Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Syncope and Orthostatic Hypotension

—

In one line

·In fainting (syncope) and orthostatic low blood pressure (hypotension), the bedside team that catches the cluster early — standing blood-pressure check plus careful history plus an ECG — outperforms the team that orders every scan and waits.

—

Normal physiology

·Your brain runs on oxygen delivered by blood. To keep that stream steady, your heart pumps about five liters of blood every minute, your blood vessels squeeze or relax to keep pressure in the right range (like adjusting the nozzle on a garden hose), and a web of nerves called the autonomic nervous system constantly fine-tunes both — speeding your heart when you stand, tightening the vessels in your legs so blood does not pool in your feet. At rest the system has plenty of reserve; under stress (heat, standing, blood loss) that reserve is used up first, which is why early trouble shows as mild dizziness and late trouble shows as a full faint.

—

What goes wrong

·In fainting (syncope) and orthostatic low blood pressure (hypotension), the brain's blood delivery fails because one of four things breaks: the heart does not pump hard or fast enough (a weak squeeze, a dangerous slow rhythm like complete heart block, or a chaotic fast rhythm like ventricular a fast heart rate (tachycardia)), there is not enough blood or fluid in the tank (bleeding from your stomach or a torn blood vessel, dehydration from throwing up or sweating, or water pills flushing out too much fluid), the blood vessels do not squeeze when they should (nerves damaged by diabetes or Parkinson's disease, medicines that block the squeeze like blood-pressure pills or alpha-blockers), or the signaling loop that connects the pressure sensors to the response is cut or misfires (autonomic neuropathy, or a vagus-nerve misfire in vasovagal fainting that slows your heart and relaxes your vessels at the wrong moment). Every symptom — dizziness, vision going gray, sweating, blackout — traces back to that one broken step.

—

Hallmark signs

·Sudden lightheadedness or feeling like you might faint
·Brief loss of consciousness (passing out for less than a minute)
·Pale, cool, clammy skin
·Vision tunneling or going gray or black
·Nausea or feeling sick to your stomach
·Fast or pounding heartbeat (palpitations)
·Weakness or rubbery legs when you stand
·Confusion or trouble thinking clearly right after standing

—

Red flags · escalate now

·Fainting (Syncope) during exercise or while lying flat (may mean a dangerous heart-rhythm problem or a blocked valve)
·Chest pain, trouble breathing, or a very fast or very slow pulse with the faint (signals a serious heart issue)
·New fainting (syncope) in someone over 60 or anyone with known heart disease (higher chance of a life-threatening cause)
·Repeated fainting spells without a clear trigger, or loss of consciousness that lasts more than one to two minutes (needs urgent work-up for seizure, serious heart block, or a structural heart problem)
·Family history of sudden death before age 50 or known inherited heart conditions like long QT syndrome or hypertrophic cardiomyopathy (fainting may be the first sign of the same deadly rhythm problem)

—

Workup

·12-lead electrocardiogram (EKG)
·Complete blood count (CBC)
·Basic metabolic panel (BMP: sodium, potassium, chloride, bicarbonate, blood urea nitrogen, creatinine, glucose)
·Troponin I or T (if chest pain, known heart disease, or EKG changes are present)
·Brain natriuretic peptide (BNP or NT-proBNP, if heart failure is suspected)
·Echocardiogram (ultrasound of the heart)
·Tilt-table test (if fainting keeps happening and the initial work-up is negative)
·Holter monitor or event recorder (24 to 48 hours or longer ambulatory EKG)

—

Treatment

·Immediate supine position (lying flat) or Trendelenburg (feet elevated 20 to 30 degrees)
·IV normal saline bolus 500 milliliters to 1 liter over 15 to 30 minutes, then recheck blood pressure and heart rate
·Continuous cardiac monitor and 12-lead EKG within 10 minutes
·Review and hold or reduce medicines that lower blood pressure or slow heart rate: diuretics (furosemide, hydrochlorothiazide), beta-blockers (metoprolol, carvedilol), ACE inhibitors (lisinopril), alpha-blockers (tamsulosin, doxazosin), nitrates, and sedatives
·Treat the identified arrhythmia: atropine 0.5 to 1 milligram IV for symptomatic a slow heart rate (bradycardia); transcutaneous or transvenous pacing for complete heart block; adenosine 6 to 12 milligrams IV for supraventricular a fast heart rate (tachycardia); cardioversion or amiodarone for unstable ventricular a fast heart rate
·Compression stockings (knee-high or thigh-high, 20 to 30 millimeters of mercury) and increased salt intake (add 2 to 4 grams of sodium per day) for chronic orthostatic low blood pressure (hypotension) or autonomic insufficiency
·Midodrine 2.5 to 10 milligrams by mouth three times daily (morning, midday, afternoon—never at bedtime) if non-medicine measures fail in chronic orthostatic low blood pressure (hypotension)

—

NCLEX trap

·In Fainting (Syncope) and Orthostatic Low blood pressure (Hypotension), the problem is blood pressure or rhythm, not a brain bleed or clot. Check standing and lying blood pressures, heart rate, and EKG first. Imaging is not the urgent step—fixing the blood flow (perfusion) is.
·Fluids help in Fainting (Syncope) and Orthostatic Low blood pressure (Hypotension) if dehydration is the break, but not if the break is a weak heart, a rhythm problem, or broken nerve wires. Fluids can hurt if the heart is already failing. Treat the specific cause, not just the label.
·In Fainting (Syncope) and Orthostatic Low blood pressure (Hypotension) caused by too many blood pressure pills, the urgent step is to talk with the heart doctor and stop or lower the dose. Continuing the dose causes more faints and falls. The real risk is harm from the medicines.
·Fainting (Syncope) and Orthostatic Low blood pressure (Hypotension) can be vasovagal (a reflex faint), but it can also signal a dangerous rhythm, a weak heart, or bleeding. Take a real history, check blood pressure lying and standing, and get an EKG. Do not assume until you have ruled out the dangerous forms.
·In Fainting (Syncope) and Orthostatic Low blood pressure (Hypotension), some medicines cause the problem (blood pressure pills, diuretics). Teach the patient which medicines might make them faint if they miss a dose and which ones need to be adjusted. Work with the heart doctor and the pharmacy on a clear plan.
·In Fainting (Syncope) and Orthostatic Low blood pressure (Hypotension), lying flat is a emergency first aid for an active faint, but it does not fix the underlying break. The patient needs the right targeted medicine, education on salt and fluids or medicine dose changes, and early follow-up with the heart doctor.

—

Install Maldek by Hill as an app — studies work even offline