Sandbox

A	B	C
D	E	F

A	B	C
D	E	F

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Low HDL

Rule out secondary causes Hypothyroidism Diabetes mellitus Uremia Liver disease Medications - diuretics, progestin, androgens, beta blockers Acute illness - MI, burns, surgery

Lifestyle modification Diet Physical exercise Smoking cessation Weight loss Intake of unhydrogenated monounsaturated fat e.g., olive oil, canola oil

No Coronary heart disease

Assess risk

High risk CHD risk>20% per 10 years

Low risk CHD≤20% per 10 years

Statins or Niacin

Positive family history of premature CHD

Negative family history of premature CHD

Considar statins or niacin

Continue non-pharmacological approach

Low HDL

Rule out secondary causes Hypothyroidism Diabetes mellitus Uremia Liver disease Medications - diuretics, progestin, androgens, beta blockers Acute illness - MI, burns, surgery

Lifestyle modification Diet Physical exercise Smoking cessation Weight loss Intake of unhydrogenated monounsaturated fat e.g., olive oil, canola oil

No Coronary heart disease

Assess risk

High risk CHD risk>20% per 10 years

Low risk CHD≤20% per 10 years

Statins or Niacin

Positive family history of premature CHD

Negative family history of premature CHD

Considar statins or niacin

Continue non-pharmacological approach

Causes of Hypotension in Alphabetical Order

Acetaldehyde Acetophenazine Achalasia-addisonianism-alacrima syndrome ACTH deficiency Acute adrenal insufficiency Acute intermittent porphyria Acute liver failure Acute pancreatitis Addisonian crisis Addison's Disease Adiponitrile Adrenal hemorrhage Adrenogenital syndrome Adrenoleukodystrophy After a major surgery Alcohol Alcohol withdrawal syndrome Alcuronium Alfuzosin Aliskiren Allgrove syndrome Alseroxylon Ambenonium Ambrisentan Amifostine Aminoglutethimide Amitriptyline Amlodipine Amoxapine Amphotericin B Amrinone Amyl nitrate Amyloidosis Anaphylactic shock Anaphylactoid reaction Andrade's syndrome Anemia Anorexia nervosa Antipsychotic agents Aortic aneurysm rupture Aortic Arch Syndrome Aortic Isthmus Stenosis Aortic regurgitation Aortic stenosis Aortocaval compression syndrome APECED Syndrome Apomorphine Atrial myxoma Atrioventricular node conduction block Autonomic failure Autonomic neuropathy Azilsartan medoxomil B type natriuretic peptide Baclofen Baroceptor dysfunction in the elderly Bartter syndrome Beta blockers Bethanechol Bethanidine Binswanger's disease Blood transfusion Blood vessel trauma Bortezomib Bosentan Botulism Bowel strangulation Bradbury-Eggleston syndrome Bretylium Bromocriptine Bupivacaine Burns Cabergoline Calcium channel blockers Candesartan Capillary leak syndrome Captopril Carcinoid syndrome Cardiac tamponade Cardiogenic shock Carotid sinus hypersensitivity Carotid sinus syndrome Cervical spine injury Chemical burn Chloroquine Chlorpheniramine Chlorpromazine Chlorthalidone Cholera Cilazapril Cinnarizine Clevidipine Clomipramine Clonidine Coarctation of aorta Colchicine Complete heart block Congenital adrenal hyperplasia Constrictive pericarditis Copper Cor triatriatum Corticosteroid-binding globulin deficiency Cyanides Cyclobenzaprine Decompression sickness Deglutition syncope Dehydration Demeton-S-methyl Dengue hemorrhagic fever Depression Deserpidine Desferrioxamine Desipramine Dexmedetomidine Diabetes insipidus Diabetic autonomic neuropathy Diabetic ketoacidosis Dialyzer hypersensitivity syndrome Diarrhea Diazinon Diazoxide Dichlorvos Dicobalt edetate Dicrotophos Diltiazem Dioxathion Diphenhydramine Dipyridamole Disopyramide Dissecting aortic aneurysm Distigmine Distributive shock Disulfoton Diuretics Donepezil DOPA decarboxylase deficiency

