i'm okay perfect as bald as possible with a very shiny head
how are you so i'm from the whole pakistan very good and i am studying mbbs from china right
and so my question is about autonomy when you were discussing about uh autonomic neuropathy
hypotension yes yes arthrostatic hypotension could you please tell me about the basic
mechanism behind that okay sure i can repeat it for you look here that let's suppose there's a man
let me explain it here the real mechanism behind the orthostatic hypotension
which is also called postural hypotension let's suppose that ok i will make it very simple
with a bottle okay look at this bottle it is half empty right this bottle is half empty if
this is human being this is the head and this is the lower part of the body in this bottle
when it is in upright position the water is gravitating down
in the same way in the same way in a human being if you suddenly stand up blood blood should
gravitate down right and when he lie down then blood should be evenly distributed in the body
but if suddenly stand up and blood really gravitate down it is very dangerous you know why
it is dangerous because if blood is accumulated into veins of the legs and lower part of the body
right then venous return to the heart will be less if less blood is returning if less blood
is returning from the lower part of the body to the heart then heart will be pumping less and we
will develop cerebral hypoxia and we may develop vertigo or we might develop what is this blackout
now the nature has been very kind actually as soon as from lying position we go to the
standing position we are not like bottle we are human beings you know what happens
our sympathetic system fire and constricts the lower part of the bottle
and it can sympathetic system constrict the blood vessels in the lower part of the body
including the veins and when these veins contract they squeeze the blood towards the upper part
of the body so reasonable venous return to the heart is maintained and heart can maintain the
cardiac output and we don't develop cerebral ischemia now now if someone has damage to his
autonomic nervous system right when he is lying down the blood is evenly contributed distributed
in the all part of the body but when when this person stand up autonomic nervous system cannot
fire because neurons are damaged due to diabetes when neurons are damaged lower part of the vessels
don't constrict when they don't constrict such person when stand up blood tend to pull
or accumulate into lower part of the body right and if you check the blood pressure there will be
significant fall in the blood pressure on sudden standing right and we will say this person has
developed hypotension due to change in posture so we call it postural hypotension is it clear
thank you yes thanks very much welcome huge fan of yourself thank you very much thank you very much