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Other Syndromes of Orthostatic Intolerance: Delayed Orthostatic Hypotension, Postprandial Hypotension, Postural Orthostatic Tachycardia Syndrome, and Reflex Syncope

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Orthostatic Hypotension in Older Adults

Abstract

Apart from classical orthostatic hypotension, the gravitational force may strongly contribute to other forms of orthostatic intolerance, delayed and postprandial OH, postural orthostatic tachycardia syndrome (POTS), and reflex syncope. In delayed OH, the significant blood pressure drop occurs first after 3-min period of orthostasis, whereas in postprandial OH, the symptoms appear first approximately 15–30 min after the meal. POTS is rarely seen in older adults and presents as abnormal sinus tachycardia on standing with symptoms of orthostatic intolerance, dizziness, fatigue, and cognitive impairment. Reflex syncope may manifest as orthostatic vasovagal reflex, situational syncope, or carotid sinus hypersensitivity, which becomes a clinical syndrome when associated with history of unexplained syncope and positive provocation test, carotid sinus massage. Older patients with a history of orthostatic intolerance, unexplained syncope and fall trauma, and negative result of active standing test should be further evaluated using cardiovascular autonomic tests such as head-up tilt testing, Valsalva maneuver, and carotid sinus massage.

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Authors and Affiliations

  1. Department of Cardiology, Skåne University Hospital, Malmö, Sweden

    Artur Fedorowski

  2. Department of Clinical Sciences, Lund University, Malmö, Sweden

    Artur Fedorowski, Viktor Hamrefors & Fabrizio Ricci

  3. Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden

    Viktor Hamrefors

  4. Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University, Chieti, Italy

    Fabrizio Ricci

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  1. Artur Fedorowski
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  2. Viktor Hamrefors
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Correspondence to Artur Fedorowski .

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Editors and Affiliations

  1. Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey

    Ahmet Turan Isik

  2. Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey

    Pinar Soysal

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Fedorowski, A., Hamrefors, V., Ricci, F. (2021). Other Syndromes of Orthostatic Intolerance: Delayed Orthostatic Hypotension, Postprandial Hypotension, Postural Orthostatic Tachycardia Syndrome, and Reflex Syncope. In: Isik, A.T., Soysal, P. (eds) Orthostatic Hypotension in Older Adults. Springer, Cham. https://doi.org/10.1007/978-3-030-62493-4_13

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