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Review
. 2009 Jan 6;119(1):139-46.
doi: 10.1161/CIRCULATIONAHA.108.805887.

Neurogenic orthostatic hypotension: a pathophysiological approach

David S Goldstein  1 , Yehonatan Sharabi
Affiliations
Review

Neurogenic orthostatic hypotension: a pathophysiological approach

David S Goldstein et al. Circulation. .
No abstract available

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Figures

Figure 1
Figure 1
Algorithm for clinical evaluation of OH. The algorithm asks if OH is persistent and consistent; if it is neurogenic; and if it is associated with postganglionic, sympathetic, noradrenergic denervation. BP indicates blood pressure; CNS, central nervous system; LBD, Lewy body dementia; and NE, norepinephrine.
Figure 2
Figure 2
Heart rate and blood pressure responses in the 4 phases of the Valsalva maneuver in (left) a control subject and (right) a patient with NOH. NOH is characterized by a progressive decline in blood pressure in phase II (arrow), slow recovery of blood pressure in phases III and IV (gray polygon), and absence of overshoot in pressure above baseline in phase IV (thick black line).
Figure 3
Figure 3
Cardiac positron emission tomographic scans after intravenous injection of 6-[18F]fluorodopamine (6-[18F]FDA) or the perfusion imaging agent [13N]-ammonia ([13N]NH3) in a patient with MSA and a patient with PD9NOH. Note absence of detectable 6-[18F]fluorodopamine–derived radioactivity in the left ventricular myocardium, despite normal perfusion as indicated by [13N]-ammonia–derived radioactivity, in the patient with PD9+NOH.
Figure 4
Figure 4
Individual values for interventricular septal myocardial concentrations of 6-[18F]fluorodopamine–derived radioactivity in patients with NOH or control subjects. Dashed line shows 2 SDs below the normal mean. Note bimodal distribution of 6-[18F]fluorodopamine–derived radioactivity in NOH patients, with approximately half having low radioactivity and half normal radioactivity.
Figure 5
Figure 5
Individual values for interventricular septal myocardial concentrations of 6-[18F]fluorodopamine–derived radioactivity in patients with NOH and central neurodegeneration who had either a definite or an equivocal diagnosis. Note bimodal distributions of radioactivity regardless of surety of diagnosis.
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References

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