Complaints and symptoms

The most common symptom of circulatory disorder is dizziness. Typically, dizziness occurs in an upright body position. If the circulation regulation fails, the blood supply to the brain is reduced. Mostly there is a diffuse dizziness, drowsiness or feeling of emptiness of the head. There is a risk of powerlessness. This is a brief loss of consciousness to understand. Due to the sudden relaxation of the musculature, it usually comes with powerlessness also to the fall. At the beginning of the investigation after fainting it must be clarified whether it was rather a cardiac arrhythmia or other heart disease instead of a circulatory disturbance. An epilepsy must be excluded as a possible cause of loss of consciousness.

It's not always dizziness or fainting. Circulatory disorders can also be accompanied by concentration problems, tiredness or palpitations. Careful history taking, the knowledgeable consultation of all typical ailments often leads to the diagnosis of some form of circulatory disorder.

With the help of the blood pressure and pulse in lying and standing (Schellong test) or with the help of tilt table examination different forms of circulatory disorders are distinguished.

With a detailed discussion of the symptoms, previous illnesses, triggering situations, the possible causes of fainting or the temporary loss of consciousness can already be focused on a few in-question diagnoses.

Classical forms of circulatory disorder include:

• orthostatic hypotension, i. the low blood pressure while standing,
• the vasovagal syncope, i. the reflex-like powerlessness
  Postural tachycardia, i. massive acceleration of the heartbeat while standing.

Orthostatic Hypotension

Die Orthostatische Hypotonie, d.h. das starke Absinken des Blutdrucks im Stehen ist die häufigste Form von Kreislaufstörungen bei Menschen im Alter über 75 Jahre. Diese Form der Kreislaufstörung wird durch ein Absinken des Blutdrucks nach Wechsel vom Liegen zum Stehen verursacht. Direkt nach dem Aufstehen oder wenige Minuten später kann es dabei zu Schwindel oder Schwarzwerden vor den Augen kommen. Prinzipiell kann auch eine kurzzeitige Ohnmacht eintreten.

A thorough search often finds not just one but several causes of orthostatic hypotension, such as:

• Fluid and / or salt deficiency eg in the context of acute infections, diarrheal diseases.
• Antihypertensive or medications with hypotensive side effects.
• Diseases that may affect cardiovascular function: diabetes mellitus, chronic renal insufficiency, heart failure, aortic valve stenosis, cardiac arrhythmia, long-standing high blood pressure, adrenal disorders
• Neurological disorders that affect the autonomic nervous system, such as Parkinson's disease, polyneuropathy or certain dementias.

Especially in the context of chronic neurological diseases such as Parkinson's disease, polyneuropathy or dementia even a very low blood pressure can stand unnoticed for a long time. This is due to the fact that rarely typical symptoms of a circulatory disorder such as dizziness, nausea, cold sweat are described. More often, orthostatic hypotension may become noticeable during the day after a prolonged period of inactivity, fatigue, difficulty concentrating, dizziness, headache and neck pain.

In addition, the importance of orthostatic hypotension for the heart health and mobility of those affected has long been underestimated. A long-term observational study over 23 years in more than 12,000 people with orthostatic hypotension showed that this circulatory disorder is a general risk of falls. Heart problems also appear to be more common in people with orthostatic hypotension.

Vasovagale Syncope

A vasovagal syncope is understood to be a reflex-like powerlessness. It is the most common form of circulatory collapse, sudden fainting. About one third of all people are affected by powerlessness or impotence at least once in their lives. The most frequent cause is the reflex-occurring circulatory collapse, i. the syncope. This occurs mostly but not exclusively standing up. Classic signs of the impending impotence are dizziness and black vision in front of eyes, a feeling of heaviness in the legs, nausea and sweating. Occasionally, however, these signs of impending powerlessness remain.

The range of possible triggers of reflex-like fainting (to be used synonymously: reflex syncope, vasovagal syncope) is broad. These include: standing for a long time, going to the toilet, pain, seeing blood, taking blood, emotions such as anxiety or excitement. Rare triggers include pressure on the neck or neck arteries due to tight-fitting collars or rapid head turning. Although the triggers vary greatly from person to person, the fainting reflex is always the same. This vasovagal reflex temporarily causes a prompt drop in blood pressure and, often, a slowing of the heartbeat.

At first glance, a reflex that results in powerlessness may seem superfluous. Perhaps, however, the vasovagal reflex has an evolutionary significance and protects us from major blood loss after injury. Against this background, fainting in the context of vasovagal syncope would be the necessary evil of an originally life-saving reflex. Even if the states of powerlessness seem unpredictable to you, you can prevent it. We have put together some practical everyday tips that have been helpful to patients with their condition.

For example, to distinguish between fainting in circulatory collapse and loss of consciousness in epilepsy, it can be very helpful if the event can be described by observers. We note again and again that even the inclusion of all observations constitutes a first differentiation between different forms of fainting, i. For example, circulatory collapse and epilepsy are possible.

Postural tachycardia syndrome (short: POTS)

Postural tachycardia, that is, the acceleration of the pulse when standing or at low physical stress is a frequently overlooked circulatory disorder - especially since the postural tachycardia syndrome rarely leads to fainting. More common are nonspecific symptoms that change during the day such as headache, dizziness, feeling weak but also anxiety or anxiety. Often sufferers repeatedly notice even a rapid heart rate or a noticeable racing heart while standing or at relatively low exercise stress. The symptoms typically occur in an upright position. When lying down, the person concerned is promptly better.

It is not always possible to prove the causes of the circulatory disturbances mentioned. Mostly, however, these disorders are transient and regress after weeks or months. Possible causes of postural tachycardia syndrome include, for example, fluid loss and / or salt losses such as renal insufficiency, thyroid disease, infections, delivery, major surgery, congenital connective tissue weakness, and occasionally anxiety disorders. This form of circulatory disorder is well treatable requires careful history taking examination to find the appropriate individually very different long term successful treatment in each case.

Typically, the diagnosis of postural tachycardia syndrome is late. In order to reduce the uncertainty, which can cause the mentioned complaints, after extensive diagnostics with us carefully informed about the postural tachycardia syndrome. For this it is important to find out which complaints should be taken into account. Which forms of stress lead to circulatory disorders. As part of the ANS Clinic we provide suitable examination methods and support you in everyday life with an electronic diary and recommendations for the prevention of circulatory disorders and an individual treatment concept.

Standardized circulatory control tests at the ANS Clinic include heart rate variability testing based on various test conditions such as deep breathing, Valsalva maneuvers, and passive upright tilting.

For the recognition of a circulatory disorder but also to find triggers of powerlessness, it is important to train those affected and relatives. Only in this way, for example, in vasovagal syncope, i. the reflex-like fainting states to assign triggers and avoid. The ANS Clinic provides information and technical support. Targeted countermeasures are effective very quickly. Circulatory training and tips for everyday life help to prevent. Rarely, medication is needed for this.

The care of the cause search and the understanding of all influencing factors contribute decisively to the treatment success. The ANS Clinic concept is based on close collaboration with colleagues in other medical disciplines such as cardiology, gastroenterology, diabetology, pulmonology and sleep medicine.