Dysautonomia Flashcards
1
Q
What is the autonomic nervous system broken down into
A
- Sympathetic (thoracolumbar)
- Parasympathetic (craniosacral)
2
Q
What are the functions of the autonomic nervous system
A
- Eyes: dilate (Sym) and constricts (Para)
- Skin: hairs stand straight, sweating, vasoconstricts (Sym)
- Lacrimal & salivary glands: decreased secretion/thicker/more viscous (Sym) and promotes secretion/watery (Para)
- Heart: increase HR (Sym) and decrease HR (Para)
- Lungs: bronchodilation (Sym) and constricts bronchi (Para)
- Digestive tract: constricts BV to digestive tract & contracts internal anal sphincter (Sym) and contracts rectum (Para)
- Liver & gallbladder: promotes breakdown of glycogen to glucose (Sym) and promotes building of glycogen (Para)
- Urinary tract: vasoconstriction of renal vessels (Sym) and inhibits contraction of the internal sphincter of bladder (Para)
- Genital system: ejaculation (Sym) and erection (Para)
- Suprarenal medulla: release of adrenaline into blood (Sym)
3
Q
The anatomical distinction between the sympathetic and parasympathetic divisions of the ANS is based primarily on
A
- The location of the presynaptic cell bodies: intermediolateral cell column or nuclei of spinal cord T1-L3 (Sym) and gray matter of brainstem & the fibers exit the CNS within CN III, VII, IX, & X and gray matter of sacral segments S2-S4 (Para)
- Which nerves conduct the presynaptic fibers from the CNS
4
Q
What neurotransmitter does each division of the ANS liberate
A
- Sympathetic: norepinephrine
- Parasympathetic: acetylcholine
5
Q
Define dysautonomia
A
- Umbrella term used to describe various conditions that cause a malfunction of the ANS
- The ANS controls most of the essential functions of the body that we do not consciously think about
6
Q
Autonomic dysfunction is common in what conditions
A
- Neurologic conditions
7
Q
Symptoms of dysautonomia
A
- Sweating abnormalities
- Dizziness and fainting
- Vision problems
- Exercise intolerance
- Nausea
- Digestive difficulties
- Urinary issues
- Sexual problems
8
Q
What diagnosis’s fall under the umbrella of dysautonomia
A
- POTS: postural orthostatic tachycardia syndrome
- IST: inappropriate sinus tachycardia
- NCS: neurocardiogenic syncope
- MSA: multiple system atrophy
- AAG: autoimmune autonomic ganglionopathy
- FD: familial dysautonomia
- PAF: pure autonomic failure
- DBHD: dopamine beta hydrolase deficiency
- OI: orthostatic intolerance
9
Q
Ddx between POTS and OI
A
- OI: no significant BP drop and no significant HR elevation
- POTS: no significant BP drop and sustained elevated HR >30 BPM or >120 bpm
10
Q
Ddx between neurogenic OH and cariogenic OH
A
- Neurogenic: orthostatic drop in BP and delta HR/delta SBP ratio <0.5
- Cardiogenic: orthostatic drop in BP and appropriate HR response
11
Q
Describe a normal baroreceptor response
A
- Fluid pooling occurs with posture change
- Decreased venous return, cardiac out put
- Decreased parasympathetic, decreased activation of carotid sinus & aortic arch baroreceptors
- Increased Sympathetic
- Increased vasoconstriction, HR, & cardiac output
- Blood [pressure maintenance
12
Q
Primary causes of neurogenic OH
A
- Neurocardiogenic syncope
- Postural orthostatic tachycardia syndrome (POTS)
- Multiple system atrophy
- Familial dysautonomia
- Pure autonomic failure
- Parkinson’s disease
- Lewy body dementia
13
Q
Steps in the process of OH intervention
A
- Medication review: identify meds that may cause/make OH worse
- Nonpharmacologic measures: increased fluid & salt intake, compression stockings, abdominal binder, activity & exercise, and education about triggers
- Pharmacologic measures to reduce OH: Midodrine & droxidopa (FDA approved); fludrocortisone & pyridostigmine (off-label)
14
Q
Education for OH prevention with nonpharmacologic measures
A
- Manage fluid intake/loss & venous pooling: drink 2 liters/day of water, increase salt intake, elevate head of bed while sleeping, compression garments, ankle pumps/isos, treat anemia/B12 deficiency if present
- Avoid triggers/reduce risk: smaller meals, fewer carbs, & anticipate OH after large meals, avoid increased body temp., bathe with shower chair
- Physical conditioning: recumbent bike, rowing, & water activities
15
Q
Cardiovascular response during exercise
A
- Increased HR, cardiac mass, & cardiac function
- Increased baroreceptor reflex
- Decreased sympathetic tone & increased vagal tone
- Increased renal & adrenal function
- Increased hemoglobin mass & blood/plasma volume
- Decreased insulin resistance
- Increased endothelial function
- Decreased blood pressure
16
Q
Describe paroxysmal sympathetic hyperactivity (PSH)
A
- Most common in severe TBI patients
- Often observed with withdrawal of sedation
- Average duration is 18-162 days
- Typically resolves within a year
- Episodic presentation if increased HR/sympathetic Sx
- Sympathetic overactivity: increased HR, BP, RR, temp., & sweating; motor activity (posturing)
17
Q
What are the 2 hypotheses as to why PSH happens
A
- 1) Epileptogenic cause: not well supported
- 2) Cerebral brain stem disconnection syndromes
18
Q
Clinical features of PSH
A
- HR <100
- RR <18
- Systolic BP <140
- Temperature <98.6
- No sweating
- No posturing during episodes
- Rated on 0-3 scale, zero values listed above
19
Q
How to diagnose PSH
A
- Person had a brain injury
- Sympathetic overactivity to normally non painful stimuli
- Features persist for >3 consecutive days for >2 wks post injury despite Tx of other possible diagnoses
- Medications used to decrease sympathetic function
- No other explanations
20
Q
What is the scoring ranges for PSH
A
- Mil: 0
- Mild: 1-6
- Moderate: 7-13
- Severe: ≥13
