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Quantitative Autonomic Testing
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Autonomic dysfunction: Diagnosis and management.

Martina Rafanelli1, Kathleen Walsh2, Mohamed H Hamdan2

  • 1Division of Geriatric Cardiology and Medicine, University of Florence, Florence, Italy.

Handbook of Clinical Neurology
|November 23, 2019
PubMed
Summary
This summary is machine-generated.

Autonomic dysfunction (AUD) affects multiple body systems due to nervous system disruption. Diagnosing baroreflex impairment via heart rate and norepinephrine responses aids in managing orthostatic hypotension (OH).

Keywords:
Autonomic dysfunctionAutonomic nervous systemBaroreflexNeurodegenerative diseasesOrthostatic hypotensionSympathetic denervation

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Area of Science:

  • Neuroscience
  • Cardiovascular Physiology
  • Autonomic Nervous System Research

Background:

  • The autonomic nervous system (ANS) is crucial for maintaining physiological homeostasis.
  • Widespread ANS connections render it susceptible to disruption by primary (e.g., Parkinson's disease) and secondary (e.g., diabetes mellitus) etiologies.
  • Autonomic dysfunction (AUD) leads to diverse symptoms affecting cardiovascular, gastrointestinal, and urogenital systems.

Purpose of the Study:

  • To review the causes, pathophysiology, and cardiovascular manifestations of autonomic dysfunction (AUD).
  • To emphasize the diagnosis and treatment of orthostatic hypotension (OH) in patients with suspected AUD.
  • To highlight diagnostic tools for assessing baroreflex impairment and cardiac sympathetic denervation.

Main Methods:

  • Review of existing literature on autonomic nervous system function and dysfunction.
  • Analysis of diagnostic approaches including heart rate and plasma norepinephrine response to orthostatic stress.
  • Discussion of imaging techniques such as MIBG scintigraphy and 18F-DA PET scanning for cardiac sympathetic denervation.

Main Results:

  • Impairment of the baroreflex, due to peripheral and/or cardiac denervation, significantly impacts hemodynamic outcomes during orthostatic stress.
  • Heart rate and plasma norepinephrine responses are valuable for diagnosing baroreflex impairment in orthostatic hypotension (OH) and suspected AUD.
  • Cardiac sympathetic denervation assessment aids in differentiating preganglionic from postganglionic involvement and diagnosing early neurodegenerative diseases.

Conclusions:

  • Autonomic dysfunction arises from various systemic diseases, causing significant cardiovascular and other systemic symptoms.
  • Accurate diagnosis of AUD, particularly orthostatic hypotension, relies on assessing baroreflex function and sympathetic denervation.
  • Effective management strategies for OH and related cardiovascular manifestations are essential for patients with autonomic dysfunction.