From the Guidelines
Dysautonomia symptoms include lightheadedness, fainting, rapid or slow heart rate, blood pressure fluctuations, exercise intolerance, fatigue, digestive issues, temperature regulation problems, and excessive or insufficient sweating, as noted in the 2020 standards of medical care in diabetes 1.
Symptoms of Dysautonomia
The symptoms of dysautonomia are varied and can affect different systems of the body. Some common symptoms include:
- Lightheadedness
- Fainting
- Rapid or slow heart rate
- Blood pressure fluctuations
- Exercise intolerance
- Fatigue
- Digestive issues such as constipation, diarrhea, or bloating
- Temperature regulation problems
- Excessive or insufficient sweating These symptoms occur because dysautonomia affects the autonomic nervous system, which controls involuntary bodily functions.
Triggers and Variability
Symptoms of dysautonomia can be triggered by various factors, including:
- Dehydration
- Stress
- Alcohol
- Caffeine
- Certain medications The presentation of dysautonomia varies widely between individuals, with some experiencing mild occasional symptoms while others have debilitating daily symptoms. Symptoms may fluctuate throughout the day and can be worse when standing (orthostatic intolerance) or during physical exertion, heat exposure, or after meals, as discussed in the 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope 1.
Importance of Medical Evaluation
If experiencing symptoms of dysautonomia, it is essential to seek medical evaluation, as dysautonomia can be primary or secondary to other conditions requiring specific treatment approaches, and optimal glucose control can prevent or delay the development of neuropathy in patients with type 1 diabetes and slow the progression of neuropathy in patients with type 2 diabetes 1.
From the Research
Symptoms of Dysautonomia
The symptoms of dysautonomia can vary depending on the specific condition, but common symptoms include:
- Orthostatic intolerance, which is the development of disabling symptoms upon assuming an upright posture that are relieved partially by resuming the supine position 2
- Postural tachycardia syndrome (POTS), characterized by palpitations due to excessive orthostatic sinus tachycardia, lightheadedness, tremor, and near-syncope 2, 3
- Neurogenic orthostatic hypotension (nOH), which is a late sign of dysautonomia and implies greater severity and worse prognosis 2
- Chronic fatigue syndrome, which is a form of dysautonomia characterized by unexplained fatigue, feeling ill after exercising, non-restorative sleep, and cognitive impairment or orthostatic intolerance 2
- Other symptoms such as dizziness, weakness, pre-syncope, palpitations, and systemic symptoms 2, 4
Types of Dysautonomia
There are several types of dysautonomia, including:
- Reflex syndromes, which are mostly benign and usually occur in patients without an intrinsic autonomic nervous system (ANS) or heart disease 2
- Postural orthostatic tachycardia syndrome (POTS), which is characterized by sustained elevation of heart rate in an orthostatic position or during the tilt test 2
- Chronic fatigue syndrome, which is a form of dysautonomia characterized by unexplained fatigue and other symptoms 2
- Neurogenic orthostatic hypotension (nOH), which is a late sign of dysautonomia and implies greater severity and worse prognosis 2
- Cardiovascular autonomic neuropathy (CAN), which is a term used to define dysautonomia with impairment of the sympathetic and/or parasympathetic cardiovascular autonomic nervous system 2
Diagnosis and Treatment
The diagnosis of dysautonomia can be complex and may involve various tests, including:
- Valsalva, respiratory, and orthostatic tests (30:15) 2
- Tilt test, which can detect cases at more advanced stages 2
- RR variability tests in the time domain and frequency domain 2 Treatment of dysautonomia may involve various medications, including:
- Fludrocortisone, midodrine, and droxidopa for symptomatic nOH 2, 5
- Bisoprolol and fludrocortisone for postural tachycardia syndrome (POTS) 3
- Alpha-adrenoceptor agonists, such as midodrine, for orthostatic hypotension due to autonomic failure 5