Dysauton
Dysauton
Dysauton
Dysautonomia
(Cause of chronic fatigue, dizziness and syncopal
episodes)
Dysautonomia is a frequent condition that can cause poor quality of life and
usually goes undiagnosed. It is particularly frequent in people with the Joint
Hypermobility Syndrome (JHS). These people may not even know that they
have lax (hypermobile) joints and physicians usually pay no attention to this
condition and do not make the diagnosis. JHS can produce musculoskeletal
complaints (joint pain, recurrent tendinitis, joint sub-luxations, etc) and
problems derived from weak tissues (dysautonomia, hernias, varicose veins,
uterine and mitral valve prolapse, myopia, spinal disc disease, early
osteoarthritis and early osteoporosis).
have valves to stop the blood from going backwards. The same happens to
people with Dyt and this is the reason why they feel faint, dizzy and may have
a syncopal episode.
As a consequence of Dyt these patients tire easily, feel sleepy and usually after
mid-day they feel “like their batteries have become discharged” and have no
energy. Due to the chronic fatigue, and episodic sensation of weakness is that
in many cases the wrong diagnosis of Depression, Fibromyalgia, Chronic
Fatigue, Hypothyroidism or Hypoglycemic crisis is made. Family and friends
usually see them as being lazy and unsociable, since they lack the energy to
participate in social meetings or to interact with other people. This happens in
both sexes.
In some cases the cause of the Dyt is not known, but in most cases is due to a
vasovagal neurological imbalance. Due to this, some patients have chronic
low BP and low pulse (bradycardia). And can experiment Dyt crisis with
strong emotions, high altitude, dehydration, acute anemia, severe pain, sight if
blood, pregnancy or while in crowded environments, such as in church.
In the last few years I have become interested in the study of the Joint
Hypermobility Syndrome (JHS), that is a genetic condition that exists in about
15% of the population worldwide, but appears to be more prevalent in the
people from Spanish background. We have found that it affects 40% of the
Chilean population. Is probably the most frequent cause of pain in the
rheumatological practice, but usually goes undiagnosed. Some of these
patients have very lax joints and are very agile or were agile in childhood and
frequently sustained sprains (ankles) or sub-luxations. Others are not lax, but
themselves or their relatives have fragile tissues and because of this, they can
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have scoliosis, hip displacia, flat feet, back problems, hernias, prolapse,
diverticulosis, cracking joints, early osteoarthritis, early osteoporosis, varicose
veins in young people, etc.). Frequently they have lax, pale skin, with
prominent veins, with hematomas due to capillary fragility. Less frequently
they may have serious problems such as, aneurisms, arterial ruptures,
expontaneous lung rupture (expontaneous pneumothorax), expontaneous
abortions and bleeding tendency. The tissue fragility is secondary to the
genetically altered collagen. Collagen is a protein, that forms the matrix of all
tissues and I tell my patients “that it is like the iron in constructions”. Since
this condition has Dominant Inheritance, 50% of the children will inherit it.
We have found that 20 to 30% of these patients with JHS have Dyt.
Symptoms of Dysautonomia
The most frequent sign is chronic fatigue. Excessive tiredness usually appears
after midday. If the person is standing for too long, without moving the
extremities, starts to feel like his life is going away, his face looks pale or
gray, may perspire and looks like he is having an hypoglycemic reaction (low
blood sugar). If she/he does not sit or lie down can have a syncopal episode.
At times the person does not feel well, may feel weak, tired, without energy,
has no interest to speak with people around her and keeps herself in a mute
status. She may look pale, tired, at times with droopy eyes and with no desire
to participate in anything. At times due to the lack of facial expression, they
are wrongly diagnosed as having Parkinson. They are usually mal interpreted
as uncooperative and antisocial. It is necessary to recognize these premonitory
symptoms to prevent falls and fractures or a cerebral concussion. Hands and
feet may feel swollen if standing, walking slowly or when the weather is too
hot. The fingers may feel tight, with some rigidity due to the swelling
secondary to poor circulation. It is necessary to make a fist and move the
fingers repeatedly to solve the problem. These people tend to have severe cold
intolerance, needing to expose themselves to the sun “like lizards”. Sometimes
they also have heat intolerance, in which case I tell them that they have a “bad
thermostat”. They catch colds easily in cold weather. Some of them know that
they have low BP, but no one has told them that they have D and that this is
the reason of their poor quality of life. They feel very happy when finally a
doctor tells them about this diagnosis.
may have dry skin, deep voice and are overweight. The diagnosis is confirmed
with the finding of slow tendon reflexes on examination and elevated TSH and
low Free T-4 on blood tests.
Note. In all these circumstances the problem results from the diminution of
the venous return from the lower extremities, resulting in lack of oxygen to
the brain, causing the Dyt symptoms. Thus is necessary to diagnose this
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Consequences of Dysautonomia.
- Poor quality of life, due to the fact that the condition is not diagnosed
and not treated.
- Tendency to falls, with contusions, injuries or fractures (these patients
frequently have osteoporosis). They usually get dizzy when jumping out
of bed or they may “see stars”.
- Dizziness, headaches, and nausea with altitude (Machu Picchu 2,350
m).
- Inability to stand without moving the extremities or standing in a social
event or while on a line, because of the development of fatigue and
tendency to syncopal episodes.
- Cold intolerance, at times severe and swelling of hands and feet, due to
poor circulation.
- Tiredness, somnolence and headaches after sexual intercourse.
- Myocardial angina symptoms (chest pains) in people with coronary
insufficiency, due to the drop in BP.
- Diagnostic confusion with: Chronic Fatigue Syndrome, Fibromyalgia,
Depression, Hypoglycemic crisis and lack of interest to participate in
social events.
The diagnosis can be confirmed with a Tilt Test, which can be done in a
Cardiology Unit. The patient lies in bed for 15 minutes, pulse and BP are
taken frequently, and the bed is inclined to 80°. The person is tied to the
bed, in a standing position, with the feet standing on a platform at the end
of the bed, but cannot move them. The test may last one hour or less, if the
BP falls substantially or if the person gets dizzy or has tendency to a
syncopal episode, in which case test is positive.
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Treatment of Dysautonomia
B.- Medications.
1.- Anti-depressants:
a. Fluoxetine
b. Sertraline
c. Cytalopram
d. Escytalopram
e. Paroxetine
Jaime F. Bravo, MD
Rheumatology-Osteoporosis
Revised: January 12, 2007
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1.- Cross the legs in front of you 2. - Cross the legs behind you