Overview: What is circulatory instability?
Unstable circulation is not an independent clinical picture.
Circulatory problems are the result of various illnesses that usually cause low blood pressure.
However, there are also situations of acute circulatory instability with (still) maintained blood pressure.
Under normal circumstances, low blood pressure is even considered to be conducive to a longer life expectancy.
In contrast, an acute and persistent drop in blood pressure leads to life-threatening circulatory instability.
In acute circulatory instability, the cardiovascular system fails for various reasons.
When the heart stops beating, blood circulation comes to a standstill.
Cardiovascular arrest is an emergency and the affected person must be resuscitated.
The functional principle of our cardiovascular system
Our left side of the heart continuously pumps oxygen- and nutrient-rich blood to all of our body’s organs via the arteries.
Deoxygenated blood flows via the veins to our right side of the heart and back to the left side of the heart via the lungs.
On its way through the lungs, the blood is enriched with oxygen and pumped back into the body via the arteries.
Different blood pressure values in the arteries and veins ensure that all organs are well supplied with blood.
The blood pressure value indicates how high this pressure is.
If the blood pressure is low, the heart has to beat faster, i.e. pump more often, in order to supply all vital organs with blood.
If this does not happen sufficiently, our brain receives too little oxygen.
This can result in our vital organs malfunctioning.
Doctors also refer to low blood pressure as hypotension.
When do I have to go to hospital if I have circulatory problems?
As a rule, low blood pressure and the associated sporadic circulatory problems are harmless.
Sometimes hypotension can also be caused by an illness, for example Parkinson’s disease or diabetes.
In older people and people with pre-existing conditions, circulatory problems may indicate a pumping weakness of the heart. Consult us if
- your blood pressure is constantly too low,
- you regularly suffer from severe circulatory problems (see below),
- an acute drop in blood pressure occurs.
Circulatory instability: causes and risk factors
There can be various causes behind an unstable circulation.
Circulatory instability due to primary hypotension
In people with primary hypotension, blood pressure is permanently too low.
The causes are not known.
Those affected often suffer from circulatory problems.
Risk factors for circulatory problems are
- very warm weather (heat),
- fluctuating temperatures,
- bathing in warm water for too long,
- long periods of bed rest,
- long periods of standing,
- Pre-existing conditions.
Circulatory instability due to secondary hypotension
Certain illnesses or medication can also cause permanently low blood pressure.
Specialists refer to this as secondary hypotension.
The following causes can lead to secondary hypotension:
- severe diarrhea
- persistent vomiting
- Heart diseases
- Vascular diseases
- Diseases of the nervous system
- Hormonal disorders (for example diabetes or hypothyroidism)
- Infections
- Lung diseases
- Kidney diseases
- Mental illnesses
These drugs can lead to circulatory problems:
- Antidepressants
- Blood pressure medication including dehydrating agents
- Eye drops against glaucoma
- Medication for benign prostate enlargement
- Chemotherapy
Other causes of acute circulatory instability
Other possible causes of short-term circulatory problems are
- Infections (inflammations)
- Poisonings
- Severe blood loss (for example due to an injury)
- allergic reactions
In some people, strong irritation of the vagus nerve can lead to circulatory problems.
The blood vessels dilate and the heart rate drops when the nerve is activated.
As a result, blood pressure drops.
This can happen, for example, when someone is frightened or scared.
Circulatory problems due to orthostatic dysregulation
Many people temporarily black out when they get up too quickly from a lying position.
If this is particularly pronounced, specialists refer to it as orthostatic dysregulation.
The reason: depending on whether we are standing, sitting or lying down, our body has to adjust our blood pressure in order to supply all organs with blood.
In orthostatic dysregulation, this mechanism is disrupted.
Due to the change in position, the blood sinks into the legs when we stand up and must first be pumped back up again.
As a result, the brain temporarily receives less oxygen and we briefly experience typical symptoms of circulatory problems (see below).
In contrast to serious circulatory disorders, these symptoms are short-lived and improve quickly within a few minutes.
Conscious measures such as standing up slowly help with these circulatory problems.
Risk factors for orthostatic dysregulation are
- Alcohol
- Blood volume deficiency
- Medication
- Cardiovascular diseases
- Hormone disorders
- neurological diseases
- Pregnancy
Circulatory instability in the heat
Many people experience circulatory problems when it is very hot.
This is because when we are too hot, our body uses various measures to try and release the excess heat.
The blood vessels in the skin dilate, blood pressure drops and the heart has to pump more in order to supply all organs sufficiently.
We also sweat more in the heat.
If we don’t drink enough, the blood thickens and can no longer circulate as well.
Without a change in circumstances, this leads to heat exhaustion.
