F.E.A.S.T.

How to measure orthostatic heart rate or blood pressure (hypotension)

Tips from the Around the Dinner Table forum

• "There are two important issues to understand regarding “heart effects” in children and adolescents with an eating disorder: one is bradycardia (too low a heart rate) and the other is being orthostatic by either heart rate or blood pressure. These two things are defined a little differently by different institutions, but only a little. At the Kartini Clinic we define bradycardia of concern as a daytime heart rate of 50 beats per minute or less. A concerning degree of orthostasis would be a pulse change of 35 beats per minute or greater after lying for 5 minutes and then standing for 2.5 minutes; or a drop in blood pressure of 10 mmHg or greater from lying to standing." 
• Underhiswings describes the orthostatic blood pressure procedure step by step:

1.     Patient lies flat (no pillow), resting for 5 minutes

2.     Blood pressure and pulse are taken and recorded

3.     Patient stands quietly for 2.5 minutes

4.     Blood pressure and pulse are again taken and recorded

Then the results are assessed by subtracting the beginning levels from the ending levels for pulse and systolic measurements

Indications for monitoring of activity level:

Pulse:  >15 bpm increase in heart rate.  At this level all activity MUST be restricted.  Fluid intake must be increased.  This means no sports, no PE, and only walking between classes, not to and from school.   A wheelchair is required if there is to be walking for any distance.  Just consider, if the heart is working this much harder just to pump the blood from the feet to the brain after standing for 2 ˝ minutes, it does not have the strength for anything more strenuous.  

Indications for hospitalization along with clinical judgment:

Severe bradycardia (low pulse rate):  <50 bpm (beats per minute)

Hypotension:  Blood pressure <80/50

Orthostatic hypotension:       >20-30 bpm increase in heart rate

                                                >10-20 mm Hg drop in systolic BP