Coat-hanger ache in orthostatic hypotension.
BACKGROUND
Questionnaires administered to orthostatic hypotension (OH) patients reveal frequent occurrence of coat-hanger ache (CHA), but laboratory-based precipitation of CHA during head-up tilt (HUT) has not been investigated. This study compared the frequency and clinical aspects of CHA in the same group of OH patients during daily activities versus during HUT.


METHODS
Retrospective IRB-approved review of prospectively collected data on 22 dysautonomic patients. Heart rate response to deep breathing, Valsalva manoeuver, HUT and thermoregulatory sweat test evaluated cardiovagal, adrenergic and sudomotor functions. Occurrence and clinical features of CHA during daily activities and during HUT were recorded. Data were analysed with descriptive statistics.


RESULTS
All patients demonstrated severe adrenergic (OH), cardiovagal and sudomotor impairment. Of 22 patients, 13 (59%) reported CHA within 3-5 minutes of standing or after 10 minutes to 2 hours of sitting that was relieved within 5-20 minutes of recumbency. During HUT, 4 of 13 (18%) patients developed CHA. Clinical features varied.


CONCLUSIONS
CHA was reported by 59% of OH patients during daily activities and by only 18% during HUT. The clinical characteristics of CHA episodes displayed inter-individual and intra-individual variability. These findings militate against direct association between OH and CHA and suggest a complex pathophysiology.
Department of Medicine, Union Memorial Hospital, 201 East University Parkway, Baltimore, MD 21218, USA. lyn.camire@medstar.net
Ramesh K
RK
Khurana
D000368:Aged; D001341:Autonomic Nervous System / Q000503:physiopathology; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000150:complications* / Q000503:physiopathology; D012189:Retrospective Studies; D020069:Shoulder Pain / Q000150:complications* / Q000503:physiopathology; D018667:Tilt-Table Test