Orthostatic Disorders of the Circulation. Mechanisms, Manifestations, and Treatment.
Authors: David H. P. Streeten
Journal: Annals of Internal Medicine (1987)

1 Physiology of the Microcirculation.- 1.1. Control of the Peripheral Vasculature.- 1.1.1. Sympathetic Innervation.- 1.1.2. Humoral Agents and Local Tissue Metabolites.- 1.2. Physiological Requirements Imposed by Orthostasis.- 1.3. Orthostatic Circulatory Adjustments: Neurohumoral Mechanisms.- 1.3.1. Catecholamine Responses.- 1.3.2. Changes in the Renin-Angiotensin-Aldosterone System.- 1.3.3. Other Physiological Changes in the Erect Posture.- 1.4. Disorders of the Peripheral Circulation.- 1.5. Orthostatic Disorders of the Circulation.- 1.6. Summary.- 2 Orthostatic Edema: Definition and Pathogenesis.- 2.1. Definition of Orthostatic Edema.- 2.2. General Mechanisms of Edema Formation.- 2.2.1. Increased Capillary Hydrostatic Pressure.- 2.2.2. Reduced Plasma Protein Oncotic Pressure.- 2.2.3. Pathologically Leaky Capillaries.- 2.2.4. Tissue Pressure Changes.- 2.2.5. Lymphatic Obstruction.- 2.3. Pathogenesis of Orthostatic Edema.- 2.3.1. Role of Posture in the Pathogenesis of Edema.- 2.3.2. Mechanisms of Orthostasis-Induced Fluid Retention.- 2.3.3. Summary of Pathogenesis.- 2.3.4. How Does Orthostasis Trigger the Abnormal Responses in Patients with Orthostatic Sodium Retention?.- 2.3.5. Cause of Excessive Orthostatic Intravascular Pooling.- 2.4. Summary.- 3 Orthostatic Edema: Clinical Features.- 3.1. Gender, Age, and Prevalence.- 3.1.1. In Women.- 3.1.2. In Men.- 3.1.3. Age of Onset.- 3.1.4. Distribution and Prevalence.- 3.2. Symptoms and Signs.- 3.2.1. Evidence of Fluid Accumulation.- 3.2.2. Nocturia.- 3.2.3. Symptoms Resulting from the Edema.- 3.2.4. Intracranial Symptoms.- 3.2.5. Cardiovascular Features.- 3.2.6. Other Clinical Features.- 3.3. Factors That Aggravate Orthostatic Edema.- 3.3.1. Menstruation.- 3.3.2. Oral Estrogen Therapy.- 3.3.3. Pregnancy.- 3.3.4. Environmental Heat.- 3.4. Laboratory Findings.- 3.5. Summary.- 4 Orthostatic Edema: Diagnosis.- 4.1. Exclusion of Known Types of Edema.- 4.1.1. Congestive Heart Failure.- 4.1.2. Renal Edema.- 4.1.3. Hepatic Disease.- 4.1.4. Other Generalized Disorders.- 4.1.5. Local Causes of Edema.- 4.1.6. Capillary Leak Syndrome.- 4.2. Positive Diagnosis of Orthostatic Edema.- 4.2.1. History.- 4.2.2. Screening Test.- 4.2.3. Definitive Tests.- 4.3. Summary.- 5 Orthostatic Edema: Treatment and Prognosis.- 5.1. General Aspects.- 5.2. Control of Posture.- 5.3. Dietary and Fluid Restrictions.- 5.4. Conventional Diuretics.- 5.5. Treatment of Potassium Depletion.- 5.5.1. Potassium-Sparing Diuretics.- 5.5.2. Potassium Supplements.- 5.6. Elastic Garments and Stockings.- 5.7. Dopamine Agonists.- 5.8. Converting Enzyme Inhibitors: Captopril.- 5.9. Vasoconstrictors.- 5.9.1. Ephedrine.- 5.9.2. Amphetamines.- 5.9.3. Midodrine.- 5.9.4. Mechanism of Action of Vasoconstrictors in Orthostatic Edema.- 5.9.5. Side Effects of Sympathomimetic Amines.- 5.9.6. Long-Term Administration of Sympathomimetic Agents.- 5.10. Summary of Therapeutic Program.- 5.11. Summary.- 6 Orthostatic Disorders of Blood Pressure Control: Definitions and Classification.- 6.1. Technique of Blood Pressure Measurement in the Upright Posture.