Dopamine beta-hydroxylase deficiency Dothiepin Doxazosin Doxepin Duodenal ulcer bleeding Dysautonomia Ectopic pregnancy rupture Eisenmenger's syndrome Embolism Enalapril Endocrine shock Endotoxic shock Epidural anaesthesia Eplerenone Epoprostenol Ethion Etoposide Excessive dieting Excessive fluid loss through dialysis Familial juvenile hyperuricemic nephropathy type 2 Fatigue Felodipine Fenoldopam Fensulfothion Fentanyl Fenthion Food additive allergy Fosinopril Fracture of bone Gastric acid stimulation test using histamines Gastric ulcer bleeding Gastric volvulus General anaesthesia Glosssopharyngeal neuralgia Glyceryl trinitrate Granulocyte-macrophage colony stimulating factor Gray baby syndrome Guanadrel Guanethidine Guanfacine Guillain-Barre Syndrome Haloperidol Hantavirus Heart arrhythmia Heart block Heart failure Heart injury Heat exhaustion Hemorrhagic shock Hemorrhagic shock and encephalopathy syndrome Hepatic vein thrombosis Hepatitis Hereditary peripheral nervous disorder Hereditary sensory and autonomic neuropathy type 3 Hexamethonium Honey bee bite Hydralazine Hydroxyzine Hypermagnesaemia Hyperosmolar hyperglycemic nonketotic coma Hypertrophic obstructive cardiomyopathy Hypoaldosteronism Hypokalemia Hyponatremia Hyporeninemic hypoaldosteronism Hypothermia Hypothyroidism Hypovolemic shock Idiopathic hypotension Iliac artery aneurysm rupture Imipramine Indapamide Indian tobacco Indoramin Insufficient fluid intake Interleukin 2 Internal bleeding Intususception Iodine containing radiocontrast media Irbesartan Ischaemic heart disease Isosorbide dinitrate Isosorbide mononitrate Isoxsuprine Isradipine Ketanserin Kwashiorkor Labetalol Lassa fever L-DOPA Levomepromazine Levosimendan Lidocaine Lisinopril Lithium Lofexidine Losartan Low salt diet Magnesium overdose Malathion Mastocytosis Mecamylamine Mechanical ventilation Methidathion Methiocarb Methomyl Methyldopa Metirosine Metolazone Micturition syncope Minoxidil Morphine Moxonidine Multiple system atrophy Mushroom poisoning Myocardial infarction Myocardial ischemia Myxedema Myxedema coma Necrotizing enterocolitis Nefazodone Neostigmine Neurogenic shock Niacin Nicorandil Nifedipine Nimodipine Nitroprusside Nortriptyline Obstructive shock Olanzapine Olmesartan Omapatrilat Opioid poisoning Orthostatic hypotension

