Form Of Autonomic Dysfunction Research Articles

CARDIOVASCULAR AUTONOMIC DYSFUNCTION IN HIV-POSITIVE PATIENTS AND ITS CORRELATION WITH CD4 CELL COUNT

According to Global human immunodeciency virus and acquired immunodeciency disease syndrome statistics, 38.4 million(33.9 million-43.8 million) people live globally with HIV in 2021, and 1.5 million people became newly infected with HIV in 2021(1). As per India HIV estimation report 2020, national adult (15–49 years) HIV prevalence was estimated at 0.22% (0.17%–0.29%) in 2020, 0.23% (0.18%–0.31%) among males and 0.20% (0.15%– 0.26%) among females(2). HIV is a condition which can progressively affect almost all body organs and systems due to immune system failure. Infection with HIV is well known to cause peripheral neuropathy and other neurological complication thus affecting the quality of life(3). Autonomic nervous system involvement can affect heart rate, vasomotor tone, sexual function, gastrointestinal motility, urination, thermoregulation and production of tears and saliva. This can lead to diverse symptoms like postural syncope, impotence, sweating, diarrhea/constipation, dry eyes and mouth, urinary incontinence and changes in skin temperature. Abnormalities in cardiac autonomic function occur at all CD4 levels(4,5). The aim of our study is to assess autonomic dysfunction in HIV-positive patients and to show the correlation between decreasing CD4 + T cell counts with increasing severity of disease in the form of autonomic dysfunction.

An Unusual Case of Polyautoimmunity with Concomitant Presentation of Postural Tachycardia Syndrome, Antiphospholipid Syndrome and Hashimoto’s Thyroiditis

Introduction: Postural tachycardia syndrome (POTS) is a chronic form of autonomic dysfunction characterized by symptoms of orthostatic intolerance, often accompanied by sudomotor dysfunction and gastrointestinal dysmotility. In a subgroup of patients with POTS, autoantibodies against adrenergic or cholinergic receptors suggest an immune-mediated etiology. Antiphospholipid syndrome (APS) is a hypercoagulative autoimmune disorder associated with anti-phospholipid-antibodies that causes arterial and venous thromboses. Concurrent occurrence of APS and immune-mediated POTS is rare. Methods and Results: Here, we report a 28-year-old female that experiences symptoms of orthostatic intolerance, vasovagal syncopes, gastrointestinal dysmotility and sudomotor dysfunction. She fulfills the formal diagnostic criteria of POTS showing a heart rate increment of ≥30 beats per minute (bpm) within 10 m of head-up tilt in the absence of orthostatic hypotension, accompanied by symptoms of orthostatic intolerance. The thermoregulatory sweat test reveals severe patchy anhidrotic areas. Gastric emptying scintigraphy shows an impaired gastrointestinal motility. Plasma norepinephrine levels and a skin biopsy appear normal. Finally, serological persistence of anti-alpha-1-adrenergic autoantibodies suggest an immune-mediated pathogenesis. Several years after initial presentation of POTS symptoms, the patient develops APS with recurrent venous emboli and persistent anti-phospholipid-antibodies. Recently the patient is diagnosed with Hashimoto’s thyroiditis (HT) expressing high levels of thyroid-stimulating hormone and high titers of anti-thyroid antibodies. Conclusion: To our knowledge, this is the first report of consecutive immune-mediated POTS, APS and HT in a young woman, possibly displaying a unique combination of three disorders of autoimmune etiology.

Early Life Epilepsies are a Comorbidity of Developmental Brain Disorders

Early-life epilepsies are a series of disorders frequently accompanied by a broad range of morbidities that include cognitive, behavioral, neuromuscular, and sleep disturbances; enteric and other forms of autonomic dysfunction; sensory processing difficulties; and other issues. Usually these morbidities cluster together in a single patient. Rather than these being separate conditions, all, including the seizures, are manifestations or coexpressions of developmental brain disorders. Instead of viewing epilepsy as the disease and the other features as comorbidities, approaching early-life epilepsies as part of the spectrum of developmental brain disorders could have implications for multidisciplinary care models, anticipatory guidance, and counseling of parents, as well as the design of randomized trials and targeting important outcomes. Ultimately, such an approach could improve understanding and help optimize outcomes in these difficult to treat disorders of early childhood.

Abstract P381: Understanding the Symptoms of Neurogenic Orthostatic Hypotension: Results From a Survey of Patients and Caregivers

Objective: To understand the burden and impact of symptoms of neurogenic orthostatic hypotension (nOH) on patients Background: nOH and its symptoms such as dizziness/lightheadedness are common in patients with Parkinson disease (PD) and other forms of autonomic dysfunction. Methods: An author-designed, US-based survey was conducted by Harris Poll. Eligible participants were aged ≥18 years with PD, multiple system atrophy (MSA), or pure autonomic failure and ≥1 of the following: orthostatic hypotension, nOH, low BP, OH/nOH symptoms, or were caregivers of eligible patients. Results: Most patients (90%) had a diagnosis of PD, and most caregivers (88%) cared for a patient with PD (Table 1) . Patients (34%) and caregivers (49%) reported experiencing nOH symptoms before PD or MSA motor symptoms and >40% indicated that nOH symptoms were more troublesome than motor manifestations of PD or MSA. Less than a quarter (22%) of respondents suggested symptoms were most severe in the morning; more (30%) reported a consistent severity throughout the day. Patients (40%) and caregivers (63%) reported trouble managing symptoms during the day. In the past 12 months, a fall due to nOH symptoms was reported by 57% of patients and 80% of caregivers. Conclusions: These findings suggest that nOH symptoms may predate the onset of motor symptoms in neurodegenerative conditions linked to alpha-synuclein pathology. Many respondents report nOH symptoms are the same severity through the day. Patients with nOH may have trouble managing symptoms and note an increased risk for falls.

