scholarly journals Post-Acute Sequelae of COVID-19 and Cardiovascular Autonomic Dysfunction: What Do We Know?

2021 ◽  
Vol 8 (11) ◽  
pp. 156
Author(s):  
Giandomenico Bisaccia ◽  
Fabrizio Ricci ◽  
Vittoria Recce ◽  
Antonio Serio ◽  
Giovanni Iannetti ◽  
...  
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Autonomic Dysfunction ◽  
Orthostatic Intolerance ◽  
Current Evidence ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Inappropriate Sinus Tachycardia ◽  
Major Health ◽  
Autonomic Nervous ◽  
Cardiovascular Autonomic Dysfunction

Post-acute sequelae of SARS-CoV-2 (PASC), or long COVID syndrome, is emerging as a major health issue in patients with previous SARS-CoV-2 infection. Symptoms commonly experienced by patients include fatigue, palpitations, chest pain, dyspnea, reduced exercise tolerance, and “brain fog”. Additionally, symptoms of orthostatic intolerance and syncope suggest the involvement of the autonomic nervous system. Signs of cardiovascular autonomic dysfunction appear to be common in PASC and are similar to those observed in postural orthostatic tachycardia syndrome and inappropriate sinus tachycardia. In this review, we report on the epidemiology of PASC, discuss current evidence and possible mechanisms underpinning the dysregulation of the autonomic nervous system, and suggest nonpharmacological and pharmacological interventions to treat and relieve symptoms of PASC-associated dysautonomia.

The role of the cardiologist in the evaluation of dysautonomia

2010 ◽  
Vol 20 (S3) ◽  
pp. 135-139 ◽  
Author(s):  
Jeffrey R. Boris
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Orthostatic Intolerance ◽  
Final Analysis ◽  
Upright Position ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Neurocardiogenic Syncope ◽  
Autonomic Nervous ◽  
Uncommon Disease

AbstractDysfunction of the autonomic nervous system, or dysautonomia, is an uncommon disease. Postural orthostatic tachycardia syndrome is one of the several types of dysautonomia. Postural orthostatic tachycardia syndrome, also known as chronic orthostatic intolerance, is the most common but least severe of the dysautonomic disorders; it will serve as the model for evaluation and management of the other dysautonomias. Overall, these patients can have variable dysfunction of the autonomic nervous system that is more severe than that observed in typical neurocardiogenic syncope. Frequently, providers are not familiar with either the evaluation or the management of this syndrome, or are just not interested in doing so. This article attempts to describe strategies for evaluation and management of postural orthostatic tachycardia syndrome. The diagnosis of postural orthostatic tachycardia syndrome is made by the finding of orthostatic intolerance associated with a pulse greater than 120 beats per minute in the first 10 minutes of upright position or an elevation in pulse greater than 30 beats per minute in the first 10 minutes of upright position. Overall, these patients can have variable dysfunction of the autonomic nervous system that is more severe than that seen in typical neurocardiogenic syncope. A wide variety of associated symptoms may exist and these symptoms can have tremendous impact on the lives of the patients and their families. Management of these patients can be difficult as well as rewarding. It is helpful to perform an extensive education up front with these patients and their families. Interventions for patients with postural orthostatic tachycardia syndrome typically fall into two broad categories: non-pharmacological and pharmacological. Non-pharmacological therapies are varied, but are based primarily on ensuring adequate status of intravascular fluid. Polypharmacy may be required to control symptoms associated with postural orthostatic tachycardia syndrome. On account of the severity of their symptoms, these patients frequently have difficulty in completing their school assignments. The physician may need to help support the attempts of the family to work with the school to help the patient stay in school. As postural orthostatic tachycardia syndrome is underdiagnosed and poorly understood, it is a disease that provides an excellent opportunity to perform research. The most important studies would be those that aim to elucidate an aetiology and a pathophysiology of postural orthostatic tachycardia syndrome. In the final analysis, the role of the cardiologist in the evaluation and management of a patient with dysautonomia is to help a patient with severe disability to feel as if they are normal, or much closer to it.

