Stress induced hypotension in pure autonomic failure

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 77; no. 4; pp. 552 - 553
• Main Authors: Thijs, R D, van Dijk, J G
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01-04-2006; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: autonomic failure; Autonomic Nervous System Diseases - physiopathology; Biological and medical sciences; Blood pressure; Catecholamines - blood; Catecholamines - deficiency; Drug toxicity and drugs side effects treatment; emotional stress; Female; Heart rate; Humans; Hyperventilation; hypocapnia; Hypotension, Orthostatic - diagnosis; Hypotension, Orthostatic - drug therapy; Hypotension, Orthostatic - etiology; Medical sciences; Middle Aged; Midodrine - therapeutic use; Nervous system; Neurology; Neuropharmacology; Neuroprotective agent; Orthostatic hypotension; petco2- end tidal CO2 tension; Pharmacists; Pharmacology. Drug treatments; Short Report; Stress, Psychological - psychology; Toxicity: nervous system and muscle; Treatment Outcome; Vasoconstrictor Agents - therapeutic use; Nervous system diseases; Stress; Diseases of the autonomic nervous system
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.2005.074369

A 47 year old woman with pure autonomic failure complained of dizziness during emotional stress. Emotional stimuli have not previously been reported to cause hypotension in patients with autonomic failure. In the patient, ambulatory blood pressure recording revealed severe hypotension (50/30 mm Hg) after a stressful event. During a tilt table test, hyperventilation was shown to cause a significant fall of blood pressure. This suggests that emotional stress can induce hypotension, probably through hyperventilation, in subjects with autonomic failure.