ДИФФЕРЕНЦИРОВАННАЯ МАГНИТОТЕРАПИЯ ПРИ РАЗЛИЧНЫХ ФОРМАХ РЕВМАТОИДНОГО АРТРИТА

На 173 больных ревматоидным артритом (РА) изучали эффективность магнитотерапии (МТ) при различных формах вегетативной дисфункции. О вегетативном тонусе судили по результатам опросника и показателям спектрального анализа ритма сердца. Вегетативный паспорт определяли методами тестирования по специальным таблицам, клиническим и рентгенологическим данным. Выявили тесную корреляционную связь формы вегетативной дисфункции с типом коморбидности и соматогении. Ваготоническаякальцийдефицитнаякоморбидность характеризовалась пониженным индексом вагосимпатического баланса, серопозитивным вариантом по ревматоидному фактору и сочеталась с тревожно-депрессивными состояниями, сопутствующим остеопорозом и объемзависимой АГ. Симпатотоническая, кальцийзависимаякоморбидность коррелировала с повышенным индексом вагосимпатического баланса, серонегативной формой РА, маниакально-панико-фобическими реакциями, кальцификацией связок и симпатоадреналовой АГ. Предложена вегетативно-суставная методика МТ при РА с воздействием на затылок и кисти. Показана эффективность постоянного магнитного поля у ваготоников, а переменного магнитного поля – у симпатотоников при РА. При сочетанной методике существенное улучшение достигалось в 21,4 % случаев.

Orthostatic Hypertension

See related article, pp 167–173 Orthostatic hypertension (OHT) is beneath the radar of many health care professionals. In the clinic, it is generally both unexpected and counterintuitive. After recheck, it may sometimes regress toward the mean. However, at other times the OHT can be dramatic and persistent. Nevertheless, our knowledge about its causes and significance remains circumscribed. It is in many ways the last hemodynamic frontier. Recently, there has been increasing interest in OHT and its possible consequences on health. The spectrum of degree and clinical context of OHT is very broad.1 In some cases, it can be a dramatic physical manifestation of 50 mm Hg or more in a disorder such as baroreflex failure. In other situations, it may only be an incidental physical finding. OHT is usually defined as an increase in blood pressure with upright posture or tilt, but precise criteria have not been established. Furthermore, few studies have entailed direct measurement of blood pressure in people with OHT. Such measurements would more faithfully reflect intraarterial pressure and would avoid the introduction of potential artifacts. Sphygmomanometers can underestimate blood pressure when it is perturbed by pressor reflexes, such as those engaged by upright posture, or if it is increased by pressor agents. Therefore, the magnitude of the blood pressure increase after standing might be even larger than is generally reported in patients with OHT. OHT has been long recognized. Some of the most thoughtful early studies were conducted by David Streeten …

Cardiovascular Autonomic Neuropathyin Chronic Kidney Diseases

INTRODUCTION:
 This study was conducted to explore cardiovascular autonomic neuropathy and its pattern in chronic kidney disease patients.
 METHODS:
 Autonomic function using five standard tests was examined in 20 diabetic patients with CKD, 20 age and sex matched diabetic patients without CKD and 20 age and sex matched controls. Analysis of difference between the autonomic function was done in the three groups using Chi-square test or Fischer's test.
 RESULTS:
 Total 20 (100%) diabetic CKD patients were found to have autonomic neuropathy. Of these, 2 (10%) patients had early parasympathetic damage, 8 (40%) patients had definite parasympathetic damage, and 10 (50%) patients had combined damage. Heart rate response to standing was statistically significant (p = 0.014) among diabetic CKD patients when compared with diabetic patients without CKD. Combined form of autonomicdysfunction was more frequent in advanced stages of diabetic CKD. Three (42.85%) patients in stage 3 CKD, 4 (66.66%) patients in stage 4 CKD and 5 (71.42%) patients in stage 5 CKD, had combined autonomic failure.
 CONCLUSIONS:
 Autonomic neuropathy is common in native Nepalese diabetic CKD patients. Heart rate response to standing is significantly abnormal in diabetic CKD patients in comparison with diabetes mellitus patient without CKD. Severity of autonomic dysfunction increases with severity of CKD..
 KEYWORDS: cardiovascualr autonomic neuropathy, chronic kidney disease, diabetes mellitus.

