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A Path Difficult to Tread: Pure Autonomic Failure, A Case ReportNagpal, Sagar, Pokhriyal, Sindhu C., Theegala, Vaishnavi, Shastri, Dipsa, Dalbah, Rami, Paladagula, Abhijith 25 April 2023 (has links) (PDF)
Introduction - Pure autonomic failure is a rare disorder characterized by orthostatic hypotension, absence of a compensatory rise in heart rate, and abnormal autonomic functions. In most cases, supine hypertension is seen coupled with orthostatic hypotension, making the management of these patients a big challenge.
We present the case of a 74-year-old gentleman, who presented to the ED with altered mental status for a day; weakness, and falls for 3 weeks. The patient had a past medical history of Hypertension, alcoholism, and REM sleep disorder. He was being treated for erectile dysfunction for the last 10 years and had a family history of Parkinson's disease in his mother and sister. The patient was compliant with Lisinopril 40 mg, Amlodipine, and Rosuvastatin, Tamsulosin 0.4 mg. His blood pressure(BP) on presentation was ranging between 109/74-194/76 mm of Hg. Systolic BP dropped by 30mmHg after tilting the angle of the bed to 45 degrees for 1 minute with no change in HR and the patient became symptomatic in this position. Orthostatic vitals showed a dramatic drop in Systolic BP of >80mmHg with no change in heart rate. MRA and MRI showed chronic microvascular changes. The Echocardiogram, Cortisol, and TSH levels were all normal. All anti-hypertensives were discontinued and supportive treatment was started with Midodrine, Droxidopa, and Pyridostigmine, thigh-high TED hose and abdominal binders at bedtime, and Nitroglycerin patch at night for hypertension. The patient was started on fludrocortisone as he continued to drop his BP by 80 mmHg on standing. The use of TED stockings and bed tilting improved the issue of uncontrolled supine hypertension at night.
Conclusion- Treatment of autonomic dysfunction continues to be challenging. There are no definitive guidelines and management is largely individualized. Both pharmacological and non-pharmacological measures are used.
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Autonomic Nervous System Functioning in Posttraumatic Stress Disorder at Rest and During Stress: The Role of the Parasympathetic Nervous SystemKeary, Therese A. 26 August 2008 (has links)
No description available.
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Autonomic Nervous System Dysregulation and Cognitive Functioning in Patients with Congestive Heart FailureGathright, Emily C. 28 April 2014 (has links)
No description available.
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Cognitive, motor, and autonomic function in infants with complex congenital heart diseases, infants born preterm, and infants born full-termChen , Chao-Ying January 2014 (has links)
No description available.
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The Role of Heart Rate Variability in the Treatment of MigrainesLedoux, Thomas M. 02 October 2015 (has links)
No description available.
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Ethnicity, Sex, and Vagal Activity: Differences in Hemodynamics Underlying Long-Term Blood Pressure RegulationWilliams, DeWayne P. January 2017 (has links)
No description available.
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RESPONSE OF HEART RATE VARIABILITY TO PHYSIOLOGICAL STRESS IN HEALTHY COLLEGE STUDENTSClaiborne, Stephen Alexander 27 April 2018 (has links)
No description available.
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LOW DOSE NERVE AGENT SARIN CAUSES DILATED CARDIOMYOPATHY AND AUTONOMIC IMBALANCE IN MICEShewale, Swapnil Vijay 16 September 2011 (has links)
No description available.
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Testing the Cognitive Control Model of Pathological Worry Using Objective Measures of Cognitive Control and Autonomic ArousalFree, Matthew Lee 26 July 2017 (has links)
No description available.
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Effects of Neural Sympathetic Nerve Activity and Endothelial Function on Ventriculovascular Coupling Efficiency in Resistance and Endurance Trained AthletesSmith, Michael M. 20 June 2012 (has links)
No description available.
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