressure. The opposite happens if the arteries get larger, as this reduces blood flow resistance and lowers blood pressure.

The body usually keeps these arteries relaxed and wide. But, certain medications or illnesses that stop this normal functioning can lead to low blood pressure. In the case of orthostatic hypotension, your blood pressure can drop when you stand up abruptly due to dehydration and your body’s failed responses of increasing heart rate and peripheral resistance.

Normally, these two mechanisms – cardiac output and peripheral vascular resistance – balance each other out. If one decreases, the other increases to maintain your blood pressure.

However, severe illness can disrupt this balance, leading to different types of shock, or a sudden drop in blood flow throughout the body. These shocks can be distributive, cardiogenic, hypovolemic, obstructive, or a mix of these.

Distributive shock is when your body struggles to maintain peripheral resistance. Your heart function tries to compensate but struggle to maintain blood flow. This can present with warm skin, swelling, increased mucus production, and a fast heart rate. An example is an anaphylactic allergic reaction or septic shock.

Cardiogenic shock happens when the heart is not producing enough output while your body maintains peripheral resistance. Symptoms include cold, dry skin and a slow heart rate.

Hypovolemic shock is a severe drop in blood volume to a point where your body can’t maintain blood pressure. This could be due to a major blood loss via trauma, overuse of diuretics, or due to specific hormone deficiencies.

Obstructive shock is when there’s a blockage in the cardiovascular system reducing the heart’s pumping efficiency and lowering blood pressure. Some examples include lung blood clots or compression/blockage around the heart.

A type of shock can also happen if the above issues occur together. For example, Waterhouse-Friderichsen syndrome – an adrenal gland failure due to severe bacterial infection can lead to a combination of hypovolemic and distributive shock.

Risk Factors and Frequency for Hypotension

The amount of people who experience low blood pressure, or hypotension, can widely vary. This is because it depends on what is actually causing the low blood pressure. In general, elderly people experience non-traumatic, noticeable episodes of hypotension more often. On the contrary, healthy and physically active individuals often have lower resting blood pressures that do not cause any symptoms or problems.

Signs and Symptoms of Hypotension

Hypotension, or low blood pressure, often doesn’t have any symptoms. However, if symptoms do show up, the most typical one is feeling lightheaded or dizzy. Extremely low blood pressure can cause a person to faint. All the other symptoms are usually related to the root cause of the low blood pressure rather than the low pressure itself. They can range from chest pain and difficulty breathing, to a high fever or severe upper back pain. Individuals may also experience irregular heartbeat, cough with phlegm, upset stomach, issues with urination, allergic reactions, tiredness, or changes in their vision.

Lightheadedness or dizziness
Fainting (in cases of extremely low pressure)
Chest pain
Shortness of breath
Irregular heartbeat
Fever higher than 101 degrees Fahrenheit
Headache
Stiff neck
Severe upper back pain
Cough with sputum
Diarrhea
Vomiting
Issues with urination
Acute allergic reactions
Fatigue
Vision changes

Testing for Hypotension

If your doctor suspects that you have a particular health issue, they will usually start with basic blood tests. These can include tests like a complete blood count, which gives the numbers of different types of cells in your blood, a thyroid-stimulating hormone test, and a free T4 test (both for checking your thyroid health), and a test for cortisol (a hormone that plays a part in stress response).

If your health situation is more urgent and you’re experiencing symptoms of shock, your doctor may order a quick ultrasound test of your heart, called an echocardiogram. This test will measure how well the chambers of your heart are working, and will also check whether there is any fluid around your heart. They may also look at the inferior vena cava, which is a large blood vessel that carries blood from your body back to your heart. This can give clues as to how your body is responding to the shock and how best to manage your fluids.

If these tests show that your heart is working well but you’re still in shock, it might be due to the blood not being distributed properly around your body. To manage this, your doctor will regularly monitor the variation in your pulse pressure (the difference between your systolic and diastolic blood pressure) to determine the best way to replenish your body’s fluids.

If your doctor thinks that you might have a type of blood clot known as a saddle embolus in your lung, which can cause very low blood pressure, they may recommend a special type of scan called a CT angiogram of your chest. This would allow them to see the blood vessels in your lungs and identify any clots.

Treatment Options for Hypotension

Low blood pressure, or hypotension, that doesn’t cause any symptoms usually doesn’t need serious treatment. But if it does cause symptoms, it’s important to figure out what’s causing the low blood pressure and try to reverse it. Certain tests and procedures can provide helpful clues to figure out the cause of the low blood pressure. These can include electrocardiograms, which are tests of the heart’s electrical activity; echocardiograms, which are ultrasound images of the heart; and chest X-rays.

If someone with low blood pressure has been in an accident and there’s no obvious bleeding, a specific type of ultrasound known as an ‘extended focused assessment with sonography in trauma’ (or e-FAST) can be performed. This exam will help identify any bleeding that might be hidden inside body cavities.

Tracking something as simple as how much urine a person is producing can be really helpful when treating low blood pressure. This helps doctors know if the fluids they’re giving to treat the low blood pressure are the right amount. Maintaining the balance of vitamins and minerals in a person’s circulation (known as electrolytes) is also important, and they might need to be replaced if levels get too low. Recording a person’s heart rate and blood pressure when they change from lying down to standing up can also provide useful information.

If a medication seems to be causing low blood pressure, it might need to be stopped. In serious cases where low blood pressure is associated with shock, replenishing the body’s fluid levels quickly and stopping any bleeding can be crucial. Sometimes, medications called vasopressors, which cause blood vessels to narrow and can raise blood pressure, might be needed if the pressure drops too low.

If low blood pressure is a symptom of an infection (known as sepsis), then taking blood samples for testing and starting antibiotics can be very important parts of treatment. If an allergic reaction is suspected and causing low blood pressure (anaphylaxis), a shot of a medication called epinephrine can help.

Finally, in some cases where low blood pressure is due to a type of shock where the blood vessels get too wide, and where fluids and vasopressor medications aren’t helping, steroids can often assist in maintaining blood pressure.

There are several types of hypotension (low blood pressure) and shock conditions, which include:

Benign hypotension: a harmless form of low blood pressure.
Distributive shock: a condition where blood isn’t distributed properly in the body’s smallest vessels.
Cardiogenic shock: a condition where the heart can’t pump enough blood to meet the body’s needs.
Hypovolemic shock: a severe blood and fluid loss that make the heart unable to pump enough blood to the body.
Obstructive shock: a condition where something blocks blood from flowing to the heart.
Combined-type hypotensive shock: a condition where more than one type of shock is present.

What to expect with Hypotension

The outlook for benign, or harmless, low blood pressure is generally very good. On the other hand, low blood pressure that comes with symptoms can vary in how it affects a person’s health. This depends on what’s causing the low blood pressure and how severe it is.

Possible Complications When Diagnosed with Hypotension

Untreated low blood pressure and poor heart function can lead to serious consequences, including death. If someone is on the verge of going into shock, or is already in it, their untreated low blood pressure can cause multiple organs to fail. To prevent these severe outcomes, current guidelines for treating patients who are in shock or heading towards severe infection emphasize giving plenty of fluids quickly and effectively.

Possible consequences of untreated low blood pressure: