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. 2021 May;116(5):981-998.
doi: 10.36660/abc.20200422.

Dysautonomia: A Forgotten Condition - Part II

[Article in English, Portuguese]
Eduardo Arrais Rocha  1 , Niraj Mehta  2   3 , Maria Zildany Pinheiro Távora-Mehta  2   3 , Camila Ferreira Roncari  4 , Alan Alves de Lima Cidrão  5 , Jorge Elias Neto  6
Affiliations

Dysautonomia: A Forgotten Condition - Part II

[Article in English, Portuguese]
Eduardo Arrais Rocha et al. Arq Bras Cardiol. 2021 May.
No abstract available

PubMed Disclaimer

Conflict of interest statement

Potencial conflito de interesse

Não há conflito com o presente artigo

Figures

Figura 1
Figura 1. Testes dos reflexos autonômicos cardiovasculares. Caso clínico de paciente com disautonomia avançada e alterações nos testes respiratórios (1,08) e no coeficiente ortostático 30:15 (1,03). Os valores precisam ser ajustados para a idade e o sexo.–
Figura 2
Figura 2. Análise da variabilidade RR no domínio da frequência durante ciclo de cinco minutos. Há necessidade de suspensão dos fármacos que possam interferir na análise da frequência cardíaca. A presença de arritmias frequentes, fibrilação atrial ou marca-passo impossibilita a análise do exame.
Componente de muito baixa frequência 0,01-0,04 Hz (FMB – VLF): avaliação das flutuações do tônus vasomotor ligado a termorregulação e a sudorese (ação predominante do simpático). Componente de baixa frequência 0,04-0,15 Hz (FB – LF): avaliação do barorreceptor (componente simpático predominante com modulação vagal). Componente de alta frequência 0,15-0,5 Hz (FA – HF): relacionado ao controle sinusal (ação parassimpática). Pode ser realizado no protocolo e em conjunto com os testes da Figura 1 (configurando o protocolo dos sete testes de avaliação dos reflexos autonômicos cardiovasculares).
Figura 3
Figura 3. Fluxograma de abordagem da hipotensão ortostática e seus diagnósticos diferenciais. Dividido em grupos com aumento da frequência cardíaca em ortostase, usualmente observada em HO por hipovolemia ou medicamentosa e sem aumento, visto nas hipotensões neurogênicas e excluindo-se o uso de fármacos bradicardizantes ou pacientes com doença do nó sinusal.
Figura 4
Figura 4. Abordagem terapêutica das disautonomias.
Figure 1
Figure 1. Cardiovascular Autonomic Reflex Tests. Clinical case of a patient with advanced disautonomia with abnormal breathing tests (1.08) and abnormal orthostatic coefficient 30/15 (1.03). Values need to be adjusted for age and sex.–.
Figure 2
Figure 2. Analysis of RR Variability in the frequency domain during a 5-minute cycle. Any drugs that interfere with heart rate analysis must be discontinued. The presence of frequent arrhythmia, atrial fibrillation or pacemaker makes it impossible to analyze the test.
Very low frequency component — 0.01–0.04 Hz (FMB – VLF) — Assessment of vasomotor tone fluctuations related to thermoregulation and sweating — (predominant sympathetic action) Low Frequency Component — 0.04–0.15 Hz (FB-LF) — Baroreceptor evaluation (predominant sympathetic component with vagal modulation) High Frequency Component — 0.15–0.5 Hz (FA — HF) — Related to sinus control (parasympathetic action) It can be carried out in the protocol with the tests in figure 1 (characterizing the protocol of the 7 Cardiovascular Autonomic Reflex Evaluation Tests).
Figure 3
Figure 3. Flowchart on the management of orthostatic hypotension and its differential diagnoses. Divided into groups with increased heart rate in orthostasis, usually observed in OH due to hypovolemia or medication and without increase, as seen in neurogenic hypotension, excluding the use of bradycardic drugs or patients with sinus node disease.
Figure 4
Figure 4. Therapeutic approach to dysautonomia.
See this image and copyright information in PMC

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