Ovarian hyperstimulation syndrome Paliperidone Panhypopituitarism Paralytic Ileus Parathion Parkinson's disease Pentamidine Perazine Pergolide Pericardial effusion Pericarditis Perimyocarditis Peripheral vasodilation Peritonitis Phenothiazines Phenoxybenzamine Phentolamine Pheochromocytoma Phosdrin Pimobendan Pinacidil Pipothiazine Piribedil Pituitary insufficiency Poison hemlock Polyradiculitis Post-operative Postpartum haemorrhage Postprandial hypotension Post-tussive syncope Postural hypotension Pramipexole Prazosin Pregnancy Profenofos Prolonged bed-rest Protamine sulfate Protriptyline Pseudohypoaldosteronism Puerpural shock Pulmonary edema Pulmonary embolism Quetiapine Ramipril Rasagiline Reboxetine Renal dialysis Renon-Delille syndrome Reserpine Retroperitoneal haemorrhage Riley-Day syndrome Rilmenidine Risperidone Rituximab Rocky mountain spotted fever Ropinirole Rotigotine Sassafras oil Scorpion bite Seizures Septic abortion Septic shock Septicemia Serotonin syndrome Serotonin-secreting tumor Severe burns Shaken baby syndrome Shock Shy-Drager syndrome Sick sinus syndrome Sildenafil Silodosin Small bowel obstruction Snake bite Sodium nitrite Sodium nitroprusside Spironolactone Splenic rupture Streptokinase Sulphonamides Superior mesenteric artery occlusion Supraventricular tachycardia Syncope Syringomyelia Systemic capillary leak syndrome Tabes dorsalis Tacrine Tadalafil Tamsulosin Tension pneumothorax Terazosin Terbufos Tetrabenazine Tetraethyl pyrophosphate Tetralogy of Fallot Tetrodotoxin Tizanidine Tobacco Tolazoline Toxic shock syndrome Tramadol Transfusion Reaction Traumatic shock Treprostinil Tricuspid stenosis Trifluperidol Trimethaphan Trimipramine Triple-A syndrome Tropical sprue Tubocurarine Urapidil Urticaria Uterine rupture Valerian Valsalva maneuver Valsartan Vardenafil Variceal Bleeding Vasovagal syncope Ventricular fibrillation Verapamil Vertebral fracture Vibrio vulnificus Volume depletion Vomiting Wasp bite Waterhouse-Friederichsen syndrome Weil syndrome Wohlwill-Andrade syndrome WPW syndrome X-ray studies using contrast media Zero gravity Ziconotide Zotepine

