New management of orthostatic hypotension

New Management of 
Orthostatic Hypotension 
Thach Nguyen, Le Thi Thuy Linh 
BACKGROUND 
Current management of orthostatic hypotension : 
 Increase salt and fluid intake 
 Midodrine (A) 
 Steroids (B) 
 Knee or thigh high stocking (C). 
There is no guideline or clinical clues when to use which and 
which combination. 
METHODS 
Divided in 2 groups: 
 Usual treatment (group 1) : Received the usual tests and 
treatment. 
 The patients ( group 2 ) : Received the new Size and 
Expansibility of the Femoral Vein (SEFV) test. 
Principles on the Size and Expansion of 
the Femoral Vein (SEFV) test 
The first principle: 
 The volume of blood going through the femoral artery 
and returning through the common femoral vein 
should be the same. 
 The size of the femoral artery = the femoral vein. 
If the amount of venous return is lower 
 => edema in the lower leg. 
The second principle: 
 In VCS, the circulating blood about 65% in veins 
but only 13% in arteries. 
 Size of arteries does not change much due to 
vascular tone  keep a fairly constant blood 
pressure. (Figure 1) 
Non-Invasive SEFV Test 
 Measure the size and the expansion of the common 
femoral vein 
 Assess accurately the arterial and venous volume 
 Examine the size of the femoral vein and its expansion 
with cough. 
Figure 2. The location where 
the probe positioned 
Figure 3. Vascular probe. 
Figure 4. In patients with 
normal fluid status 
Figure 5. The size of the 
femoral vein is a little larger 
than the size of the common 
femoral artery 
Figure 6. Normal expansion of the femoral vein to less 
than 2 times larger than the baseline 
Figure 7. In patient with pulmonary hypertension, 
dehydration or hypovolemia, there is no or minimal 
expansion of the femoral vein 
Excessive Venous Pooling 
Causing Syncope 
Panel A. The femoral 
vein at its baseline 
Panel B. The femoral vein 
expanded to a huge volume 
upon cough 
 15 patients - January 2015 to April 2016 
 (10/15) arrived while on full dose of midodrine and 
florinef 
 8/15 patients –abnormal SEFV test - severe venous 
pooling - improved well with thigh high ted hose. 
RESULTS 
 Have the SEFV early + the results positive 
=> Wear thigh high stocking. 
 Larger scale of clinical trial or registries are needed. 
Conclusion: 
 Thach Nguyen[1], Advait Soni[1], Ryan Phan[2], Linh 
Thi Thuy Le[3], Tung Mai[4], Duane Pinto[5, 4] 
 St Mary Medical Center, Hobart IN, USA 
Notre Dame University, South Bend IN, USA 
 Tan Tao University Medical School, Long An, 
Vietnam 
Detroit Medical Center, Detroit MI, USA 
 Beth Israel Deaconess Medical Center, Boston MA, 
USA 
References 
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