Circulatory Manifestations

Abstract

Hypotensive circulatory disturbances can be expected to occur in children beginning at about the age of 5 years. Hypotension is hardly noted during a single blood pressure measurement, since a physical examination is, for the child, a situation filled with tensions and anxieties and therefore may lead to blood pressure elevation. The child’s medical history, however, is characteristic: he or she has had a marked growth spurt during recent months, suffers from easy fatigability, lack of concentration, recurrent headache, distinct lability of the autonomic nervous system (change in skin color, tachycardia, diaphoresis, dermographia), tendency to kinetoses, or recurrent abdominal pain. Differences in blood pressure readings are noted between the measurements conducted in the recumbent and the upright positions. There is a decrease of the systolic or of the systolic and diastolic pressures (with a concomitant decrease of the pulse pressure) when the measurement is taken on a patient in the upright position. Even syncope may ensue after prolonged standing or after psychologic stress. All findings are characteristic of the orthostatic dysregulation of the hypotensive individual. Frequently, there is familial disposition to hypotension.