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Journals / MN Kardiyoloji / 2003 / Cilt: 10 - Sayı: 6

Orthostatic hypotension and the evaluation of the efficacy of atenololin mitral valve prolapse

Mitral kapak prolapsusunda ortostatik hipotansiyon ve tedavisinde atenorol'ün etkinliğinin değerlendirilmesi

DURSUN DURSUNOĞLU
Harun EVRENGÜL
Işık BAŞAR
Barış İLERİGELEN
Lale KOLDAŞ
Faruk AYAN
Asuman KAFTAN
Mustafa KILIÇ
Pages
453–460
DOI
—
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

For the treatment of orthostatic hypotension and relieving the related symptoms, beta blockade with atenolol may be useful.

📌 3 Key Takeaways

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Objective & Hypothesis:Aim: Orthostatic hypotension (OH) in mitral valve prolapse (MVP) which is found very infrequently, can be due to several different mechanisms.
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Key Findings & Data:Material and Method: In order to demonstrate the OH, systolic (SBP) and diastolic (DBP) arterial blood pressures were measured in the supine and standing positions in 122 patients (90 female, 32 male) who were confirmed to have MVP by echocardiography.
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Conclusion & Impact:For the treatment of orthostatic hypotension and relieving the related symptoms, beta blockade with atenolol may be useful.
🔬Design:Research Article
📍Scope:Comprehensive Sample
⚙️Variables:Adrenerjik beta-antagonistleri · Atenolol · Hipotansiyon

Abstract

Aim: Orthostatic hypotension (OH) in mitral valve prolapse (MVP) which is found very infrequently, can be due to several different mechanisms. However, when it ooccurs it disturbs the patients quality of life considerably. In this study, the relationship between orthostatic hypotension and particularly recurrent dizziness or syncope and the patients' response to beta-adrenergic blockade were investigated in symptomatic patients with MVP. Material and Method: In order to demonstrate the OH, systolic (SBP) and diastolic (DBP) arterial blood pressures were measured in the supine and standing positions in 122 patients (90 female, 32 male) who were confirmed to have MVP by echocardiography. OH (a drop in SBP of 20 mmHg or more upon standing) was demonstrated in 17 patients. These patients were asked to report any symptoms, and were performed cardiac examination. In all patients with OH, 24-hour Holter ECG recordings were obtained. Results: 14 of 17 patients with OH presented with a history of recurrent dizziness or syncope and constitute 66.7 percent of the total number of patients with such symptoms in this series. Although all of these 14 patients reported transient dizziness during periods of ambulatory electrocardiographic recording, in only 2 patients, the symptoms were chronologically related to cardiac arrhythmias. 4 of them described dizziness or near-syncope during the postural test in association with orthostatic drop in blood pressure. Improvement in symptoms and correction of the orthostatic hypotension were demonstrated in 11 patients after beta-adrenergic blockade with atenolol. Before therapy, the mean SBP dropped from 116±13.1 mmHg in the supine position to 88±6.8 mmHg upon standing. The associated heart rate (HR) per minute was 86±10.3 beats and 110±10.9 beats respectively. In repeated postural tests performed after 4 weeks of treatment, the SBP changed from 112.9±8.9 mmHg supine to 107.7±9.5 mmHg upon standing and the HR per minute changed from 70±6.6 beats to 80±5.8 beats. The percentages of differences of the postural values before and after treatment were estimated to be -23.8±3.7 and -4.6±2.5 for SBP and 28.7±11.8 and 14.6±5.5 for HR, and they have statistically significant difference (p< 0.001). Conclusion: In patients with MVP, the presence of orthostatic hypotension frequently leads to recurrent dizziness or syncope. Although the precise cause of those sypmptoms are obscure, autonomic nervous or neuroendocrine dysfunction may be the underlying mechanisms the arrhythmias. For the treatment of orthostatic hypotension and relieving the related symptoms, beta blockade with atenolol may be useful.

Özet

Amaç: Mitral Kapak prolapsusunda (MKP) ortostatik hipotansiyon (OH), değişik mekanizmalarla oluşmaktadır, fakat sık görülmemektedir. Buna karşın varlığında hastaları oldukça rahatsız eder. Bu çalışmada, özellikle tekrarlayan başdönmesi veya bayılma semptomları gösteren ekokardiyografik tanılı MKP'lu hastalarda semptomların ortostatik hipotansiyonla ilgisi ve hastaların beta- adrenerjik blokere (atenolol) yanıtı araştırıldı. Gereç ve Yöntem: Ekokardiyografik olarak saptanan 122 MKP' lu (90 kadın, 32 erkek) hastada postural test ile OH araştırıldı. OH'u göstermek için sistolik (SKB) ve diyastolik (DKB) arteryel kan basınçları yatar durumda ve ayakta ölçüldü. OH (ayakta SKB 'nda $\geq$20 mmHg düşüş) saptanan 17 hastanın semptomları sorgulanarak kardiyak muayeneleri yapıldı ve 24 saatlik Holter EKG kayıtlarında aritmi varlığı araştırıldı. Bulgular: 17 OH'lu hastanın 14'ünde (tüm benzer semptomluların %66.7'si) başdönmesi veya bayılma öyküsü gözlendi. Bu 14 hastanın yalnızca ikisinde semptomlar kardiyak aritmilere bağlandı. 4 hastada ise kan basıncı ölçümü sırasında başdönmesi ve/veya bayılma hissi oluştu. Atenolol ile beta-adrenerjik blokaj sonrası 11 hastada OH'nun düzeldiği ve semptomların kaybolduğu saptandı. Tedavi öncesi (TÖ) ortalama SKB yatarken 116±13.1 mmHg'dan ayakta 88±6.8 mmHg'ya düştü. Eşlik eden dakika kalp hızı (KH) ise, sırasıyla 86±10.3 vurudan 110±10.9 vuruya yükseldi. Tedaviden 4 hafta sonra (TS) tekrarlanan postural testte ise SKB yatarken 112.9±8.9 mmHg'lık değerden ayaktayken 107.7±9.5 mmHg'ya değişim gösterdi. KH ise, sırasıyla 70±6.6 vurudan 80±8 vuruya yükseldi. Hesaplanan postural % farklar; SKB' nda TÖ ve TS sırasıyla -23.8±3.7 ve -4.6±2.5 iken; KH'nda sırasıyla 28.7±11.8 ve 14.6±5 idi. Hem SKB'nda hem de KH'nda tedavi sonrasındaki değişmeler ileri düzeyde anlamlıydı (p < 0.001). Sonuç: Mitral kapak prolapsusu olan olgularda ortostatik hipotansiyon varlığı sıklıkla tekrarlayıcı başdönmesi ya da senkopa yol açabilir. Bu semptomların nedeni açık olmamakla birlikte, aritmiler dışında otonom sinir sistemi veya nöroendokrin bozukluklardan kaynaklanıyor olabilir. Ortostatik hipotansiyonu tedavi etmek ve ilgili semptomları ortadan kaldırmak için atenolol ile beta bloker tedavi faydalı olabilir.

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Cite This Article

DURSUNOĞLU, D., EVRENGÜL, H., BAŞAR, I., İLERİGELEN, B., KOLDAŞ, L., AYAN, F., KAFTAN, A., KILIÇ, M. (2003). Orthostatic hypotension and the evaluation of the efficacy of atenololin mitral valve prolapse. MN Kardiyoloji, Cilt: 10 - Sayı: 6, 453–460. https://ajindex.com/articles/297689

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