Cách thức điều trị mới cho hạ huyết áp tư thế

New Management of Orthostatic Hypotension Thach Nguyen, Le Thi Thuy Linh BACKGROUND Current management of orthostatic hypotension :  Increase salt and fluid intake  Midodrine (A)  Steroids (B)  Knee or thigh high stocking (C) There is no guideline or clinical clues when to use which and which combination METHODS Divided in groups:  Usual treatment (group 1) : Received the usual tests and treatment  The patients ( group ) : Received the new Size and Expansibility of the Femoral Vein (SEFV) test Principles on the Size and Expansion of the Femoral Vein (SEFV) test The first principle:  The volume of blood going through the femoral artery and returning through the common femoral vein should be the same  The size of the femoral artery = the femoral vein If the amount of venous return is lower => edema in the lower leg The second principle:  In VCS, the circulating blood about 65% in veins but only 13% in arteries  Size of arteries does not change much due to vascular tone  keep a fairly constant blood pressure (Figure 1) Non-Invasive SEFV Test  Measure the size and the expansion of the common femoral vein  Assess accurately the arterial and venous volume  Examine the size of the femoral vein and its expansion with cough Figure The location where the probe positioned Figure Vascular probe Figure In patients with normal fluid status Figure The size of the femoral vein is a little larger than the size of the common femoral artery Figure Normal expansion of the femoral vein to less than times larger than the baseline Figure In patient with pulmonary hypertension, dehydration or hypovolemia, there is no or minimal expansion of the femoral vein Excessive Venous Pooling Causing Syncope Panel A The femoral vein at its baseline Panel B The femoral vein expanded to a huge volume upon cough RESULTS  15 patients - January 2015 to April 2016  (10/15) arrived while on full dose of midodrine and florinef  8/15 patients –abnormal SEFV test - severe venous pooling - improved well with thigh high ted hose Conclusion:  Have the SEFV early + the results positive => Wear thigh high stocking  Larger scale of clinical trial or registries are needed References  Thach Nguyen[1], Advait Soni[1], Ryan Phan[2], Linh Thi Thuy Le[3], Tung Mai[4], Duane Pinto[5, 4]  St Mary Medical Center, Hobart IN, USA  Notre Dame University, South Bend IN, USA  Tan Tao University Medical School, Long An, Vietnam  Detroit Medical Center, Detroit MI, USA  Beth Israel Deaconess Medical Center, Boston MA, USA Thank you for listening ... Center, Hobart IN, USA  Notre Dame University, South Bend IN, USA  Tan Tao University Medical School, Long An, Vietnam  Detroit Medical Center, Detroit MI, USA  Beth Israel Deaconess Medical