Severe orthostatic hypotension: Case report and description of response to sympatheticomimetic drugs

• Published in: The American heart journal Vol. 56; no. 3; pp. 412 - 424
• Main Authors: Barnett, A.J., Wagner, G.R.
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.09.1958
• Subjects: Humans; Hypotension - therapy; Hypotension, Orthostatic; Old Medline; Sympathomimetics - therapeutic use; HYPOTENSION/therapy; SYMPATHOMIMETICS/therapeutic use
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/0002-8703(58)90280-1

1. 1. A case is described of severe orthostatic hypotension of acute onset in a young man. 2. 2. Investigation of the autonomic nervous system showed widespread loss of sympathetic nervous activity and more limited loss of parasympathetic activity. In both instances the evidence pointed to a peripheral lesion. 3. 3. A remarkable feature was the extreme sensitivity to certain sympatheticomimetic amines (noradrenalin, Neo-Synephrine, and methoxamine) and lack of response to others (ephedrine, Methedrine, mephentermine, amphetamine, and pholedrine). 4. 4. The effect of Neo-Synephrine, methoxamine, ephedrine, and pholedrine were noted in another patient with orthostatic hypotension, again with evidence for a peripheral lesion but in this case sparing one limb. In this patient the blood pressure responded to all these drugs. 5. 5. The response of patients with orthostatic hypotension to pressor amines could be explained on the basis of the hypothesis that some pressor amines act directly on vessels, while others act, at least in part, by preserving noradrenalin. The effect will depend on the sensitivity of the vessels and the amount of noradrenalin available for preservation.