Abstract
A simple bedside test to distinguish neurogenic from non-neurogenic causes of orthostatic hypotension (OH) is the ratio of heart rate increase during OH to the simultaneous decrease in systolic blood pressure (SBP), i.e. the ΔHR/ΔSBP ratio. In a patient suffering from persistent OH we monitored the ΔHR/ΔSBP ratio to aid with a targeted therapy. During a six-week period four pairs of postural tests were performed, one in the fasting and the other in the postprandial state. Inconsistency of the ΔHR/ΔSBP ratio under the patient's apparently stable clinical condition was confusing. So, the ΔHR/ΔSBP ratio did not help in taking therapeutic decisions.
Highlights
A simple bedside test to distinguish neurogenic from non-neurogenic causes of orthostatic hypotension (OH) is the ratio of heart rate increase to the simultaneous decrease in systolic blood pressure during OH (ΔHR/ΔSBP ratio) [1]
Since hypovolemia and deconditioning had resolved but OH persisted we considered that critical illness neuropathy might be implicated in the causation of OH [3, 4]
Common causes of OH are medications, hypovolemia, and autonomic neuropathies either primary or secondary [9,10]
Summary
A simple bedside test to distinguish neurogenic from non-neurogenic causes of orthostatic hypotension (OH) is the ratio of heart rate increase to the simultaneous decrease in systolic blood pressure during OH (ΔHR/ΔSBP ratio) [1]. A 72-year-old man was admitted for post-acute care, having recovered from complications of elective surgery He was a longtime hypertensive with the blood pressure (BP) fairly controlled on valsartan treatment. When the patient's condition further improved, he could be weaned from parenteral fluids. He had a good appetite, was sitting the on a chair most of the day, was walking without assistance 50 meters three times a day. The patient postponed electrophysiologic testing in the face of the corona epidemic
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