Orthostatics
Formal Definition
Orthostatic vital signs: serial blood pressure and heart rate measurements taken supine, sitting, and standing to detect orthostatic hypotension — a drop in systolic BP ≥20 mmHg or diastolic BP ≥10 mmHg within 3 minutes of standing, often with a compensatory heart rate rise.
How It's Used on the Ward
"Check orthostatics" or "orthostatics are positive" — ordered when a patient has syncope, near-syncope, or suspected volume depletion.
Example
""Elderly patient with two falls: orthostatics positive — lying 138/80 HR 68, standing 112/60 HR 92. That's a 26-point systolic drop with a 24-point reflex tachycardia. Volume depleted or autonomic dysfunction — hold her diuretics and antihypertensives.""
Clinical Context
Orthostatic hypotension causes more than just dizziness — it's a fall risk, a syncope cause, and a marker of autonomic dysfunction (diabetic neuropathy, Parkinson's) or volume depletion. It's reproducible and cheap to check — just three BP readings. Compensatory HR rise (≥20 bpm) suggests volume depletion; absent HR rise despite BP drop suggests autonomic failure. Common drug culprits: diuretics, antihypertensives, alpha-blockers, antipsychotics.