Dyscirculatory Encephalopathy in Chernobyl Disaster Clean-Up Workers (a 20-year study)

Results obtained over 20-years of following 536 Chernobyl clean-up workers and 436 control subjects are presented. Dyscirculatory encephalopathy developed more frequently in persons exposed to radiation at age 30 years. As compared with the control group, workers were characterized by early onset of disease, faster progression, stable symptomatology for 5-6 years, and further progression of disease in the form of autonomic dysfunction, psycho-organic syndrome, and epilepsy. Major strokes were also more common in clean-up workers.

Impaired cardiovascular function in primary biliary cirrhosis.

Cardiovascular system dysregulation in the form of autonomic dysfunction is common at all stages of the disease process in the autoimmune liver disease primary biliary cirrhosis (PBC) and associates with the symptom of fatigue. The mechanisms underpinning autonomic dysfunction in PBC are, however, at present unclear. In this study we set out to explore, for the first time, cardiac structure and function in PBC using impedance cardiography (ICG) and magnetic resonance methodologies. ICG was assessed beat to beat in response to orthostasis (by head-up tilt) in age and sex case-matched high-fatigue and low-fatigue PBC groups (assessed by Fatigue Impact Scale), normal control subjects (n = 15 each group) and a liver disease control cohort (primary sclerosing cholangitis). Cardiac structure and bioenergetics were examined in 15 of the PBC subjects and 8 of the normal control subjects by magnetic resonance spectroscopy and cine imaging. Capacity of the left ventricle to respond to orthostasis [left ventricular ejection time (LVET)] was impaired in PBC compared with matched normal control subjects (P = 0.05). This was a PBC-specific phenomenon unrelated to fatigue status. PBC patients exhibited significantly lower cardiac muscle phosphocreatine-to-ATP ratio (PCr/ATP ratio; measure of cardiac bioenergetic integrity) compared with control subjects (P < 0.01). PCr/ATP <1.6 (indicative of increased risk of death in cardiomyopathy) was present in 6/15 (40%) PBC patients (0/8 control subjects; P < 0.05). Cardiac structure and function were similar in all measures of left ventricular morphology between control subjects and PBC. The close relationship between PCr/ATP and LVET seen in normal subjects (r(2) = 0.6; P < 0.05) was lost in PBC patients, a finding compatible with myocardial dysfunction. Significant correlation was seen between fatigue severity in PBC and fall in cardiac output on orthostasis (r(2) = 0.25; P = 0.005). Our findings suggest the presence of altered myocardial function in PBC. Autonomic "dysfunction" may, rather than being an abnormal process, represent a compensatory mechanism to increase cardiac return to mitigate these effects.

Posturales orthostatisches Tachykardiesyndrom (POTS): Ätiologie, Diagnose und Therapie

Since the renaissance of tilt table testing in clinical cardiology some 15 years ago, the syndromes of autonomic dysfunction with orthostatic intolerance underwent improved differentiation and classification. In the present review a variant of autonomic dysfunction with orthostatic intolerance--POTS (postural orthostatic tachycardia syndrome)--will be discussed. The affected patients present with orthostatic intolerance, postural tachycardia, exercise intolerance, fatigue, dizziness and in some cases with other dysautonomic symptoms such as gastrointestinal or sudomotor dysfunction. Together with the clinical history, tilt table testing is the cornerstone of diagnostic evaluation by which the syndrome can be distinguished from typical neurocardiogenic disorders. POTS is characterized by different subtypes; accordingly, therapy for relief of symptoms is variable and includes beta blockers for patients with the hyperadrenergic type and alphamimetics for those with partial dysautonomia. Although it is now possible to differ POTS from other forms of autonomic dysfunction, further research is warranted to clarify the pathophysiology of this syndrome and its subtypes and to improve therapeutic interventions.

Heart Rate Variability in Mitral Valve Prolapse Syndrome

Background and Objectives:Studies in patients with mitral valve prolapse syndrome (MVPS) have shown the coexistence of various forms of autonomic dysfunction, and so this is an area that requires further investigation. Materials and Method:The study group consisted of 65 patients (36 men and 29 women), aged 16 to 43 years (mean±SD, 28±8) with symptomatic, echocardiographically proven mitral valve prolapse (MVPS) who were free of other organic heart diseases and arrhythmias. In a prospective study, heart rate variability (HRV) indexes were calculated from 24-hour Holter recordings obtained during normal daily activity and plasma norepinephine was measured, and then these data were compared among the study group according to clinic heart rate (HR). Results:The study group was divided into below 60 bpm (group 1:n=13), 60-80 bpm (group 2:n=36) and over 80 bpm (group 3:n=16) on the basis of clinic HR. These patient groups were matched with respect to age and gender. There were significant difference in SDNNIDX, rMSSD and pNN50 between these groups (p=0.005, 0.009 and 0.002 respectively), and these HRV measures correlated inversely with clinic HR (p<0.01). As clinic HR increased, there was a tendency for plasma norepinephrine concentration to also rise (p<0.05), but there was no statistical significant difference between these groups. Conclusion:Our data suggests that MVPS may have subgroups of HRV, reflecting cardiac autonomic modulation, according to clinic HR. (Korean Circulation J 1998;28(12):1973-1980)