Various forms of dysautonomia exist:
Dysautonomia, a term that describes dysfunction of the autonomic nervous system (ANS), affects millions of people worldwide. The ANS controls involuntary functions in the body, such as digestion, kidney function, breathing, and temperature control. In this article, we will explore several forms of dysautonomia, their symptoms, and causes.
Postural Orthostatic Tachycardia Syndrome (POTS):
One of the more common forms of dysautonomia, POTS is characterised by a rapid increase in heart rate (tachycardia) upon standing, palpitations, lightheadedness, dizziness, fatigue, fainting, headaches, sweating abnormalities, cognitive issues ("brain fog"), nausea, and gastrointestinal symptoms. POTS can follow viral infections or injury, and may have autoimmune, neuropathic, hyperadrenergic, or genetic contributions, often affecting young females.
Orthostatic Hypotension:
Orthostatic hypotension, a significant blood pressure drop upon standing, causes symptoms such as dizziness, lightheadedness, fainting or near-fainting. This condition can result from autonomic failure, secondary diseases, medication effects, dehydration, diabetes, aging, or pure autonomic failure (accumulation of alpha-synuclein protein damaging autonomic nerves).
Vasovagal Syncope (Autonomically Mediated Syncope):
Vasovagal syncope, a form of fainting due to an issue regulating blood pressure, leads to decreases brain perfusion. Episodes of fainting or near-fainting caused by sudden blood pressure drop, often with little or variable heart rate change, characterise this condition. It is triggered by stress, pain, or prolonged standing, leading to reflex-mediated vasodilation and bradycardia or tachycardia.
Inappropriate Sinus Tachycardia (IST):
Inappropriate Sinus Tachycardia (IST) describes a persisting elevated heart rate at rest or minimal exertion, palpitations, fatigue, dizziness. This condition is caused by dysfunctional regulation of the heart's sinus node often without identifiable structural heart disease.
Autoimmune Autonomic Ganglionopathy (AAG):
Autoimmune Autonomic Ganglionopathy (AAG) is a very rare type of dysautonomia, with only about 100 people receiving a diagnosis in the United States each year. Symptoms include severe autonomic failure, such as orthostatic hypotension, gastrointestinal dysmotility, anhidrosis (lack of sweating), dry mouth, and bladder dysfunction. This condition occurs due to an autoimmune attack on autonomic ganglia, causing widespread autonomic dysfunction.
Baroreflex Failure:
Baroreflex failure is an uncommon condition that can lead to significant shifts in blood pressure, and symptoms may include increased heart rate that does not respond to medication, sweating, and headache. This condition is caused by damage to the baroreceptor reflex arc regulating blood pressure, often due to surgery, radiation, or trauma.
Familial Dysautonomia:
Familial Dysautonomia is an inherited condition that affects approximately 350 people worldwide and mostly affects people of Ashkenazi Jewish descent. Symptoms may include poor blood pressure and heart rate control, difficulty swallowing, and inability to feel pain.
Pure Autonomic Failure (PAF):
Pure autonomic failure (PAF) is a rare type of dysautonomia that affects fewer than 200,000 people in the United States. It is more common in males and onset is most often in middle age. Orthostatic hypotension is one of the main features of pure autonomic failure, and additional symptoms may include urinary dysfunction, bowel issues, and difficulty with temperature regulation.
Multiple System Atrophy (MSA):
Multiple System Atrophy (MSA) is a progressive and fatal form of dysautonomia that affects the central nervous system and the ANS. Symptoms may include tremors, stiffness, fainting, bladder control issues, and clumsiness. MSA usually occurs in people over a certain age, and symptoms quickly progress over 5-10 years, leaving many people immobile in a few years.
In summary, overlap exists but key distinguishing features often involve the pattern of heart rate and blood pressure changes, presence of other neurological symptoms, and underlying causes such as autoimmune attack, neurodegeneration, or genetic mutation. More than 70 million people worldwide have some form of dysautonomia, making it an important area of research and treatment.
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