The Orthostatic Intolerance (OI) Center
Why you need to do these things every day
There are some basic things that will help your body deal with blood pressure issues. You will probably have to pay attention to these things for a long time, maybe even the rest of your life.
The first thing to stress is that most of these things have 1 purpose - to help your body handle standing up better so you can go about your regular life. They have been shown by clinical studies and experience to improve blood flow to the heart when you stand up. There are other things to do that will help you deal with the effects of the chemical release and with the changes in your life and future that come with a chronic illness, especially one that has as big an effect as orthostatic intolerance.
The goal for the physical body is to reverse problems wherever possible. It that isn't possible, then the goal is to control or decrease the problems that are causing the orthostatic symptoms. The challenge is to not make things worse. Some things need to be put into place before you can move on to retraining your body so it can heal.
First, the problems that lead to orthostatic problems with POTS and NMH (Neurally-mediated orthostatic hypotension) are low blood volume, cardiovascular deconditioning, and muscle deconditioning*. Much of the management focuses on reversing or dealing with these problems*:
» Low blood volume
» Change in the sensitivity of the special BP receptor cells in the neck and aorta
» Decreased muscle size and strength**
» Blood pooling in the legs and abdomen when the person stands up
» Muscle atrophy and weakness, related to changes that happen with prolonged bedrest (muscle deconditioning)
» Sympathetic (hormone/chemical) release
*In the medical literature or discussions with physicians, they may call this the 'pathophysiology' - which means changes in how the body is functioning inside.
Some have reported a smaller heart size in some patients with POTS and with CFS. I tis thought to be related to gravitational deconditioning.
Matching What You Do In Everyday Life With The Problem It Fixes
What you are doing (Lifestyle) |
Why you are doing it - the problem it is meant to help |
Medications that help this problem
|
|---|---|---|
Increase fluids and salt |
Low blood volume |
• Florinef |
Compression garments Tricks to avoid getting dizzy |
Blood pooling in the legs and abdomen when you stand up |
• Midodrine • Stimulants (Dexedrine, Ritalin, Adderall) • SSRI/SNRI: Prozac, Zoloft, Lexapro, Effexor, Cymbalta • Provigil |
Raising the Head of the Bed |
Change in the sensitivity of the special BP receptor cells in the neck and aorta |
• Pyridostigmine |
Move Into Health - Physical retraining lying down |
Change in the sensitivity of the special BP receptor cells in the neck and aorta |
--- |
Move Into Health - Physical retraining lying down |
Decreased muscle size and strength |
--- |
Move Into Health - Physical retraining lying down |
Muscle atrophy (decrease size), weakness and lower endurance,related to changes that happen with prolonged bedrest (muscle deconditioning) |
--- |
Deal & Heal techniques |
Sympathetic (hormone/chemical) release |
• Beta-blockers: Atenolol, Propranolol • Disopyramide (Norpace) • Angiotensin Converting Enzyme Inhibitors (ACEI) |
Author: Kay E. Jewell, MD
Page Last Updated: September 13, 2012