Hypotension

Causes by Organ System

Cardiovascular	Aortic aneurysm rupture, Aortic Arch Syndrome, Aortic Isthmus Stenosis, Aortic regurgitation, Aortic stenosis, Atrioventricular node conduction block, Baroceptor dysfunction in the elderly, Capillary leak syndrome, Cardiac tamponade, Cardiogenic shock, Carotid sinus hypersensitivity, Carotid sinus syndrome, Coarctation of aorta, Complete heart block, Constrictive pericarditis, Cor triatriatum, Dissecting aortic aneurysm, Distributive shock, Eisenmenger's syndrome, Embolism, Endocrine shock, Endotoxic shock, Heart arrhythmia, Heart block, Heart failure, Heart injury, Hemorrhagic shock, Hemorrhagic shock and encephalopathy syndrome , Hypertrophic obstructive cardiomyopathy, Hypovolemic shock, Idiopathic hypotension, Iliac artery aneurysm rupture, Internal bleeding, Ischaemic heart disease, Myocardial infarction, Myocardial ischemia, Obstructive shock, Orthostatic hypotension, Pericardial effusion, Pericarditis, Perimyocarditis, Peripheral vasodilation, Postural hypotension, Pulmonary embolism, Shock, Sick sinus syndrome, Supraventricular tachycardia , Syncope, Systemic capillary leak syndrome, Tetralogy of Fallot, Traumatic shock, Tricuspid stenosis, Vasovagal syncope, Ventricular fibrillation, WPW syndrome, B type natriuretic peptide, Aortocaval compression syndrome, Atrial myxoma, Post-tussive syncope
Chemical / poisoning	Acetaldehyde, Adiponitrile , Amyl nitrate, Copper, Cyanides, Demeton-S-methyl, Diazinon , Dioxathion, Disulfoton , Ethion , Fensulfothion, Fenthion, Honey bee bite, Indian tobacco, Iodine containing radiocontrast media, Malathion, Methidathion, Methiocarb, Methomyl, Mushroom poisoning , Parathion, Phosdrin, Poison hemlock, Profenofos, Scorpion bite, Sodium nitrite, Terbufos, Tetraethyl pyrophosphate , Tetrodotoxin, Tobacco , Wasp bite
Dermatologic	Mastocytosis
Drug Side Effect	Acetophenazine, Alcuronium, Alfuzosin, Aliskiren, Alseroxylon, Ambenonium, Ambrisentan, Amifostine, Aminoglutethimide, Amitriptyline, Amlodipine, Amoxapine, Amphotericin B, Amrinone, Antipsychotic agents, Apomorphine, Azilsartan medoxomil, Baclofen, Beta blockers, Bethanechol, Bethanidine, Bortezomib, Bosentan, Bretylium, Bromocriptine, Bupivacaine, Cabergoline, Calcium channel blockers, Candesartan, Captopril, Chloroquine, Chlorpheniramine, Chlorpromazine, Chlorthalidone, Cilazapril, Cinnarizine, Clevidipine, Clomipramine, Clonidine, Colchicine, Cyclobenzaprine, Deserpidine, Desferrioxamine, Desipramine, Dexmedetomidine, Diazoxide, Dichlorvos , Dicobalt edetate, Dicrotophos , Diphenhydramine, Dipyridamole, Disopyramide, Distigmine, Diuretics, Donepezil , Dothiepin, Doxazosin, Doxepin, Enalapril, Epidural anaesthesia, Eplerenone, Epoprostenol, Etoposide, Felodipine , Fenoldopam, Fentanyl, Fosinopril, General anaesthesia, Glyceryl trinitrate, Granulocyte-macrophage colony stimulating factor, Gray baby syndrome, Guanadrel, Guanethidine, Guanfacine, Haloperidol, Hexamethonium, Hydralazine, Hydroxyzine, Imipramine, Indapamide, Indoramin, Interleukin 2, Irbesartan, Isosorbide dinitrate, Isosorbide mononitrate, Isoxsuprine, Isradipine, Ketanserin, Labetalol, L-DOPA, Levomepromazine, Levosimendan, Lidocaine , Lisinopril, Lithium, Lofexidine, Losartan, Mecamylamine, Methyldopa, Metirosine, Metolazone, Minoxidil, Morphine, Moxonidine, Nefazodone, Neostigmine, Niacin, Nicorandil, Nifedipine, Nimodipine, Nitroprusside, Nortriptyline, Olanzapine, , Olmesartan, Omapatrilat, Opioid poisoning, Paliperidone, Pentamidine, Perazine, Pergolide, Phenothiazines, Phenoxybenzamine, Phentolamine, Pimobendan, Pinacidil, Pipothiazine, Piribedil, Pramipexole, Prazosin, Protamine sulfate, Protriptyline, Quetiapine, Ramipril, Rasagiline, Reboxetine, Reserpine, Rilmenidine, Risperidone, Rituximab, Ropinirole, Rotigotine, Sassafras oil, Serotonin syndrome, Sildenafil, Silodosin, Sodium nitroprusside, Spironolactone, Streptokinase, Sulphonamides, Tacrine, Tadalafil, Tamsulosin, Terazosin, Tetrabenazine, Tizanidine, Tolazoline, Tramadol, Treprostinil, Trifluperidol, Trimethaphan, Trimipramine, Tubocurarine, Urapidil, Valerian, Valsartan, Vardenafil, Verapamil, Ziconotide, Zotepine, Diltiazem
