From the Guidelines
Hyperadrenergic types of dysautonomia include Postural Orthostatic Tachycardia Syndrome (POTS), which is characterized by an inappropriate heart rate increase without concomitant blood pressure fall, likely due to a hyperadrenergic state. According to the 2018 ESC guidelines for the diagnosis and management of syncope 1, POTS is defined as an inappropriate HR increase without concomitant BP fall, likely mechanisms include severe deconditioning, immune-mediated processes, excessive venous pooling, and hyperadrenergic state.
Key Characteristics of POTS
- Inappropriate HR increase without concomitant BP fall
- Likely mechanisms: severe deconditioning, immune-mediated processes, excessive venous pooling, and hyperadrenergic state
- Orthostatic intolerance symptoms: light-headedness, palpitations, tremor, weakness, blurred vision, and fatigue
- Syncope is rare and usually elicited by vasovagal reflex activation
Management of Hyperadrenergic Dysautonomia
Management of POTS typically involves medications such as beta-blockers, central sympatholytics, and lifestyle modifications. Beta-blockers such as propranolol or metoprolol can be used to manage symptoms, and should be started at low doses and gradually increased to minimize side effects. Lifestyle modifications including increased salt and fluid intake, compression garments, and gradual exercise programs can also help alleviate symptoms.
Underlying Mechanism
The underlying mechanism of hyperadrenergic dysautonomia involves dysregulation of the autonomic nervous system, particularly overactivation of sympathetic pathways or impaired sympathetic inhibition, causing an exaggerated catecholamine response to positional changes or other triggers. This dysregulation can lead to excessive sympathetic nervous system activity, resulting in elevated levels of norepinephrine and other catecholamines.
From the Research
Hyperadrenergic Types of Dysautonomia
The hyperadrenergic types of dysautonomia are characterized by an overactive sympathetic nervous system. Some of the conditions that fall under this category include:
- Postural Orthostatic Tachycardia Syndrome (POTS) 2, 3
- Neurocardiogenic syncope (NCS) 3
- Orthostatic hypotension (OH) with a hyperadrenergic response 2
Characteristics of Hyperadrenergic Dysautonomia
Hyperadrenergic dysautonomia is often associated with:
- Increased heart rate and blood pressure in response to standing or stress 2, 4
- Symptoms such as dizziness, weakness, pre-syncope, palpitations, and other systemic symptoms 2
- A chaotic state of the hypothalamic/autonomic/endocrine axis, leading to breakdown of organ systems through long-standing energy deficiency 5
Diagnosis and Treatment
Diagnosis of hyperadrenergic dysautonomia involves a combination of clinical evaluation, autonomic function tests, and other diagnostic tools 6, 4. Treatment typically focuses on managing symptoms, improving autonomic function, and addressing underlying causes or comorbidities 2, 6, 3.