Hipotensión ortostática inicial
Disautonomías > HO
Hipotensión ortostática inicial.
- Corresponde a la hipotensión arterial que ocurre en el primer minuto de ponerse de pie. El criterio es un descenso de la presión arterial de 40/20 mmHg o más en el primer minuto, ya sea en la presión sistólica o máxima o en la diastólica o mínima. Los síntomas ocurren a los 5-10 seg, en especial después de estar acostado o en cuclillas [11-15].
- El sello de la HO inicial (HOI) es que es inmediata y transitoria con restablecimiento de la presión arterial en el primer minuto. Sin embargo, puede ocasionar mareos, fatiga, pre síncope o síncope propiamente tal. La recuperación ocurre muchas veces con el individuo de pie. Otra diferencia con el síncope vaso vagal, cuando ocurre al pararse, es que éste último ocurre algunos minutos después de ponerse de pie. No es inmediato. El síncope vaso vagal además cursa con bradicardia, a diferencia de la HO inicial que presenta aumento compensatorio de la frecuencia cardiaca.
- Se estima que el 50% de los adolescentes sufre HOI y un poco menos a los 20 años de edad y más raro después de los 30 años. Es casi de regla en los pacientes con síndrome de hipermovilidad articular. En el adulto mayor y y en paciente añoso, se torna peligroso, en especial con el uso de drogas vasoactivas, diuréticos y con la deshidratación que es frecuente en estos pacientes. Esta entidad está más cercana a un condición normal que patológica, pero que a veces conlleva mala calidad de vida y requiere manejo. En esencia corresponde a lentitud del mecanismo ortostático compensatorio inicial [16].
- Tratamiento: a menudo, todo lo que se necesita es tranquilidad, especialmente si no hay pérdida del tono postural y los episodios son breves. El levantarse más rápidamente viene con la juventud y desaparece con la edad. Levantarse más lentamente puede ser una terapia suficiente. Las situaciones o enfermedades que promueven una contracción del volumen sanguíneo a menudo se pueden tratar o evitar. Pueden resultar útiles las medidas que aumentan el volumen sanguíneo, como son la mayor ingesta de sal y agua. Para formas más debilitantes de HOI, las opciones de tratamiento y prevención actualmente favorecen las maniobras físicas. La empuñadura bilateral durante 15 segundos antes de elevarse es útil al evocar el reflejo presor del ejercicio que puede aumentar sustancialmente la presión arterial La contracción de los músculos de la parte inferior del cuerpo mientras está sentado (por ejemplo, bombear los músculos de la pantorrilla) también puede ser útil como maniobra preventiva. Además, la tensión de los músculos de la parte inferior de las piernas, glúteos y el abdomen atenúa particularmente la disminución transitoria de la presión arterial una vez que se ha producido la bipedestación y puede potenciarse con la empuñadura de las manos. La postura reclinada y en cuclillas son medidas generales que se utilizan para remediar todas las formas de intolerancia ortostática. En general no se requiere tratamiento farmacológico [16].
HO Inicial, artículos en inglés
Bibliografía.
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