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General: If a person has symptoms of hypotension, the goal is to determine the underlying cause. A doctor may perform one or more of the following tests to reach a diagnosis. Blood tests: Blood tests may be performed to determine if an infection is present in the blood. They are also used to detect possible endocrine problems, such as low blood sugar levels, an underactive or overactive thyroid gland, or adrenal insufficiency. Blood tests may also determine if the patient has vitamin B-12 or folate deficiencies and/or anemia. Echocardiogram (echo): An echocardiogram may also be performed to detect possible abnormalities in the heart muscle. This test is similar to an ultrasound that is used in pregnant women. A wand-like device (called a transducer) is rubbed on the patient's chest, and sound waves produce images of the heart. This test can detect abnormalities in the heart rhythm or structure. It can also detect possible heart muscle damage caused by heart attacks or heart disease. Electrocardiogram (ECG, EKG): An electrocardiogram may be performed to detect abnormalities in the heart's rhythm or structure. It can also detect problems with the supply of blood to the heart muscle. During the procedure, small electrode patches attached to the person's chest, arms, and legs. These electrodes transmit information about the electrical activity of the heart to a monitor. Stress test: A stress test may also be performed to determine how blood pressure changes when the heart is working harder than normal. This test may make it easier for a doctor to diagnose hypotension. During the test, the patient either exercises (often on a treadmill) or is given medication to make the heart work harder. Small electrodes are placed on the patient's chest to monitor the electrical activity of the heart. The patient's blood pressure may also be monitored. People with hypotension will have lower blood pressure during a stress test than healthy people who undergo a stress test. Tilt-table test: Patients who have postural hypotension or neutrally mediated hypotension may undergo a tilt-table test. During the test, the patient lies on a table that is tilted to raise the upper part of the body. The patient's blood pressure is measured during the test to determine how the body reacts to changes in position. Valsalva maneuver: A valsalva maneuver test may be performed to evaluate the functioning of a patient's autonomic nervous system. This test analyzes the patient's heart rate and blood pressure after several cycles of deep breathing. The patient is asked to take a deep breath and force air out through the lips when exhaling. In a healthy person, this action traps blood in the major arteries, preventing it from entering the chest and right atrium. When the person breathes out, the intrathoracic pressure drops and the trapped blood is quickly pumped through the heart. This causes an increase in the heart rate and the blood pressure. Immediately after the valsalva maneuver, the heartbeat starts to slow down. Abnormalities in this response may indicate problems with the person's autonomic nervous system.
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