scholarly journals A35 ASSOCIATIONS BETWEEN AUTONOMIC DYSFUNCTION, COLONIC DYSMOTILITY AND ABSENT DEFECATION REFLEXES IN PATIENTS WITH CHRONIC REFRACTORY CONSTIPATION

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 276-278
Author(s):  
L Liu ◽  
N Milkova ◽  
M Ali ◽  
K Sharma ◽  
J D Huizinga ◽  
...  
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
High Resolution ◽  
Autonomic Dysfunction ◽  
Sympathetic Tone ◽  
Stress Index ◽  
Autonomic Reactivity ◽  
Autonomic Tone ◽  
Autonomic Nervous ◽  
Colonic Manometry

Abstract Background A defecation reflex involves sensory information from the colon sent to the central nervous system which results in propulsive motor patterns in the colon through programmed neural activity from the autonomic nervous system. Neurological causes of constipation are recognized but specific neurological pathways that contribute to pathophysiology of the disease is underexplored. Diagnosis and treatment usually do not involve the autonomic nervous system. Aims Our objective was to assess autonomic dysfunction and abnormal defecation reflexes as a possible cause of chronic constipation. Methods Defecation reflexes were assessed by high-resolution colonic manometry through balloon distention, meal intake, and rectal bisacodyl. Specific heart rate variability (HRV) parameters were used to assess general orthostatic autonomic reactivity, and autonomic functioning during high resolution colonic manometry, in 14 patients with chronic refractory constipation considered for surgery. Results All patients had a unique combination of motility, reflex ability and HRV profiles. Patients overall did not generate HAPWs or had lower HAPW amplitude and lower propulsive activity compared to healthy individuals. Half of the 14 patients were tested to have high sympathetic tone based on Baevsky’s stress index prior to HRCM, and 11 of the patients had sympathetic hyper-reactivity and/or low parasympathetic reactivity to at least one type of colonic stimulation during HRCM. Abnormal autonomic tone or autonomic reactivity to colonic stimulation was present in all four patients with absence of the vagosacral defecation reflex. Five of the seven patients with absence of the sacral defecation reflex showed high sympathetic tone or high sympathetic reactivity to stimulation. Only two patients had abnormality in coloanal coordination and this was associated with low parasympathetic reactivity to stimulation in both patients. Conclusions The assumption that colonic resection was needed to remove an inert colon was wrong in most patients, but most patients had some form of reflex abnormality. Sympathetic dominance far outweighed parasympathetic dysfunction. Incorporation of assessments of defecation reflexes and autonomic nervous system activity into diagnosis of chronic refractory constipation provides a comprehensive pathophysiological understanding of specific defective neurological pathways contributing to dysmotility. This forms the basis for our individualized treatment efforts through sacral neuromodulation. Funding Agencies CIHR

Abstract 12919: Quantitative Assessment of Cardiovascular Autonomic Impairment in Cancer Survivors: A Single Center Experience

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Benjamin Noor ◽  
Shannel Akhavan ◽  
Michael Leuchter ◽  
Eric H Yang ◽  
Olujimi A Ajijola
Keyword(s):  
Cancer Survivors ◽  
Autonomic Dysfunction ◽  
Cancer Diagnosis ◽  
Alkylating Agents ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Inappropriate Sinus Tachycardia ◽  
Cardiovascular Autonomic Dysfunction ◽  
Autonomic Testing ◽  
Reflex Testing ◽  
Autonomic Reflex

