Ambulatory norepinephrine treatment of severe autonomic orthostatic hypotension
Olaf Oldenburg, MD*,
Anna Mitchell, MD ,
Jens Nürnberger, MD,
Susanne Koeppen, MD ,
Raimund Erbel, MD, FACC, FESC*,
Thomas Philipp, MD and
Andreas Kribben, MD
* Division of Internal Medicine, Department of Cardiology, University Hospital, Essen, Germany
Division of Internal Medicine, Department of Nephrology and Hypertension, University Hospital, Essen, Germany
Clinic of Neurology, University Hospital, Essen, Germany
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Figure 1 Changes of MAP during a 60° head-up tilt-table test (HUT) in a patient with Shy-Drager syndrome (Patient 4). Syncope occurred after 10 min during conventional nonpharmacological and pharmacological treatment (lower line), whereas a symptom-free 45 min test was possible with the patient-controlled, ambulatory norepinephrine treatment (upper line). Heart rate remained stationary in both cases. MAP = mean arterial blood pressure.
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Figure 2 Ambulatory blood pressure measurements (MAP) during medical treatment (dashed line) and patient-controlled norepinephrine treatment (solid line) in a patient with Shy-Drager syndrome (Patient 4). The initial drop in MAP at 8:30 h during norepinephrine treatment was due to a delayed start of the infusion pump; the high pressure at 14:50 h was due to an inadvertent additional bolus application. The blood pressure drops at night, especially during conventional treatment, are due to recurrent postural changes during micturition because of urinary incontinence. MAP = mean arterial blood pressure.
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