Ear Nose Throat	No underlying causes
Endocrine	ACTH deficiency, Acute adrenal insufficiency, Addisonian crisis, Addison's Disease, Adrenal hemorrhage, Adrenogenital syndrome, Adrenoleukodystrophy , B type natriuretic peptide, Congenital adrenal hyperplasia, Diabetes insipidus, Diabetic autonomic neuropathy, Diabetic ketoacidosis, Hyperosmolar hyperglycemic nonketotic coma, Hypoaldosteronism, Hyporeninemic hypoaldosteronism, Hypothyroidism, Myxedema, Myxedema coma, Panhypopituitarism, Pituitary insufficiency, Endocrine shock, Achalasia-addisonianism-alacrima syndrome, Allgrove syndrome, Triple-A syndrome, APECED Syndrome , Pseudohypoaldosteronism, Renon-Delille syndrome, Carcinoid syndrome
Environmental	No underlying causes
Gastroenterologic	Achalasia-addisonianism-alacrima syndrome, Acute liver failure , Acute pancreatitis, Allgrove syndrome, Bowel strangulation, Deglutition syncope, Diarrhea, Duodenal ulcer bleeding, Gastric ulcer bleeding, Gastric volvulus, Hepatitis, Intususception, Necrotizing enterocolitis, Paralytic Ileus, Peritonitis , Postprandial hypotension, Retroperitoneal haemorrhage, Small bowel obstruction, Splenic rupture, Triple-A syndrome, Tropical sprue , Variceal Bleeding, Vomiting, Hepatic vein thrombosis, Superior mesenteric artery occlusion
Genetic	Acute intermittent porphyria, APECED Syndrome , Corticosteroid-binding globulin deficiency , Familial juvenile hyperuricemic nephropathy type 2, Hereditary peripheral nervous disorder , Hereditary sensory and autonomic neuropathy type 3, Pseudohypoaldosteronism, Renon-Delille syndrome, Riley-Day syndrome, Wohlwill-Andrade syndrome, Bartter syndrome, Achalasia-addisonianism-alacrima syndrome, Allgrove syndrome, Triple-A syndrome, Andrade's syndrome
Hematologic	Anemia, Acute intermittent porphyria
Iatrogenic	After a major surgery, Blood transfusion , Dialyzer hypersensitivity syndrome, Excessive fluid loss through dialysis, Gastric acid stimulation test using histamines, Mechanical ventilation, Post-operative, Renal dialysis, Transfusion Reaction
Infectious Disease	Botulism, Cholera, Dengue hemorrhagic fever, Hantavirus, Lassa fever, Rocky mountain spotted fever , Septic shock, Septicemia , Toxic shock syndrome, Vibrio vulnificus, Waterhouse-Friederichsen syndrome, Weil syndrome
Musculoskeletal / Ortho	Vertebral fracture, Cervical spine injury, Fracture of bone
Neurologic	Autonomic failure, Autonomic neuropathy, Binswanger's disease , Bradbury-Eggleston syndrome, DOPA decarboxylase deficiency, Dopamine beta-hydroxylase deficiency, Dysautonomia, Glosssopharyngeal neuralgia, Guillain-Barre Syndrome, Multiple system atrophy, Neurogenic shock, Parkinson's disease, Polyradiculitis, Seizures, Shy-Drager syndrome, Syringomyelia, Tabes dorsalis, Hemorrhagic shock and encephalopathy syndrome , Vasovagal syncope, Diabetic autonomic neuropathy, Hereditary peripheral nervous disorder , Hereditary sensory and autonomic neuropathy type 3, Riley-Day syndrome, Wohlwill-Andrade syndrome, Andrade's syndrome
Nutritional / Metabolic	Kwashiorkor
Obstetric/Gynecologic	Aortocaval compression syndrome, Ectopic pregnancy rupture, Ovarian hyperstimulation syndrome, Postpartum haemorrhage, Pregnancy, Puerpural shock, Septic abortion , Uterine rupture
