Patient: [Patient Name]
MRN: [Medical Record Number]
Date: [Date of Encounter]
Chief Complaint:
Dizziness or lightheadedness upon standing (can be brief or prolonged)
Near syncope (almost fainting) or syncope (fainting) with standing
or sitting up too quickly
Visual disturbances (blurring, dimming) upon standing
Fatigue or weakness
History of Present Illness:
Onset, duration, and frequency of symptoms.
Symptoms triggered by standing or sudden changes in position (sitting to
standing, lying to standing).
Associated symptoms (nausea, diaphoresis, palpitations).
Activities or situations that worsen symptoms.
Response to lying down or elevating legs (symptoms improve).
Past Medical History:
Underlying medical conditions that may contribute to orthostatic hypotension
(e.g., dehydration, autonomic neuropathy, endocrine disorders,
congestive heart failure).
Medications currently taken (some medications can cause orthostatic
hypotension as a side effect).
History of blood loss or excessive fluid losses.
Previous episodes of syncope or dizziness.
Social History:
Alcohol or caffeine intake (can worsen orthostatic hypotension).
Prolonged periods of bed rest or inactivity (can decondition
the autonomic nervous system).
Family History:
Family history of syncope or fainting.
Physical Examination:
Vital signs: Measure blood pressure and heart rate in both supine and
standing positions. Look for postural hypotension (significant drop in
blood pressure upon standing).
Orthostatic vital signs: Measure blood pressure and heart rate within
1 minute and 3 minutes of standing. A drop in systolic blood pressure
of >20 mmHg or diastolic blood pressure of >10 mmHg upon standing
suggests orthostatic hypotension.
General examination: Assess for signs of dehydration, autonomic
dysfunction (e.g., dry mouth, pupillary abnormalities), or underlying
medical conditions.
Diagnostic Tests (if indicated):
Electrocardiogram (ECG): May be used to rule out cardiac causes of
dizziness or syncope.
Laboratory tests: Depending on suspected cause, tests may include
blood counts, electrolytes, thyroid function tests, and blood sugar level.
Assessment:
Orthostatic hypotension: Based on clinical presentation (symptoms
and orthostatic vital signs) and supported by history and physical
examination findings.
Severity of orthostatic hypotension: Consider the degree of blood
pressure drop and impact on symptoms and daily activities.
Possible underlying cause: Identify potential causes of orthostatic
hypotension based on history and physical examination findings.
Differential Diagnoses:
Consider other conditions that may mimic orthostatic hypotension:
Dehydration
Inner ear problems (vertigo)
Anemia
Medication side effects
Cardiac arrhythmias (less likely if blood pressure drops significantly
upon standing)
Plan:
Address underlying cause: If possible, treat any underlying
medical conditions contributing to orthostatic hypotension.
Non-pharmacological management: Lifestyle modifications
such as increased fluid intake, increased salt intake (with caution and
under medical supervision), compression stockings, and gradual position
changes (avoiding rapid standing) can be helpful.
Medications: Certain medications may be prescribed to improve
blood pressure regulation upon standing (e.g., midodrine, fludrocortisone).
Patient education: Educate the patient about orthostatic hypotension,
risk factors, and strategies to prevent or manage symptoms (e.g., increasing
fluids, avoiding triggers).
Prognosis:
Prognosis depends on the underlying cause and severity of orthostatic
hypotension. With appropriate management, symptoms can often be
improved and the risk of falls and injuries reduced.
Follow-up:
Schedule follow-up appointments to monitor symptoms,
pen_spark
response to
treatment, and adjust management plan as needed.