Coat-hanger ache in orthostatic hypotension
Khurana RK – Coat–hanger ache (CHA) was reported by 59% of OH patients during daily activities and by only 18% during head–up tilt (HUT). The clinical characteristics of CHA episodes displayed inter–individual and intra–individual variability. These findings militate against direct association between OH and CHA and suggest a complex pathophysiology.Methods
- Retrospective IRB–approved review of prospectively collected data on 22 dysautonomic patients.
- Heart rate response to deep breathing, Valsalva manoeuver, HUT and thermoregulatory sweat test evaluated cardiovagal, adrenergic and sudomotor functions.
- Occurrence and clinical features of CHA during daily activities and during HUT were recorded.
- Data were analysed with descriptive statistics.
- All patients demonstrated severe adrenergic (OH), cardiovagal and sudomotor impairment.
- Of 22 patients, 13 (59%) reported CHA within 3–5 minutes of standing or after 10 minutes to 2 hours of sitting that was relieved within 5–20 minutes of recumbency.
- During HUT, 4 of 13 (18%) patients developed CHA. Clinical features varied.