Autonomic Disorders Flashcards
POTS
Postural Tachycardia Syndrome
More in women
HR increases 30 BPM upon standing with no change in BP
Lightheaded, palpitations, tremors, visual changes, head throbs, weakness
50% symptom free in 2-5 years
Outcomes on POTS
Bloating, constipation, diarrhea, bladder, acid reflux, changes in sweating and sleep, anxiety, tiredness
Causes of POTS
Peripheral autonomic neuropathy w/ inability to control vascular tone (SNS…leads to blood pooling…increase HR and contractility to try and maintain cereral perfusion
Maybe after viral, surgery, sepsis, trauma
hyperadrenergic symptom show increase BP and increase NE…point mutation and with migraines
Chronic diabetes (small fiber denervation)
**All from vascular unresponsiveness
Tx of POTS
Increase salt, fluid and exercise to increase skeletal muscle pump
Compression stocking
Off label drugs for POTS
Propranolo (B-blocker) to reduce HR
Fludocortisone to retain water and salt
Pyridostigmine to increase paraysmapthetic function
Alpha 1 adrenergic agonist to increase BP (phenyleprhine)
Horner syndrome
Trauma mediated or compression mediated
1/3 of cluster headache patients
Ipsilateral ptosis, miosis, facial anhidrosis, and no pain
Horner syndrome causes
Pancoast tumor
Seat belt trauma to brachial plexus (clavicle and first rib fractures)
Long duration compression (superiro cervical ganglion)
Reduced symp control of the eye and orbit
Diagnosis of Horner
Topical cocaine application to prevent reuptake of NE
Topical apraclonidine which is weak alpha 1 agonist…normla eye will not response but interrupted SNS flow will increase alpha 1s…mydriasis
Chest x-ray, etc.
Alzheimers
2 types of drugs
NMDA receptor antagonists and Ach E inhibitors
Horrible side effects…raise Ach
Parkinsons
Use dopamine agonists (side effects like nausea, vomiting and dizziness)
Anticholinergics - to restore balance between Ach and DA
COMT inhibitors and L-DOPA to increase DA
