Conditions- Acute
- Chronic
- Diabetes
- Parkinsonism (multi-system atrophy)
- Shy-Drager syndrome
Symptoms- CVS
- GI
- Upper - Vomiting
- Lower - Nocturnal diarrhoea
- Sweating
- Gustatory, in response to tyramines
- GUS
- Erectile dysfunction (early sign)
- Trouble voiding
Examination - Pulse
- < 20 BPM change after 6 deep breaths
- < 15 BPM change after standing
- BP
- > 15/10 mmHg postural drop
- But wait 3 MINS before measuring
- Keep arm at heart level
- ECG RR ratio
- Changes after valsava (breathe into manometer + maintain 40 mmHg pressure)
Postural hypotension management
- Conservative
- Sit on bed for 3 mins before standing
- Fluids (3 L per day)
- Salt
- Stockings
- Sleep head-up
- Physical countermeasures
- Buttock tensing
- Stand on toes
- Tense arms and shoulders
- Medication
- Fludrocortisone
- Alpha agonist
- Erythropoietin
Gaits- Cerebellar
- Wide-based
- Drunken
- With slurred speech
- Stroke
- Spastic paraparesis
- Parkinsons
- Shuffling
- Fenestrating (accelerating)
- Foot slap (common peroneal palsy)
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