Profoundly Hypotensive

Disclosure: Muhammad Hashmi declares no relevant financial relationships with ineligible companies.

Hypotension

Hypotension is a decrease in systemic blood pressure below accepted low values. While there is not an accepted standard hypotensive value, pressures less than 90/60 are recognized as hypotensive. Hypotension is a relatively benign condition that is under-recognized mainly because it is typically asymptomatic. It only becomes a concern once pumping pressure is not sufficient to perfuse key organs with oxygenated blood. This leads to symptoms impacting the quality of life of a patient. Hypotension is classified based on the biometric parameters of the blood pressure measurement. It may be absolute with changes in systolic blood pressure to less than 90 mm Hg or mean arterial pressure of less than 65 mm Hg. It may be relative to a decrease in diastolic blood pressure to less than 40 mm Hg. It may be orthostatic with a decrease in systolic pressure or 20 mm Hg or greater or a decrease in diastolic pressure of 10 mm Hg or greater on positional change from lying to standing. It may be profound which is defined as being medication-dependent. In acute conditions, the hypotensive shock is a possible and life-threatening condition. Blood pressure is defined as:

1. Blood Pressure = Cardiac output x Total peripheral vascular resistance

1. The mean arterial pressure is an average blood pressure over the course of one cardiac cycle. It is calculated as:

1. Mean arterial pressure = 2/3 diastolic pressure + 1/3 systolic pressure

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Conflict of interest statement

Disclosure: Sandeep Sharma declares no relevant financial relationships with ineligible companies.

Disclosure: Muhammad Hashmi declares no relevant financial relationships with ineligible companies.

Disclosure: Priyanka Bhattacharya declares no relevant financial relationships with ineligible companies.

Sections

• Continuing Education Activity
• Introduction
• Etiology
• Epidemiology
• Pathophysiology
• History and Physical
• Evaluation
• Treatment / Management
• Differential Diagnosis
• Prognosis
• Complications
• Enhancing Healthcare Team Outcomes
• Review Questions
• References

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   Why Is This Patient Profoundly Hypotensive?

   

   A 70-year-old male is brought to the emergency department with subacute shortness of breath and fatigue. Upon searching her father’s home, his daughter reports she found his medication — a nearly empty bottle of metoprolol, 100 mg bid. She believes her father has coronary artery disease. On examination, the patient is confused. His blood pressure is 69/49 mmHg and he has a heart rate of 48 bpm. An ECG reveals the findings seen here. After initiating oxygen and atropine, which of the following is the best treatment for this patient’s presentation?

   A. Dual anti-platelet therapy
   B. Inamrinone
   C. Glucagon
   D. Epinephrine

   Find the answer, discuss this case and more on Figure 1.

   

   Explore cases, quiz yourself, and solve medical mysteries along with thousands of other medical professionals around the world on Figure 1, the free app where doctors expand their clinical knowledge.

   Explore cases, quiz yourself, and solve medical mysteries along with thousands of other medical professionals around the world on Figure 1, the free app where doctors expand their clinical knowledge.