Neurally Mediated Hypotension

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Have you ever felt dizzy after a few minutes of standing up? So dizzy that you feel that if you don’t sit down, you might faint? If so, then you might have a disease called Neurally Mediated Hypotension. This disease is often mistaken for Chronic Fatigue Syndrome. In this paper, you will learn about the symptoms of NMH, possible treatments to this disease, other ways to control the symptoms, tilt table testing, and a comparison to Chronic Fatigue Syndrome.

        You might be asking yourself, what exactly is Neurally Mediated Hypotension? It occurs when there is an abnormal reflex interaction between the heart and the brain. The word ‘hypotension’ is the formal medical term for low blood pressure; and syncope means fainting. Instead of your brain sending signals to speed up the heart, it tells it to slow down and the vessels in the arms and legs to dilate. The blood pools in your feet and then your blood pressure drops.

This brings on a faint. Other common names for NMH are: fainting reflex, neurocardiogenic syncope, vasodepressor syncope, vaso-vagal reflex, and autonomic dysfunction. Some common symptoms of NMH are lightheadedness, nausea, mental confusion, headaches, weakness, and fainting.

        When does NMH lead to symptoms? Standing for to long of a time period can lead to symptoms. If you’re in a warmer environment than you’re used to, or taking a hot shower, you may be at risk. People also feel symptoms immediately after they finish exercising. If you experience emotionally stressful events, symptoms have also been known to occur. Each person’s susceptibility to NMH is affected by his or her genetic make-p, dietary factors, and psychological make-up. Some symptoms that can be caused by NMH are recurring lightheadedness, fainting, and prolonged fatigue. After a faint occurs, mental confusion is common, difficulty concentrating, staying on task, paying attention, and struggle to find the right words.

        How is NMH diagnosed? It cannot be detected by blood pressure or heart rate screening. Often, doctors will use the “tilt table test” or “standing test”. The tilt table test measure your heart rate and blood pressure. The reason for the evaluation is because there is recurring fainting happening. During the test, they strap you horizontally to a table, then gradually tilt it farther and farther upwards to observe the reactions and to watch you faint. During the test it is common to feel lightheadedness, nausea and to faint. The tilt table test prohibits someone from doing their natural defenses. Some things that you can do on your own to help avoid fainting are crossing your legs, sitting or lying down, and fidgeting.

        What causes NMH? At this point in time, no one really has a certain answer. It been considered that possibly it has some connection to genetic origins. It is not uncommon to find background in the family with NMH. There has been no gene identified with the condition. A common problem that has been identified with NMH is not enough salt intakes. To fix this you increase your dosage of sodium pills. Increased amounts of salt and water help to reduce common symptoms. Treatments require patience, willingness, and commitment.

        Does treatment cure the problem? Even when the medications are successful, they do not sure the problem. They do however help to control the symptoms. Symptoms worsen for women around the time of their menstrual cycle. Other things you can do that will help are, avoiding situations which might bring on symptoms. Don’t shop at busy times, take shorter cooler showers, avoid standing still. Some helpful maneuvers that you can do to help avoid symptoms are crossing your legs, squatting, standing with one leg on a chair, and bending forward from waist.

        My sister Elizabeth Yost has Neurally Mediated Hypotension. She’s now 21 and she was 15 when she first fainted. She’s fainted probably 20 times a year for 6 years. Leading up to the faint, she is tired and usually stressed out. She doesn’t have much warning before she actually does faint. Right before she passes out, her eyes look glazed over and they appear to roll back into her head. While she is passed out, her body looks as though it is convulsing. She was tested when she was first diagnosed for seizures. After she gains consciousness she has mental confusion, is very disoriented, and is very “loopy” or goofy. She is unable to tell us what happened immediately before she passed out. It usually takes her a good couple of hours to become “normal” again. After the faint, she is freezing cold. On average, she is out for 3 or 4 minutes. It’s been up to the most of 45 minutes to 1 minute. Things that she does to prevent fainting are, bending her knees, wearing support hoes, drinking lots of water, takes sodium pills and potassium pills. She avoids standing up in one position for a very long time.

        Her having a fainting disorder has impacted not only her life, but everyone she knows as well. When she was in high school, to would faint at school and the ambulance would come. All of her friends and the family have to know what to do in case she does faint. They need to know how to bring her out of it. What works for Elizabeth is to lift up her feet very high to help the pooled blood flow back to her brain. We put many blankets on her and slowly and calmly try to wake her up. Luckily it has never happened when she was sitting so she is still able to do most things. She handles her condition very well and knows how to avoid situations that would make her faint.