{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T09:44:39Z","timestamp":1750239879333,"version":"3.37.3"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,2,4]],"date-time":"2020-02-04T00:00:00Z","timestamp":1580774400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,2,4]],"date-time":"2020-02-04T00:00:00Z","timestamp":1580774400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013327","name":"Lundbeck","doi-asserted-by":"crossref","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}],"id":[{"id":"10.13039\/501100013327","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Cardiovasc Disord"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Neurogenic orthostatic hypotension, a sustained decrease in blood pressure upon standing, is caused by autonomic nervous system failure and characterized by an insufficient increase in heart rate needed to maintain blood pressure upon standing. In this case, neurogenic orthostatic hypotension symptoms preceded a diagnosis of Parkinson disease. A diagnosis of underlying neurogenic orthostatic hypotension significantly changed the course of treatment for this patient.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>An 84-year-old woman was referred to a cardiologist by her primary care practitioner for evaluation of exertional dyspnea and chest pain upon walking a few feet. Her medical history included hypertension, hypothyroidism, and osteoarthritis. Based on her continued symptoms, the patient underwent 2 cardiac catheterizations for coronary artery stenosis. After the catheterizations, exertional dyspnea and chest pain continued, and subsequently, dysphagia to solid foods and episodic dizziness developed. Orthostatic evaluation showed a supine blood pressure of 150\/80\u2009mmHg with a heart rate of 70 beats per min. Upon standing for 3\u2009min, the patient\u2019s blood pressure decreased to 110\/74\u2009mmHg with a heart rate of 76 beats per min. The diagnostic criteria for orthostatic hypotension were met, and the lack of an adequate compensatory heart rate increase upon standing was consistent with a neurogenic cause (ie, neurogenic orthostatic hypotension), which was supported by tilt-table testing results. Although nonpharmacologic treatments were initially successful, episodes of lightheadedness, chest pain, and dyspnea upon standing became more frequent, and the patient was prescribed droxidopa (200\u2009mg; 3 times daily). Droxidopa significantly improved her symptoms, with the patient reporting resolution of her chest pain and significant improvement of dyspnea and dizziness. She was diagnosed with Parkinson disease approximately 6\u2009months later.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>This case highlights the importance of evaluating and identifying potential causes of symptoms of cardiovascular disease when persistent symptoms do not improve after cardiac interventions. This case complements findings demonstrating that signs of autonomic failure, such as neurogenic orthostatic hypotension, may precede the motor symptoms of Parkinson disease. Importantly, this case provides real-world evidence for the efficacy of droxidopa to treat the symptoms of neurogenic orthostatic hypotension, after an appropriate diagnosis.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12872-020-01348-w","type":"journal-article","created":{"date-parts":[[2020,2,4]],"date-time":"2020-02-04T18:02:54Z","timestamp":1580839374000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Persistent unexplained chest pain and dyspnea in a patient with coronary artery disease: a case report"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1766-9045","authenticated-orcid":false,"given":"Sameh K.","family":"Mobarek","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,2,4]]},"reference":[{"key":"1348_CR1","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1007\/s10286-011-0119-5","volume":"21","author":"R Freeman","year":"2011","unstructured":"Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21:69\u201372.","journal-title":"Clin Auton Res"},{"key":"1348_CR2","doi-asserted-by":"publisher","first-page":"1567","DOI":"10.1007\/s00415-016-8375-x","volume":"264","author":"CH Gibbons","year":"2017","unstructured":"Gibbons CH, Schmidt P, Biaggioni I, Frazier-Mills C, Freeman R, Isaacson S, et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol. 2017;264:1567\u201382.","journal-title":"J Neurol"},{"key":"1348_CR3","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1056\/NEJMcp074189","volume":"358","author":"R Freeman","year":"2008","unstructured":"Freeman R. Clinical practice. Neurogenic orthostatic hypotension. N Engl J Med. 2008;358:615\u201324.","journal-title":"N Engl J Med"},{"key":"1348_CR4","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1111\/jch.12062","volume":"15","author":"C Shibao","year":"2013","unstructured":"Shibao C, Lipsitz LA, Biaggioni I. ASH position paper: evaluation and treatment of orthostatic hypotension. J Clin Hypertens (Greenwich). 2013;15:147\u201353.","journal-title":"J Clin Hypertens (Greenwich)"},{"key":"1348_CR5","doi-asserted-by":"publisher","first-page":"2212","DOI":"10.1007\/s00415-012-6736-7","volume":"260","author":"M Metzler","year":"2013","unstructured":"Metzler M, Duerr S, Granata R, Krismer F, Robertson D, Wenning GK. Neurogenic orthostatic hypotension: pathophysiology, evaluation, and management. J Neurol. 2013;260:2212\u20139.","journal-title":"J Neurol"},{"key":"1348_CR6","first-page":"101","volume":"27","author":"S Maule","year":"2012","unstructured":"Maule S, Milazzo V, Maule MM, Di Stefano C, Milan A, Veglio F. Mortality and prognosis in patients with neurogenic orthostatic hypotension. Funct Neurol. 2012;27:101\u20136.","journal-title":"Funct Neurol"},{"key":"1348_CR7","doi-asserted-by":"publisher","first-page":"1062","DOI":"10.1161\/01.HYP.30.5.1062","volume":"30","author":"J Shannon","year":"1997","unstructured":"Shannon J, Jordan J, Costa F, Robertson RM, Biaggioni I. The hypertension of autonomic failure and its treatment. Hypertension. 1997;30:1062\u20137.","journal-title":"Hypertension."},{"key":"1348_CR8","first-page":"AP379","volume":"70","author":"LA Hewitt","year":"2017","unstructured":"Hewitt LA, Adler CH, Claassen DO, Gibbons CH, Raj SR. Patient and caregiver experiences with the diagnosis of neurogenic orthostatic hypotension. Hypertension. 2017;70:AP379.","journal-title":"Hypertension."},{"key":"1348_CR9","doi-asserted-by":"publisher","first-page":"237","DOI":"10.7861\/clinmedicine.2-3-237","volume":"2","author":"CJ Mathias","year":"2002","unstructured":"Mathias CJ. To stand on one's own legs. Clin Med. 2002;2:237\u201345.","journal-title":"Clin Med"},{"key":"1348_CR10","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1007\/s10286-007-0396-1","volume":"17","author":"DS Goldstein","year":"2007","unstructured":"Goldstein DS, Sharabi Y, Karp BI, Bentho O, Saleem A, Pacak K, et al. Cardiac sympathetic denervation preceding motor signs in Parkinson disease. Clin Auton Res. 2007;17:118\u201321.","journal-title":"Clin Auton Res"},{"key":"1348_CR11","unstructured":"Northera\u00ae (droxidopa). Full Prescribing Information, Lundbeck, Deerfield 2017."},{"key":"1348_CR12","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1186\/s12883-017-0867-5","volume":"17","author":"I Biaggioni","year":"2017","unstructured":"Biaggioni I, Arthur Hewitt L, Rowse GJ, Kaufmann H. Integrated analysis of droxidopa trials for neurogenic orthostatic hypotension. 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As the current study was a case report, there was no ethics committee to approve the study.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"I have obtained written consent to publish this case study from the participant and to report individual patient data.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"SKM is a consultant and speaker for Lundbeck, Novartis, and Janssen.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"54"}}