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Cardiac Tachypacing for Severe Refractory Idiopathic Orthostatic Hypotension

Peter Weissmann, MD; Michael T. Chin, MD, PhD; and Arthur J. Moss, MD
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Requests for Reprints: Arthur J. Moss, MD, University of Rochester Medical Center, 255 Crittenden Blvd., Rm. 123 HWH, Rochester, NY 14620.

Current Author Addresses: Drs. Weissmann, Chin, Moss: University of Rochester Medical Center, 255 Crittenden Blvd., Rm. 123 HWH, Rochester, NY 14620.

Ann Intern Med. 1992;116(8):650-651. doi:10.7326/0003-4819-116-8-650
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This excerpt has been provided in the absence of an abstract.

In 1925, Bradbury and Eggleston described three patients with marked postural decline in the blood pressure, fixed heart rate, anhidrosis, nocturnal polyuria, and impotence (1). This idiopathic disorder is caused by primary autonomic nervous system dysfunction, which may be central with multiple neurologic defects (the Shy-Drager Syndrome) (2) or peripheral with a defect limited to the efferent sympathetic nerves (3). Orthostatic hypotension usually develops insidiously over a period of years and eventually becomes functionally disabling. Patients experience orthostatic faintness and syncope, especially in the morning after they awaken.

Therapy for this disorder is unsatisfactory and usually involves a multifaceted approach


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