USMLE Orthostatic "HypEr-tension" weird question UW

[Mkandil]

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Hi there guys
I came across a question in UW that describes a patient with high blood pressure and low renin, the diagnosis turned out to be Conn's syndrome

The weird part was that the patient's systolic blood pressure goes up (from 190 to 195) on standing; and his heart rate drops (from 72 to 70) also on standing. His diastolic blood pressure didn't change with changing position.

they didn't mention in the answers why that happened, and I really tried to find an explanation but no clue :/

any thoughts?
Thanks

 

[aspiringmd1015]

on standing it will go up because of the alpha constriction of the patients blood vessels,, so with that the patient will have a reflex brady. Thats at least my understanding of it.

 

[Mkandil]

on standing it will go up because of the alpha constriction of the patients blood vessels,, so with that the patient will have a reflex brady. Thats at least my understanding of it.

Isn't it supposed to drop first due to blood escaping in lower limbs?, afterwhich low blood pressure would stimulate baroreceptors ---> + sympathetic ---> then alpha constriction

 

[pathologyDO]

Hi there guys
I came across a question in UW that describes a patient with high blood pressure and low renin, the diagnosis turned out to be Conn's syndrome

The weird part was that the patient's systolic blood pressure goes up (from 190 to 195) on standing; and his heart rate drops (from 72 to 70) also on standing. His diastolic blood pressure didn't change with changing position.

they didn't mention in the answers why that happened, and I really tried to find an explanation but no clue :/

any thoughts?
Thanks

on standing it will go up because of the alpha constriction of the patients blood vessels,, so with that the patient will have a reflex brady. Thats at least my understanding of it.

Strange Uworld question for sure. I remember Goljan saying that diastolic pressure is basically determined by TPR... so if the mechanism is indeed increased alpha-adrenergic stimulation causing vessel contraction, that should increase TPR and thus increase diastolic BP I would think... I dunno!

@seminoma ?

 

[Mkandil]

so if the mechanism is indeed increased alpha-adrenergic stimulation causing vessel contraction, that should increase TPR and thus increase diastolic BP

Yes, I totally agree

 

[aspiringmd1015]

yeah but i believe with conns, you have increased aldo, that increase in plasma volume would fill your entire vascular system, so it wont be able to pool, tahts what i thought in my head. I guess more of a justification if anything, and alpha vc does increase TPR and diastolic but at the same time constricts your complaint veins increasing VR.

 

[EmergDoc2B]

Age of the patient in the stem? Older patient could aortic stiffening with SBP increasing but not DBP.

 

[RnaPolymerase2]

i believe this pt change in HR on standing is due to the reflex bradycardia

 

[dfib slim]

That was such a small change and with the error in non-invasive blood pressure monitoring I assumed there was no significant change between sitting and standing. If you take someone's blood pressure 5 times in the same position you're most likely going to get 5 different numbers.

 

[Jabbed]

Hi there guys
I came across a question in UW that describes a patient with high blood pressure and low renin, the diagnosis turned out to be Conn's syndrome

The weird part was that the patient's systolic blood pressure goes up (from 190 to 195) on standing; and his heart rate drops (from 72 to 70) also on standing. His diastolic blood pressure didn't change with changing position.

they didn't mention in the answers why that happened, and I really tried to find an explanation but no clue :/

any thoughts?
Thanks

Reading that, I would only appreciate the absence of orthostatic hypotension. Keep in mind that sphygmomanometers are only precise to within 5 mmHg, and that a variation of 2 bpm is nothing.

 

[Mkandil]

Age of the patient in the stem? Older patient could aortic stiffening with SBP increasing but not DBP.

The patient was 32 and even if older I don't think it would elevate Bl. pr on standing

That was such a small change and with the error in non-invasive blood pressure monitoring

sphygmomanometers are only precise to within 5 mmHg

Thanks guys
I think the measurement variation is the reason