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WHAT IS NEURALLY MEDIATED HYPOTENSION (NMH)?
Neurally Mediated Hypotension is a condition or syndrome where the body's regulation of blood pressure is found to be difficult, especially when standing upright. The reason why this condition occurs is unknown. Blood pressure and heart rate are effected. In this condition the blood pressure will suddenly drop causing dizziness, weakness, sweating, or lightheadedness. Most sufferers feel the sensation that they may faint. Some actually do faint. Recently, studies have reveiled that some people suffering with Chronic Fatigue Syndrome and/or Fibromyalgia also have Neurally Mediated Hypotension. However, people with CFS or FMS are not the only people to suffer with Neurally Mediated Hypotension.
HOW IS NEURALLY MEDIATED HYPOTENSION DIAGNOSED?
To diagnose NMH, doctors perform a tilt table test on the patient. This is to see if an abnormal fainting reflex is exhibited. NMH is not the same as the common momentary dizzines that many well people get when they arise from a chair or a bed too quickly, therefore, this special test is necessary. The patient will rest on a special table that actually tilts slowly upward to an almost standing position. Blood pressure and pulse rates are constantly monitored. If the blood pressure falls along with a sudden drop in the patients pulse rate, the test is determined to be positive. If the blood pressure doesn't fall, medication is used to raise the pulse rate is administered intravenously. If the blood pressure and pulse rate fall during this stage, then the test is determined to also be positive. Dramatic drops in blood pressure during the test many times results in actual fainting. Under the doctors supervision certain medications that may affect the results of the test should be discontinued a few days prior to testing.
WHAT ABOUT TREATMENTS?
Many patients can get relief from the symptoms, but treatment isn't always effective. Treatments are tailored for each patient because there is as of yet, no standard treatment. Currently, medication that prevents the heartbeat from slowing when it should be speeding up is used. Also, medication to boost the blood pressure combined with a change in diet to include more sodium has seemed to help some people. Patients diagnosed with CFS and NMH need to be particularly careful when beginning a new drug therapy because of demonstrated hypersensitivity to some medications.
JOHNS HOPKINS HOSPITAL AND NMH
Johns Hopkins Hospital in Baltimore, MD, has been leading the way in studying the possible correlation between CFS and NMH. Approximately 250 patients were evaluated and 95 percent had an abnormal response to the tilt table test. Dr. Hugh Calkins of the Hopkins study said, "The condition involves a mix-up in connections between the heart and the brain. Normally, standing leads blood to pool in the legs, so the body compensates by sending a message to the heart to beat faster and more vigorously. In Neurally Mediated Hypotension, abnormally sensitive sensors in the heart are activated and send the wrong message to the brain, which then triggers the heart and the circulatory system to slow down, blood pressure to drop and lightheadedness, nausea, disorientation and sometime fainting to result." Dr. Calkins noted that people with the abnormality have normal blood pressure most of the time and therefore the underlying condition cannot be picked up on routine blood pressure screening. The Hopkins study team has also published in JAMA in the September 27, 1996 issue. A treatment plan was suggested where patients were started on Florinef, a steroid that helps the body retain salt and increases blood volume, and potassium pills. This was supplemented or replaced, as needed, with heart drugs such as the beta blocker, Tenormin. In addition, patients were asked to increase salt intake. The approach requires patience and regular physician monitoring to adjust doses to the individual patient and watch for potentially serious side effects, Dr. Rowe stressed.
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