The typical initial step in diagnosing low blood pressure is by measuring a person’s blood pressure in both the standing or supine (lying) positions. Individuals who manifest symptoms of hypotension often register a sudden drop in their blood pressure when they start to stand and they more often than not may acquire orthostatic symptoms and an increased heart rate. The aim of the diagnosis is to know the factor(s) that cause(s) low blood pressure, that is, as soon as the cause of the symptoms has been ascertained. There are occasions when the causes of hypotension become somewhat obvious. This may, for example, be sudden shock after the person underwent an x-ray test that entailed the use of iodine or loss of blood caused by trauma. Sometimes, the cause may only be known through testing. Tests for low blood pressure can include:
- Blood electrolyte test – This test measures electrolytes in the blood to see if the patient is suffering from too much acid in the blood (acidosis), kidney failure or mineral depletion or dehydration.
- CBC or complete blood count – This test may identify anemia in the patient due to increased white blood cells caused by infection or blood loss
- Urine and blood cultures – These tests are done in order to identify bladder infections and septicemia respectively.
- Cortisol levels – The amount of cortisol in the body is ascertained to effectively diagnose for Addison’s disease or adrenal insufficiency
- AKG or electrocardiograms – An EKG test can monitor for heart muscle damage, pericarditis or abnormally rapid or slow heart beats caused by either poor supply of blood to the heart muscles that has yet not resulted in a heart attack or from previous heart attacks
- Radiology studies – These tests can include computerized tomography (CAT or CT) scans, stomach ultrasounds and chest X-rays to identify conditions such as diverticulitis, pancreatitis, gallstones, heart failure and pneumonia
- Holter monitor recordings – This is used to identify for instances of irregular heart rhythms. If these abnormal rhythms intermittently occur, then it means that the EKG test done during your doctor’s appointment did not detect any irregular rhythm. The Holter monitor is used for a span of 24 hours recording the rhythm of your heart beat for one whole day. The Holter monitor is utilized to record and diagnose sporadic events of tachycardia or bradycardia.
- Patient-activated event recorder – If the patient experiences sporadic episodes of tachycardia or bradycardia and if a day-long Holter recording fails to capture these episodes, then he can use a patient-activated event recorder for about a month. A patient-activated event recorder is used by pressing a button to commence recording when the patient feels the onset of low blood pressure symptoms or an abnormal heart rhythm caused by low blood pressure. The recordings are evaluated by the doctor to identify the abnormal episodes.
- Ultrasound examinations – This test focuses on the patient’s leg veins. Chest CT scans can help the doctor detect for any pulmonary embolism or deep vein thrombosis.
- Echocardiograms are examinations of the structures and motion of the heart using ultrasound. Echocardiograms can detect a wide range of heart conditions like rare tumors of the heart, heart valve diseases, muscle damage caused by heart attacks and pericarditis due to too much pericardial fluid.
- Tilt-table tests – These tests are helpful in assessing patients who might be suffering from syncope or postural hypotension caused by dysfunction of the autonomic nerves. When undergoing this test, the patient lies on an examination table and given intravenous infusion while his blood pressure and heart rate is evaluated. Afterwards the table is tilted upright for 1/4 to 3/4 of an hour. Blood pressure and heart rate are observed every minute or so. The aim of a Tilt-table test is to reproduce postural hypotension. The doctor usually prescribes epinephrine (Isuprel or adrenalin) intravenously to cause postural hypotension.
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