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Short report
Orthostatic blood pressure recovery patterns in suspected syncope in the emergency department
  1. Veera K van Wijnen1,
  2. Dik Ten Hove1,
  3. Reinold O B Gans1,
  4. Wybe Nieuwland2,
  5. Arie M van Roon1,
  6. Jan C Ter Maaten1,
  7. Mark P M Harms1
  1. 1 Department of Internal, Emergency and Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  2. 2 Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  1. Correspondence to Dr Mark P M Harms, Department of Internal, Emergency and Vascular Medicine, University Medical Center Groningen, University of Groningen, Groningen 9713 GZ, The Netherlands; m.p.m.harms{at}umcg.nl

Abstract

Introduction Orthostasis is a frequent trigger for (pre)syncope but some forms of orthostatic (pre)syncope have a worse prognosis than others. Routine assessment of orthostatic BP in the ED can detect classic orthostatic hypotension, but often misses these other forms of orthostatic (pre)syncope. This study aimed to determine the frequency of abnormal orthostatic BP recovery patterns in patients with (pre)syncope by using continuous non-invasive BP monitoring.

Methods We performed a prospective cohort study in suspected patients with (pre)syncope in the ED of a tertiary care teaching hospital between January and August 2014. Orthostatic BP was measured during the active lying-to-standing test with Nexfin, a continuous non-invasive finger arterial pressure measurement device. Orthostatic BP recovery patterns were defined as normal BP recovery, initial orthostatic hypotension, delayed BP recovery, classic orthostatic hypotension and reflex-mediated hypotension.

Results Of 116 patients recruited, measurements in 111 patients (age 63 years, 51% male) were suitable for analysis. Classic orthostatic hypotension was the most prevalent abnormal BP pattern (19%), but only half of the patients received a final diagnosis of orthostatic hypotension. Initial orthostatic hypotension and delayed BP recovery were present in 20% of the patients with (pre)syncope of whom 45% were diagnosed as unexplained syncope. Reflex-mediated hypotension was present in 4% of the patients.

Conclusion Continuous non-invasive BP measurement can potentially identify more specific and concerning causes of orthostatic (pre)syncope. Correct classification is important because of different short-term and long-term clinical implications.

  • vascular-arterial
  • non invasive
  • emergency department

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/emermed-2017-207207

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    Footnotes

    • Contributors VKvW, DTH, WN, JCTM and MPMH conceived the study and designed the study protocol. JCTM acquired the waiver from the Institutional Review Board. VKvW and DTH performed the measurements and VKvW, DH, MPMH and AMvR performed the analysis. ROBG critically revised the manuscript. All authors contributed to the final draft of the manuscript.

    • Competing interests None declared.

    • Ethics approval Medische Ethische Toetsingscommissie Groningen.

    • Provenance and peer review Not commissioned; externally peer reviewed.