April 22, 2019

Background: Syncope and presyncope are common presenting complaints to the Emergency Department. Orthostatic vital signs are often included in the ED evaluation of syncope to assess for volume depletion despite their poor performance characteristics as previously discussed. In particular, it is important to understand that older adults often have abnormal orthostatic vitals at baseline,  due to numerous causes including medications, despite having a normal physiologic state (Ooi 1997, Aronow 1988). In spite of the evidence, orthostatic vital signs measurements continue to be recommended by the AHA/ACC/HRS guidelines (Shen 2017) and occupy valuable provider and nursing time.

March 5, 2018

Definition: Orthostatic hypotension (OH) is a form of low blood pressure that occurs with positional change (i.e. sitting up from lying down, standing up from sitting). It is commonly used for the diagnosis of volume depletion

Orthostatic Vital Signs

  • A reduction of systolic blood pressure (SBP) of at least 20 mm Hg
  • A reduction in diastolic blood pressure (DBP) of at least 10 mm Hg
  • An increase in heart rate (HR) by > 30 beats per minute

One of the above criteria must be met while measured 3 minutes after standing from a supine position.

Clinical Question: Are orthostatic vital signs useful in finding patients with occult volume loss? Do they add to our standard clinical assessment of patients?