Background: Cardiovascular autonomic dysfunction in cancer survivors is poorly understood. Objectives: To better characterize the clinical characteristics and types of autonomic dysfunction in this population. Methods: A retrospective analysis of cancer survivors within an academic cardio-oncology program referred for suspected autonomic dysfunction was performed. Autonomic reflex testing of adrenergic, cardiovagal, and sudomotor function was done. Patients with pre-existing autonomic dysfunction prior to their cancer diagnosis were excluded. Results: Of approximately 282 patients in the UCLA Cardio-Oncology program, twenty-four patients met the inclusion criteria. Twenty-two had autonomic impairment on autonomic reflex testing. Eight patients were female, and the mean age at time of autonomic testing was 51.3 years. The average duration from cancer diagnosis to autonomic testing was 10.3 years. The reasons for referral included dizziness, tachycardia, palpitations, and syncope. The majority of patients (75%) had hematologic disorders. The most common chemotherapies administered were vinca alkaloids (54.2%), alkylating agents (66.7%), and anthracyclines (54.2%). Most patients received radiation to the thorax (66.7%) and neck (53.3%). Eleven patients had mild autonomic impairment, seven had moderate, and four had severe autonomic impairment. Dysfunction was commonly present in the sympathetic and parasympathetic branches, but most pronounced in the sympathetic system. The majority of patients were diagnosed with orthostatic hypotension (50%), inappropriate sinus tachycardia (20.8%), and postural orthostatic tachycardia syndrome (12.5%) and had subjective improvement with treatment. Conclusion: Cardiovascular autonomic dysfunction occurs in cancer survivors, and commonly affects both the sympathetic and parasympathetic systems. Symptom recognition in patients should prompt autonomic testing and treatment where appropriate.

Syncope in migraine

Neurology ◽  
2006 ◽  
Vol 66 (7) ◽  
pp. 1034-1037 ◽  
Author(s):  
R. D. Thijs ◽  
M. C. Kruit ◽  
M. A. van Buchem ◽  
M. D. Ferrari ◽  
L. J. Launer ◽  
...  
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Orthostatic Intolerance ◽  
Population Based ◽  
Lifetime Prevalence ◽  
Postural Tachycardia Syndrome ◽  
Population Based Study ◽  
Autonomic Nervous ◽  
Control Subjects ◽  
And Control

Objective: To examine the association between migraine and syncope-related autonomic nervous system (ANS) symptoms.Methods: A population-based study among migraineurs with and without aura (n = 323) and control subjects (n = 153) was conducted. A systematic questionnaire and cardiovascular measurements during rest, while standing, and after venipuncture addressed the prevalence of syncope, orthostatic intolerance, orthostatic hypotension (OH), and the postural tachycardia syndrome (POTS) in migraineurs and control subjects.Results: The lifetime prevalence of syncope in all participants was 41%, more often in women (45 vs 32%; p = 0.02). Compared with control subjects, migraineurs had a higher lifetime prevalence of syncope (46 vs 31%; p = 0.001), frequent syncope (five or more attacks) (13 vs 5%; p = 0.02), and orthostatic intolerance (32 vs 12%; p < 0.001). There was no association between ANS symptoms and the severity of migraine or migraine subtype. Cardiovascular measurements and the prevalence of POTS and OH did not differ significantly between migraineurs and control subjects.Conclusion: This population-based study demonstrated an elevated prevalence of syncope and orthostatic intolerance in migraineurs without clear interictal signs of autonomic nervous system dysfunction.

scholarly journals Autonomic nervous system evaluation in Type 2 diabetic patients and effect of its duration

2013 ◽  
Vol 1 (2) ◽  
pp. 77-83
Author(s):  
DB Karki ◽  
S Acharya ◽  
P Shrestha ◽  
S Pant ◽  
A Pokhrel ◽  
...  
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Autonomic Dysfunction ◽  
Preventive Measures ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Autonomic Nervous ◽  
Medical College ◽  
Type 2 Diabetic

