Dysautonomia Overview
Printable materials about dysautonomia are available at the
end of this page.
Dysautonomia is an umbrella
term used to describe any
malfunction, disease, or illness
caused by a malfunction or
imbalance of the Autonomic Nervous System (ANS).
In this section, find symptoms, a description of the ANS, types of dysautonomia, and detailed descriptions of ANS testing for the different types of dysautonomia.
Symptoms:
Symptoms of dysautonomia can include, but are not limited to:
-Dizziness
-Fatigue
-Fainting
-Increased heart rate (tachycardia)
-Low heart rate (bradycardia)
-A variety of digestive and urinary problems
-Tingling/numbness/pain in the extremities
-Problems swallowing
-Chronic pain
-Fluctuations in blood pressure
-Shortness of breath
-Chest pain
-Sleep disturbances
-Cognitive impairment
-Chills and/or flushing and hot flashes
-Feelings of anxiety
-Headaches, migraines
Many patients have symptoms that come and go, are seemingly unrelated, and change over time. This makes dysautonomia very hard to diagnose.
Primary forms of dysautonomia are not caused by another disease.
Secondary dysautonomia can occur as a result of another disease or condition, such as Diabetes, Autoimmune diseases, Parkinson’s, and even Alcoholism.
Sometimes, once the underlying condition is treated, the dysautonomia symptoms improve. Some forms are of dysautonomia are temporary and mild, and some rare forms are progressive and fatal. Dysautonomia currently has no cure. Patients deal with fluctuating symptoms, and treatment involves trying to improve and control these symptoms, both with lifestyle changes and sometimes medications.
The ANS:
The Autonomic Nervous System is made up of two main branches; the Sympathetic and the Parasympathetic. They control the automatic functions of the body that we do not consciously think about - including digestion, heart rate, respiration, organ function, and blood pressure. They also control how our bodies respond to outside stimuli such as stress, gravity, and temperature.
The Sympathetic Nervous System is responsible for the “fight or flight” responses and functions of the body. Some of these include dilation of the pupils, increased heart rate, slowing digestion, and stimulation of the adrenal glands (producing adrenaline).
The Parasympathetic Nervous System is the “rest and digest” portion of the ANS. It stimulates digestion, slows heart rate, and constricts pupils (among other things) that help the body calm itself. In people without dysautonomia, it acts to perfectly balance out the Sympathetic Nervous System.
Types of Dysautonomia:
There many conditions and diseases that are recognized as forms of dysautonomia. Some of them are:
- Orthostatic Intolerance
- Postural Tachycardia Syndrome (POTS)
- Neurally Mediated Syncope (also known as Neurocardiogenic, Reflex, or Vasovagal)
- Multiple System Atrophy (MSA)
- Pure Autonomic Failure (PAF)
- Autoimmune Autonomic Ganglionopathy (AAG)
- Autonomic Neuropathy
- Dopamine β-Hydroxylase Deficiency
- Familial Dysautonomia
- Baroreflex Failure
- Holmes-Adie Syndrome
- Reflex Sympathetic Dystrophy (RSD)
- Gastroparesis
Autonomic Nervous System Testing:
If you or someone you know suspects they have dysautonomia, there are a number of tests that can be performed by a physician experienced in autonomic dysfunction. Usually these include Neurologists and Cardiologists - specifically Electrophysiologists (EP), a type of Cardiologist that specializes in the electrical signals and functions of the heart. There are physicians across all specialties that can diagnose and treat dysautonomia though, as it is a multi-system condition.
Specific autonomic tests performed may include:
-Head Up Tilt Table Test (HUTT): The patient lies on a stretcher-like support. Straps that are similar to seat belts are attached around the abdomen and legs and the patient is tilted upright. The exact angle of the tilt varies and is usually between 60 and 80 degrees. The tilting goes on for up to 45 minutes, and blood pressure and heart rate measurements are taken.
-Basic orthostatic heart rate and blood pressure measurements: Blood pressure and heart rate measurements are taken at intervals while laying, sitting, and standing. Also called, "A Poor Man's Tilt."
-ECG monitoring: Recording the electrical activity of the heart.
