orthostatic intolerance ( OI ) is the development of symptoms when standing upright relieved when lying down. There are many types of orthostatic intolerance. OI can be a subcategory of dysautonomia, an autonomic nervous system disorder that occurs when a person stands up.
There is a substantial overlap between orthostatic intolerance syndrome on the one hand, and either chronic fatigue syndrome (CFS) or fibromyalgia (FM) on the other. It affects more women than men (women-male ratio at least 4: 1), usually under the age of 35 years.
Orthostatic intolerance occurs in humans because standing upright is a fundamental stressor and requires rapid and effective blood and neurological circulatory compensation to maintain blood pressure, cerebral blood flow, and consciousness. When humans stand, about 750 mL of chest blood is suddenly transited down. People suffering from OI do not have the basic mechanism to compensate for this deficit. Changes in heart rate, blood pressure, and cerebral blood flow that produce OI can be caused by abnormalities in the interaction between blood volume control, cardiovascular system, nervous system and circulatory control system.
Video Orthostatic intolerance
Symptoms
Orthostatic intolerance is divided, roughly based on patient history, in two variants: acute and chronic.
Acute OI
Patients suffering from acute OI usually show impairment with temporary loss of consciousness and posture, with rapid recovery (simple fainting, or syncope), and remain conscious during posture loss. This differs from syncope caused by heart problems because there are known triggers for fainting (standing, heat, emotion) and identifiable prodrome symptoms (nausea, blurred vision, headache). Like Dr. Julian M. Stewart, an expert at OI from New York Medical College stated, "Many syncope patients do not have the same illness, between fainting, they're okay."
Symptoms:
- Changed vision (blurred vision, "white smoothness"/gray, gray, double vision)
- Anxiety
- Training intolerance
- Fatigue
- Headache
- The heart palpitates, as the heart hits to compensate for falling blood pressure
- Hyperpnea or sensation of breathing or swallowing difficulty (see also hyperventilation syndrome)
- Lightheadedness
- Sweating
- Tremulousness
- Weaknesses
The classic manifestation of acute OI is a soldier who fainted after standing stiffly at attention for long periods of time.
OI Chronic
Patients with chronic orthostatic intolerance have symptoms on most or all days. Their symptoms may include most of the symptoms of acute OI, plus:
- Nausea
- Neurocognitive deficits, such as attention problems
- Pallor
- Sensitivity to heat
- Sleeping problems
- Other vasomotor symptoms.
Maps Orthostatic intolerance
Trigger
OI symptoms are triggered by the following:
- An upright attitude for a long time (eg standing in line, standing in the bathroom, or even sitting at a table).
- A warm environment (such as in summer weather, busy room, hot shower or bath, after exercise).
- Emotional stress events (see blood or bloody scenes, fear or anxiety).
- Astronauts returning from space have not yet adapted to gravity.
- Extra bed
- Insufficient fluid and salt intake.
Diagnosis
OI "is very difficult to diagnose." As a result, many patients are undiagnosed or misdiagnosed and not treated or treated for other disorders. The current test for OI (Tilt table test, autonomic assessment, and vascular integrity) can also determine and simplify treatment.
Management and prognosis
Most patients experience improvement in their symptoms, but for some people, OI can be very disabling and can be progressive, especially if caused by a deteriorating underlying condition. The ways in which the symptoms appear vary greatly from patient to patient; as a result, an individual care plan is required.
OI is treated both pharmacologically and non-pharmacologically. Treatment does not cure OI; but control the symptoms.
Doctors who specialize in treating OI agree that the most important treatment is to drink more than two liters (eight cups) of fluid every day. Stable water supply and many or other liquids reduce most, and for some patients, all the major symptoms of this condition. Usually, patients get the best price when they drink a glass of water no less than every two hours during the day, rather than drinking large amounts of water at a point in the day.
For most severe cases and some mild cases, a combination of drugs is used. Individual responses to different drugs vary widely, and drugs that dramatically improve one patient's symptoms may make other patients' symptoms much worse. Drugs focus on three main issues:
Drugs that increase blood volume:
- Fludrocortisone (Florinef)
- Erythropoietin
- Hormonal contraceptives
Drugs that inhibit acetylcholinesterase:
- Pyridostigmine
Drugs that increase vasoconstriction:
- Stimulants: (e.g., Ritalin or Dexedrine)
- Midodrine (ProAmatine)
- Ephedrine and pseudoephedrine (Sudafed)
- Theophylline (low dose)
- Selective serotonin reuptake inhibitors (SSRI's - Prozac, Zoloft, and Paxil)
Changes in behavior that can be performed by patients with OI are:
- Avoiding triggers such as sitting long, standing in a calm, warm environment, or vasodilating drugs
- Uses postural maneuvering and pressure clothing
- Treat existing medical conditions
- Increase fluid and salt intake
- Physical and sports therapy
Famous patient
A leading OI sufferer is Greg Page, the original founder and lead singer of the famous Australian children's band The Wiggles. It was because it was diagnosed with this disease that Greg left the group in 2006. Two years later, he went on to create his own funds for OI to help fund the research into this then little known disorder. Greg recovered enough to temporarily return to The Wiggles in 2012 to help transition to the next generation of Wiggles, after which he again left the group.
See also
- orthostatic hypertension
- Orthostatic hypotension
- Postural orthostatic tachycardia syndrome (POTS)
- Vasovagal Response
References
External links
Source of the article : Wikipedia
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