Autonomic Disorders Flashcards
True or false: orthostatic hypotension is a sign of advanced autonomic failure
True
True or false: impairments throughout the NS can produce autonomic s/sx
True
What are the three major cardiovagal heart rate tests?
- HR response to deep breathing
- HR response to valsalva
- HR response to standing
What are the two major adrenergic vasoconstriction (SNS) tests?
- BP valsalva maneuver response
- BP response to standing or tilt
What is the diagnostic criteria for orthostatic hypotension?
Drop of 20 / 10 or more upon standing from a supine position immediately, at 1 min, and 3 minutes after standing. Pulse should also increases by more than 20 bpm
Should a patient ever be checked in the sitting position for orthostasis?
No
How much should pulse go up in checking orthostatics with low blood volume? What if it does not?
At least 20
If not, then autonomic dysfunction
What are the treatments for orthostatic hypotension?
- HOB elevation
- Leg crossing, squatting
- Avoid prolonged standing
- Arise slowly
What is the dietary change that should be added with orthostatic hypotension?
Increased salt intake
What is the role of compression stocking and abdominal binders in treating orthostatic hypotension?
Used but not very effective
What are the first line agents for treatment of orthostatic hypotension? (4)
- Fludrocortisone
- Midodrine
- EPO
- Vasopressin analogues
What is the MOA of midodrine?
alpha-1 agonist
What is the MOA of clonidine?
Alpha-2 agonist
What is multi system atrophy (shy-Drager syndrome)?
Autonomic failure of orthostatic hypotension, impotence, and bladder/bowel dysfunction. Often presents as PD that is not responsive to L-DOPA treatment
What are the motor s/sx of MSA?
Parkinson Disease and cerebellar dysfunctions
How common is orthostatic hypotension with Parkinson’s?
Uncommon
What is the major bowel problem with PD?
Constipation
What are the s/sx of pure ANS failure (aka idiopathic orthostatic hypotension)?
-Idiopathic orthostatic hypotension
What are the ANS s/sx of GB syndrome?
- Tachyarrhythmia
- Bradycardia or asystole
- Large swings in BP
- Urinary retention
- Pupil dysfunction
- GI dysmotility with ileus
What are the heart ANS dysfunction with GB syndrome?
- Tachyarrhythmia
- Bradycardia or asystole
- Large swings in BP
What are the CSF findings of GB syndrome?
Large amount of protein, low cell counts
What are the GU and GI ANS s/sx of GB syndrome?
- Urinary retention
- GI dysmotility with ileus
What are the eye ANS findings associated with GB syndrome?
Pupil dysfunction
What is acute autonomic neuropathy?
Similar to GB syndrome, but with pandysautonomia with progression over weeks