Introduction: Dysfunction of the autonomic nervous system is common in diabetic patients. Presence of autonomic dysfunction should alert the physicians of its serious consequences that require timely preventive measures. Objectives: This study was done to fi nd out the autonomic nervous system involvement in Type 2 diabetic patients and to see its relation with the duration of diabetes. Methods: This was a hospital based cross-sectional study. All consecutive diabetic patients of both genders attending Kathmandu Medical College and a private clinic, Temple of Healing were included. A battery of six well validated and accepted autonomic nervous system evaluation tests were done to evaluate the autonomic function in 245 Type 2 diabetic patients. Results: Prevalence of autonomic dysfunction was found to be 71.02% with 58.78% patients having mild autonomic dysfunction and 12.24% having moderate dysfunction. Severe autonomic dysfunction was detected in none of the patients. Parasympathetic dysfunction was much more common than sympathetic dysfunction (68.16% vs. 17.96%). No association was found between autonomic dysfunction and duration of diabetes. Conclusions: Autonomic dysfunction is very common in diabetics and can be detected by simple tests. Timely detection of autonomic dysfunction in diabetic patients is advised so that its preventive measures can be effective. DOI: http://dx.doi.org/10.3126/jkmc.v1i2.8142 Journal of Kathmandu Medical College, Vol. 1, No. 2, Oct.-Dec., 2012: 77-83

scholarly journals DYSFUNCTION OF THE AUTONOMIC NERVOUS SYSTEM IN EPILEPSY

2019 ◽  
Vol 72 (1) ◽  
pp. 120-123
Author(s):  
Beata Łabuz-Roszak ◽  
Iwona Mańka-Gaca
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Ion Channels ◽  
Antiepileptic Drugs ◽  
Autonomic Dysfunction ◽  
Circulatory System ◽  
Epileptic Seizures ◽  
Autonomic Nervous ◽  
The Central Nervous System

Generalized or partial epileptic seizures may be accompanied by autonomic dysfunction. They may also take the form of self-inflicted seizures or be present during interictal period. Arrhythmias, resulting in haemodynamic disturbances in the circulatory system and prolonged hypoxia of the central nervous system, may itself provoke secondary episodes of seizure morphology. The doctor when diagnosing patients with epileptic seizures should always be aware of the potential for cardiogenic disorders. Consideration should be given to the effect of epilepsy on the structure of the autonomic nervous system, the effect of antiepileptic drugs, and the potential for mutations within the ion channels.

scholarly journals Sensitivity of the Baroreceptors and the State of the Autonomic Nervous System in Patients with Chronic Impairment of Consciousness Due to Severe Brain Damage

2019 ◽  
Vol 15 (5) ◽  
pp. 61-73 ◽  
Author(s):  
V. N. Dorogovtsev ◽  
D. S. Yankevich ◽  
A. L. Parfenov ◽  
A. E. Skvortsov ◽  
A. V. Kotelnikova
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Orthostatic Hypotension ◽  
Brain Damage ◽  
Main Trend ◽  
Control Group ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Orthostatic Test ◽  
Autonomic Nervous ◽  
Group 1

Purpose of the study: to examine sensibility of baroreceptors and the autonomic nervous in the passive orthostatic test in patients with chronic impairment of consciousness due to severe brain damage and determine their role in the rehabilitation process.Materials and methods. The study included 30 patients with long-term impairment of consciousness due to severe brain damage (group 1), 10 of them being in the vegetative state (VS) and 20 being in the minimally conscious state (MCS). Craniocerebral trauma was the main cause of severe damage in that group (53% of patients). The comparison group included 24 patients with focal neurological symptoms caused predominantly — 79.2% of cases — by cerebrovascular disorders (group 2). The control group (group 3) consisted of 22 healthy volunteers of a comparable age. All measurements were done with the help of a Task Force Monitor 1030i (CNSystem, Austria) in the course of passive orthostatic test at 0°–30°–60°–0°. Changes in the power of low-frequency (LFS) and highfrequency spectrum (HFS) of heart rate variability and baroreceptors sensibility (BRS) were analyzed. Statistical analysis was carried out using Statistica-10 software. Significance of inter-group differences on unrelated samples was determined by the Mann–Whitney U-test. Differences between groups were considered significant at P 0.05.Results. Maximal background values of BRS were found in the control group. In group 1 and 2 patients, considerable decrease of that index was noted, which was proportional to the brain damage severity. Similar dynamics was observed for the indices of autonomic nervous system sensibility (LFS and HFS). The main trend of orthostatic changes of BRS, LFS, and HFS was characterized by progressive decrease of the indices with increase of the patients’ angle of tilting and their return to the baseline level after the patients were put back into the horizontal position. 4 patients of group 1 (14%) displayed signs of orthostatic disorders upon tilting to 30°: in 3 cases, orthostatic hypotension was observed, and in one case the postural orthostatic tachycardia syndrome (POTS) was diagnosed. Those patients differed by lower BRS and higher sympathetic system activity (LFS) vs. the same indices of other patients in that group.Conclusion. Patients with chronic impairment of consciousness during the post-comatose period after a severe brain damage display a significant decrease of baroreceptors sensibility and autonomic nervous system disorders manifesting in significantly lower activity of the sympathetic and parasympathetic systems. The prominence of such disorders is associated with brain damage severity. Their risk of developing orthostatic hypotension during tilting towards a vertical position is higher in patients who have lower baroreceptors sensibility, and this should be taken into account beginning the process of their verticalization.