- 6.2. Orthostatic Blood Pressure and Heart Rate Changes: Normal Limits.- 6.3. Definable Disorders of Blood Pressure and Heart Rate Control.- 6.3.1. Orthostatic Arterial Anemia.- 6.3.2. Neurocirculatory Asthenia.- 6.4. Classification of Orthostatic Disorders of Blood Pressure Control.- 6.4.1. Role of the Autonomic Nervous System.- 6.4.2. Heart Rate Changes.- 6.4.3. Effects of Adrenocortical Insufficiency.- 6.4.4. Excessive Orthostatic Rise in Diastolic Blood Pressure.- 6.4.5. Types of Orthostatic Blood Pressure Disorders.- 6.5. Summary.- 7 Orthostatic Disorders of Blood Pressure Control: Pathocenesis.- 7.1. Orthostatic Hypotension.- 7.1.1. Autonomic Insufficiency.- 7.1.2. Hyperadrenergic Postural Hypotension.- 7.2. Orthostatic Hypertension and Other Types of Orthostatic Blood Pressure Disorders.- 7.3. Causes of Orthostatic Blood Pressure Disorders.- 7.4. Pathogenesis of Orthostatic Blood Pressure Disorders Associated with Intact Autonomic Function.- 7.4.1. Effects of Changes in Blood Volume Induced by Venesection.- 7.4.2. Evidence of Excessive Gravitational Pooling of Blood.- 7.4.3. Effects of Posture on Cardiac Filling.- 7.4.4. Effects of Posture on Cardiac Output.- 7.4.5. Postural Changes in Plasma Norepinephrine Concentration.- 7.4.6. Blood Kinin Concentration.- 7.4.7. Potential Role of Insulin.- 7.5. Conclusions.- 7.6. Summary.- 8 Orthostatic Disorders of Blood Pressure Control: Clinical Features.- 8.1. Frequency of Main Symptoms.- 8.2. Intracranial Features.- 8.2.1. Lightheadedness and Blurred Vision.- 8.2.2. Syncope.- 8.2.3. Convulsive Seizures.- 8.2.4. Orthostatic Hemiplegia.- 8.2.5. Headaches.- 8.2.6. Symptoms of Carotid or Basilar Artery Insufficiency.- 8.3. Other Clinical Features.- 8.3.1. Fatigue and Weakness.- 8.3.2. Nausea.- 8.3.3. Palpitations, Flushing Spells, and Excessive Sweating.- 8.3.4. Nocturia.- 8.3.5. Aggravation by Heat.- 8.3.6. Edema.- 8.3.7. Cyanosis of the Legs.- 8.3.8. Changes in Blood Pressure and Heart Rate.- 8.3.9. Cardiac Disorders.- 8.3.10. Plasma Volume Changes.- 8.3.11. Other Features of Autonomic Failure.- 8.4. Summary.- 9 Orthostatic Disorders of Blood Pressure Control: Prevalence and Diagnosis.- 9.1. Prevalence.- 9.2. Sex Incidence and Age of Onset.- 9.3. Hereditary Factor.- 9.4. Diagnosis of Orthostatic Blood Pressure Derangements.- 9.4.1. Orthostatic Hypotension.- 9.4.2. Differentiation of Central from Peripheral Autonomic Failure.- 9.4.3. Venous Pooling Syndrome.- 9.5. Summary.- 10 Orthostatic Disorders of Blood Pressure Control: Treatment and Prognosis.- 10.1. Treatment.- 10.1.1. Physical Compression of the Lower Limbs and Abdomen...- 10.1.2. Vasoconstricting Drugs.- 10.1.3. ?-Adrenergic Antagonists.- 10.1.4. Fludrocortisone and Other Volume Expanders.- 10.1.5. Prostaglandin Synthetase Antagonists.- 10.1.6. Vasopressin.- 10.1.7. Atrial Pacemakers.- 10.1.8. Other Measures.- 10.1.9. Treatment of Orthostatic Hypertension.- 10.2. Prognosis.- 10.3. Summary.- Appendix I Clinical and Laboratory Data Obtained in 169 Patients with Orthostatic and Nonorthostatic Edema.- Appendix II Clinical and Laboratory Data Obtained in 159 Patients with Orthostatic Blood Pressure Disorders.- References.