Syndromes of orthostatic intolerance: a hidden danger

Authors

  • A. Fedorowski,

    Corresponding author
    1. Arrhythmia Department, Skåne University Hospital, Malmö, Sweden
    2. Unit of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Malmö, Sweden
    • Department of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
    Search for more papers by this author
  • O. Melander

    1. Department of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
    Search for more papers by this author

Correspondence: Artur Fedorowski, PhD, Arrhythmia Department, Inga Marie Nilssons gata 46, Skåne University Hospital, 205 02 Malmö, Sweden.

(fax: +46 40 33 62 25; e-mail: artur.fedorowski@med.lu.se).

Abstract

Orthostatic hypotension (OH) is a relatively common heterogenous and multifactorial disorder, traditionally classified as neurogenic (less common but often more severe) or nonneurogenic (more common, with no direct signs of autonomic nervous system disease). The different clinical variants of orthostatic intolerance include initial, classical and delayed OH as well as postural tachycardia syndrome. Orthostatic instability may induce syncopal attacks either alone or in combination with other mechanisms, and is often dismissed as a precipitating factor. Moreover, prevalent OH is an independent risk factor for all-cause mortality and cardiovascular morbidity, and the majority of patients with OH are asymptomatic or have few nonspecific symptoms. Management of symptomatic orthostatic intolerance includes both nonpharmacological and pharmacological methods, but it is not always successful and may lead to complications. Future studies of OH should focus on mechanisms that lead to neurogenic and nonneurogenic OH, novel diagnostic methods and more effective therapeutic modalities.

Ancillary