-A cold pressor test: The cold pressor test evaluates efferent sympathetic function. It is carried out by placing the hand in a basin filled with 50% ice and 50% water for approximately 1 minute.
-Isometric hand-grip test: During this test, a patient squeezes a hand-grip until their arm is fatigued, and blood pressure and heart rate are monitored.
-Deep breathing tests: Deep breathing evaluates the vagal function on heart rate modulation during slow inhalation for 5 seconds and exhalation for 5 seconds over 90 seconds.
-The Valsalva Maneuver: The Valsalva maneuver is performed by blowing through a closed mouthpiece with a tiny leakage (16-gauge hole) to maintain 40 mmHg for approximately 15 s. It tests several components of the baroreflex arc.
-Quantitative Sudomotor Axon Test (QSART): The test requires a mild electrical stimulation on the skin which allows acetylcholine, a naturally occurring chemical, to stimulate sweat glands. The QSART measures the volume of sweat produced by this stimulation.
-Thermoregulatory Sweat Test (TST): The thermoregulatory sweat test and the quantitative sudomotor axon reflex test both determine the sweat gland function and the integrity of efferent cholinergic sympathetic nervous system function.
-Measurements of catecholemines in the blood (both lying down and standing): Blood levels are measured after resting laying flat for a period of time, and then again after standing for a period of time to detect abnormal levels of serum catecholemines.
-A blood plasma volume test: There are two types of blood volume tests, one is a nuclear lab procedure used to measure the volume (amount) of blood in the body, the other (called a Daxor) uses a dye to measure levels. The tests also measures the volume of plasma and of red cells in the blood, useful for measuring hypovolemia in dysautonomic patients.
Basic cardiac testing should also be performed to rule out other serious cardiac conditions or structural abnormalities, including an echocardiogram (ECC), an electrocradriogram (EKG/ECG), a 24 hour or continuous halter monitor, and possibly an MRI of the heart if your physician feels it is warranted.
Sources:
1. Dysautonomias: Clinical Disorders of the Autonomic Nervous System, Moderator: David S. Goldstein, MD, PhD; Discussants: David Robertson, MD; Murray Esler, MD; Stephen E. Straus, MD; and Graeme Eisenhofer, PhD. Ann Intern Med. 2002;137:753-763.
2. The Cleveland Clinic: Dysautonomia
3. NIH: Medline Plus, National Institute of Neurological Disorders and Stroke
4. Clinical Methods: The History, Physical, and Laboratory Examinations, Chapter 75: An Overview of the Autonomic Nervous System. 3rd edition. Walker HK, Hall WD, Hurst JW, editors. Boston:
Butterworths; 1990.
5. The Vanderbilt Autonomic Dysfunction Center
6. Autonomic nervous system function. Low PA. J Clin Neurophysiol. 1993 Jan;10(1):14-27.
7. The Mayo Clinic Autonomic Nerve Disorder Department
8. Clinical Disorders of the Autonomic Nervous System Associated With Orthostatic Intolerance: An Overview of Classification, Clinical Evaluation and Management. Blair P. Grubb, M.D., Barry Karas, M.D., Division of Cardiology, Department of Medicine, The Medical College of Ohio, Toledo, Ohio USA
9. Quantitative autonomic testing. Novak P. J Vis Exp. 2011 Jul 19;(53).
10. Autonomic Disorders Consortium, The Rare Disease Network, National Institutes of Health
11. Autonomic testing: common techniques and clinical applications. Weimer LH. Neurologist. 2010 Jul;16(4):215-22.
12. Autonomic diseases: clinical features and laboratory evaluation. C. Mathias, J Neurol Neurosurg Psychiatry. 2003 September; 74(Suppl 3): iii31–iii41.
13. Dysautonomia: perioperative implications. Mustafa HI, Fessel JP, Barwise J, Shannon JR, Raj SR, Diedrich A, Biaggioni I, Robertson D., Anesthesiology. 2012 Jan;116(1):205-15.
*Find links and full text articles in our Journal Library.
Originally written by Claire Martin, President of Dysautonomia SOS