CHANGES IN ELECTROENCEPHALOGRAM INDICATORS IN ADOLESCENTS WITH VEGETATIVE DYSFUNCTION

2021 ◽  
Vol Special issue (3) ◽  
pp. 17-20
Author(s):  
Shadie Kurtieva ◽  
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Clinical Manifestation ◽  
Autonomic Dysfunction ◽  
Recovery Period ◽  
Physical Exertion ◽  
Physical Parameters ◽  
Autonomic Nervous ◽  
Perinatal Pathology ◽  
History Of

This work is based on the results of a study of the assessment of physical parameters of the electroencephalogram in adolescents with autonomic dysfunction, depending on gender and the presence of perinatal pathology in the anamnesis. We examined 87 adolescents 12-18 years old with clinically and laboratory-instrumental confirmed dysfunction of the autonomic nervous system -autonomic dystonia syndrome (ADS). The average age of the clinical manifestation of ADS in girls was 12.2 ± 1.8 years, in boys -13.5 ± 2.1 years. As a result of the study, it was revealed that adolescents with a history of perinatal pathology have the maximum risk of disturbances in the processes of myocardial repolarization at the end of the recovery period after physical exertion, especially in females

Influence of vertebral manipulations on the autonomic nervous system

2021 ◽  
pp. 106-120
Author(s):  
J. M. Sebastian Rausell ◽  
A. B. Martinez Garcia ◽  
A. S. Jaume Llinas ◽  
I. Escobio Prieto
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Spinal Manipulation ◽  
Parasympathetic Nervous System ◽  
Clinical Effectiveness ◽  
Current Evidence ◽  
Autonomic Nervous

Introduction. Although its neurophysiological effects have not been fully elucidated, current evidence suggests the clinical effectiveness of spinal manipulation. Different studies suggest that manual therapy induces changes in the autonomic nervous system (ANS). Recent studies showed that mobilization produced a sympatheticexcitatory effect. However, studies using thrust manipulation appeared to be less consistent in their results.Objectives. The main objective of this review was to evaluate whether spinal manipulation induces effects on the ANS. Another objective was to correlate the changes in the measured variables with the activation or inhibition of the sympathetic or parasympathetic nervous system and with the level of spinal manipulation.Materials and methods. We performed a literature search in the following databases: PubMed, PEDro, CINAHL and OVID, using the keywords «Manipulation, spinal» and «Autonomic Nervous System». The PEDro scale was used to assess the methodological quality.Results. Nine studies met the inclusion criteria. Six trials measured cardiovascular function indicators (blood pressure, heart rate, Heart Rate Variability). Three other trials measured the pupil reaction. In most studies, cervical or upper thoracic region was manipulated.Conclusions. Our review does not provide definitive evidence of the effects of spinal manipulation on the ANS. However, most studies observed the existence of autonomic effects by modifying parameters such as blood pressure or Heart Rate Variability after manipulation. Increased parasympathetic activation probably occurs after cervical and lumbar treatment and increased sympathetic activation after dorsal treatment.

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