Abstract
Supine orthostatic hypertension with orthostatic hypotension is an autonomic dysfunction where the patients present with hypertension when supine and with decrease in blood pressure while bearing an upright posture. We report on a 74-year-old male who was admitted with dizziness and was found to have profound orthostatic hypotension with supine hypertension. The patient also developed orthostatic paroxysmal premature ventricular beats as well as nonsustained ventricular tachycardia. In this report, we attempt to present the possible mechanism of orthostatic ventricular tachycardia in our patient and the overview of the treatment strategies used in management of patients with supine hypertension and orthostatic hypotension.
Highlights
A 74-year-old Caucasian male with a history of hypertension, stroke 4 years ago, hypothyroidism, and profound deafness was admitted to the hospital with episodes of orthostatic dizziness and disorientation
The patient was admitted to the telemetry and started having premature ventricular contractions (PVCs) and runs of nonsustained ventricular tachycardia (NSVT)
Physical examination of the patient revealed a significant orthostatic blood pressures drop from supine 155/79, to sitting 110/69, and standing 88/58 with no fluctuation in heart rate
Summary
Normal standing increases pooling of more than half a liter of blood to the dependent body compartments, which significantly lowers venous return and eventually affecting cardiac output, leading to decreased blood pressure. This initiates a compensatory reflex mechanism in the carotid sinus and aortic arch.[1] This compensatory mechanism leads to a boost in.
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