Oncologic	Atrial myxoma, Carcinoid syndrome , Pheochromocytoma, Serotonin-secreting tumor
Opthalmologic	No underlying causes
Overdose / Toxicity	Acetophenazine, Alcuronium, Alfuzosin, Aliskiren, Alseroxylon, Ambenonium, Ambrisentan, Amifostine, Aminoglutethimide, Amitriptyline, Amlodipine, Amoxapine, Amphotericin B, Amrinone, Antipsychotic agents, Apomorphine, Azilsartan medoxomil, Baclofen, Beta blockers, Bethanechol, Bethanidine, Bortezomib, Bosentan, Bretylium, Bromocriptine, Bupivacaine, Cabergoline, Calcium channel blockers, Candesartan, Captopril, Chloroquine, Chlorpheniramine, Chlorpromazine, Chlorthalidone, Cilazapril, Cinnarizine, Clevidipine, Clomipramine, Clonidine, Colchicine, Cyclobenzaprine, Deserpidine, Desferrioxamine, Desipramine, Dexmedetomidine, Diazoxide, Dichlorvos , Dicobalt edetate, Dicrotophos , Diphenhydramine, Dipyridamole, Disopyramide, Distigmine, Diuretics, Donepezil , Dothiepin, Doxazosin, Doxepin, Enalapril, Epidural anaesthesia, Eplerenone, Epoprostenol, Etoposide, Felodipine , Fenoldopam, Fentanyl, Fosinopril, General anaesthesia, Glyceryl trinitrate, Granulocyte-macrophage colony stimulating factor, Gray baby syndrome, Guanadrel, Guanethidine, Guanfacine, Haloperidol, Hexamethonium, Hydralazine, Hydroxyzine, Imipramine, Indapamide, Indoramin, Interleukin 2, Irbesartan, Isosorbide dinitrate, Isosorbide mononitrate, Isoxsuprine, Isradipine, Ketanserin, Labetalol, L-DOPA, Levomepromazine, Levosimendan, Lidocaine , Lisinopril, Lithium, Lofexidine, Losartan, Mecamylamine, Methyldopa, Metirosine, Metolazone, Minoxidil, Morphine, Moxonidine, Nefazodone, Neostigmine, Niacin, Nicorandil, Nifedipine, Nimodipine, Nitroprusside, Nortriptyline, Olanzapine, , Olmesartan, Omapatrilat, Opioid poisoning, Paliperidone, Pentamidine, Perazine, Pergolide, Phenothiazines, Phenoxybenzamine, Phentolamine, Pimobendan, Pinacidil, Pipothiazine, Piribedil, Pramipexole, Prazosin, Protamine sulfate, Protriptyline, Quetiapine, Ramipril, Rasagiline, Reboxetine, Reserpine, Rilmenidine, Risperidone, Rituximab, Ropinirole, Rotigotine, Sassafras oil, Serotonin syndrome, Sildenafil, Silodosin, Sodium nitroprusside, Spironolactone, Streptokinase, Sulphonamides, Tacrine, Tadalafil, Tamsulosin, Terazosin, Tetrabenazine, Tizanidine, Tolazoline, Tramadol, Treprostinil, Trifluperidol, Trimethaphan, Trimipramine, Tubocurarine, Urapidil, Valerian, Valsartan, Vardenafil, Verapamil, Ziconotide, Zotepine, Magnesium overdose, Diltiazem
Psychiatric	Anorexia nervosa, Depression
Pulmonary	Post-tussive syncope, Pulmonary edema, Tension pneumothorax, Pulmonary embolism
Renal / Electrolyte	Bartter syndrome, Hypermagnesaemia, Hypokalemia, Hyponatremia, Familial juvenile hyperuricemic nephropathy type 2
Rheum / Immune / Allergy	Amyloidosis, Anaphylactoid reaction, Andrade's syndrome, Food additive allergy , Urticaria, X-ray studies using contrast media, Anaphylactic shock, Honey bee bite, Scorpion bite, Wasp bite, Mastocytosis , Blood transfusion , Dialyzer hypersensitivity syndrome, Transfusion Reaction, Guillain-Barre Syndrome, Wohlwill-Andrade syndrome
Sexual	Renon-Delille syndrome
Trauma	Blood vessel trauma, Burns, Cervical spine injury, Chemical burn, Fracture of bone, Severe burns, Shaken baby syndrome, Heart injury, Traumatic shock, Tension pneumothorax
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Alcohol, Alcohol withdrawal syndrome, Decompression sickness, Dehydration, Excessive dieting , Fatigue, Heat exhaustion , Insufficient fluid intake, Low salt diet, Prolonged bed-rest, Snake bite, Valsalva maneuver, Volume depletion , Zero gravity , Micturition syncope, Syncope, Deglutition syncope, Hypothermia