Circulatory instability during pregnancy
Circulatory problems occur more frequently during pregnancy.
The hormonal changes cause the blood vessels to dilate.
Blood pressure can drop.
Many pregnant women suffer from circulatory problems, especially in the first six months.
Falls are dangerous for the expectant mother and the child.
If you notice any signs of circulatory problems, you should sit down immediately or preferably lie down and elevate your legs.
Symptoms: Recognizing circulatory instability
Depending on whether the blood pressure drops suddenly or is permanently too low, circulatory problems can manifest themselves in different ways.
Symptoms of a sudden drop in blood pressure
In the event of a sudden drop in blood pressure (acute hypotension), the brain and other organs temporarily do not receive enough oxygen.
Typical symptoms of an acute drop in blood pressure are
- Eye flickering, “blackness” before the eyes,
- Dizziness,
- Paleness
- Cold skin
- Break out in a sweat,
- Nausea,
- Change of character up to fainting (syncope).
Symptoms of persistently low blood pressure
In some patients, blood pressure is permanently too low (chronic hypotension).
In addition to the typical circulatory problems, other symptoms may occur:
- Lack of drive
- Increased need for sleep, tiredness
- Concentration difficulties
- Headache
- Ringing in the ears
- Cold hands and feet
- Loss of appetite
Symptoms of acute circulatory instability
Acute circulatory instability is life-threatening.
It must be treated immediately.
Every minute counts.
Cardiac arrest is the most severe form of acute circulatory instability and the signs of it are
- Fainting/ motionlessness
- Lack of breathing
- Missing pulse (difficult to detect)
- wide, unresponsive pupils (unsafe sign)
- Pale gray skin discoloration (uncertain sign)
Caution: Circulatory arrest is an emergency.
In the event of circulatory arrest, resuscitation measures must be initiated immediately.
You should also call the emergency services (144) immediately and continue resuscitation measures until they arrive.
Callers to the emergency number 144 will also receive instructions on first aid measures to bridge the waiting time until the rescue service arrives.
Diagnosis of circulatory instability
Depending on the time course, severity and accompanying circumstances, we will clarify your circulatory problems in different ways.
We distinguish between
- Life-threatening acute circulatory instability
- Chronic circulatory weakness
In acute emergencies such as cardiac arrest, immediate treatment is provided as a team.
Staff from anesthesia, emergency medicine, cardiology, neurology, trauma surgery, radiology and intensive care work together to save your life.
This takes place in a well-equipped treatment room – the shock room.
Many medical measures can be taken here before life-saving immediate surgery.
After the initial support of vital functions, a computer tomography or cardiac catheter examination is carried out to find the cause.
Intensive care units or intermediate care units are available for optimal follow-up care.
In the case of circulatory weakness that is not immediately life-threatening, we will clarify your problems either in our cardiology outpatient clinic or ward.
We will ask you a few questions to clarify what is behind your circulatory problems:
- How long have you had circulatory problems?
- Have you noticed any other changes, pain, shortness of breath?
- Do the complaints occur in certain situations?
- Do you take any medication?
If so, which ones?
- Are you aware of any pre-existing conditions?
Following the consultation, we will examine you physically.
We have various examination methods at our disposal for this purpose:
- Checking the heartbeat for regularity and frequency
- Measurement of blood pressure
- Preparation of an ECG
- Schellong test (test for the diagnosis of orthostatic dysregulation)
If we suspect an illness behind your symptoms, further examinations may be necessary. These include:
Specialists at the USZ
The best possible medical infrastructure is available to us at the USZ for your treatment.
At the heart of our success is our outstanding teamwork with world-renowned specialists in your field.
This enables us at the USZ to guarantee maximum medical care at an international level, even in exceptional situations.
Clearly standardized procedures are complemented by the latest treatment methods.
In the field of circulatory failure in particular, we are not only practitioners but also teachers.
Doctors around the world rely on our expertise as cardiovascular physicians and undergo further training with us (e.g. PCHF).
Circulatory instability: prevention, early detection, prognosis
You should always take frequent circulatory problems seriously.
Sometimes it is enough to drink more fluids and exercise regularly.
If your circulation is so unstable that it disrupts your everyday life, you should consult us and have the symptoms investigated.
In older people, circulatory problems can also indicate other illnesses.
These should always be examined by us.
In acute emergencies, call the emergency services (144).
Acute circulatory instability can lead to fainting or even complete cardiovascular failure.
Circulatory instability: treatment not always necessary
Mild circulatory problems can usually be treated quickly and effectively with simple measures.
No special therapy is necessary.
However, if the organs are repeatedly insufficiently supplied with blood, a comprehensive examination is advisable. The Institute of Anesthesiology will select the anesthesia procedure best suited to your individual needs for a surgical procedure.