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Re: Effects of MAS on the heart

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Jim,

Thanks for the info.

I will definitely make a copy of the paper and send it

to you. It will be next week as my husband left it at

work and won't be back there until Monday.

The paper doesn't specifically say it affects patients

in late stage MSA. I gathered that from the context. I

don't have the paper in front of me, but I recall it

stating something like, " Eventually patients may

develop irregular heartbeat. " Maybe I read too much

into that statement. At any rate, I'll get you a copy

and see what you think. Dr. Jankovic doesn't go into a

lot of detail about it. He just says that sometimes

beta blockers are used and, rarely, pacemakers are

required.

in OK

--- Jim Stark wrote:

> ,

>

> Here is one report dealing with Orthostatic

> Intolerance and the effect on

> the heart.

>

> I find it a little strange Dr. Janovic related to

> " late Stage MSA " There are

> really no set pattern to what symptoms show up

> first. I personally would

> like to see that paper.

>

> There is another syndrome called progressive

> orthostatic tachycardia (TOP).

> It definitely effects the heart causing tachycardia

> when one stands from a

> sitting or prone position.

>

> If you would not mind, make a copy of that paper and

> send it too me at:

>

> D. Stark Jr.

> 6435 Bridgeport Dr.

> Greenwell Springs, LA 70739

>

> I will continue to search for references for you,

>

> God Bless,

> Jim Stark

>

>

>

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<h4 align= " center " ><a

href= " #Definitions " >Definitions</a> | <a

href= " #History " >History</a> |

<a href= " #Symptoms " >Symptoms</a> | <a

href= " #Management " >Management</a> | <a

href= " #Prognosis " >Prognosis</a><br>

</h4>

<h3 align= " left " ><a

name= " Definitions " >Definitions</a></h3>

<p align= " left " >It is estimated that over 500,000

Americans are

afflicted with Orthostatic Intolerance. Despite the

enormity of

the number, these conditions are among the least

understood of

the autonomic disorders.</p>

<p align= " left " >Affecting predominately younger

individuals,

often in those under the age of thirty five, these

syndromes

affect more women than men. The onset can be sudden,

and the

impact can be significant on both lifestyle and on the

capacity

to work.</p>

<p align= " left " >Often, these conditions tend to be

misdiagnosed

as either a psychiatric or anxiety - related

disorders, due to

the nature of the symptoms.</p>

<p align= " left " >Standing upright results in a series

of reflexive

bodily responses, regulated by the <a

href= " ans.htm " >Autonomic

Nervous System</a>, to compensate for the effect of

gravity upon

the distribution of blood. These conditions are a

result of an

inappropriate response to this change in body

position. </p>

<p align= " left " >The normal response for a change in

body

position, results in a stabilization to the upright

position in

approximately sixty seconds. During this process, the

normal

change in heart rate would include an increase in

heart rate of

10 to 15 beats per minute, and an increase in

diastolic pressure

of 10 mm Hg, with only a slight change in systolic

pressure.</p>

<p align= " left " >For those who are afflicted with

Orthostatic

Intolerance, there is an excessive increase in heart

rate upon

standing, resulting in the cardiovascular system

working harder

to maintain blood pressure and blood flow to the

brain.</p>

<p align= " left " >Upright posture also brings about a

neurohumoral

response, involving a change in the levels of

vasopressin, renin,

angiotensin and aldosterone levels - all of which are

involved in

the regulation of blood pressure.</p>

<p>Additionally, arterial baroreceptors, particularly

those in

the carotid sinus area, play an important role in the

regulation

of blood pressure and the response to positional

changes. As the

heart pumps blood to the body, the left atrium is

passively

filled with blood as a result of the force exerted by

venous

blood pressure. The baroreceptors in the left atrium

respond,

proportionately, to the pressure exerted by this

venous blood

pressure. Thus, a drop in venous blood pressure will

trigger a

compensatory response to increase blood pressure. </p>

<p>Any disruption in any of these processes, or their

coordination, can result in an inappropriate response

to an

upright position, and can lead to a series of

symptoms, and may

include syncope.<br>

</p>

<h5><a href= " #Definitions " ><img border= " 0 "

src= " images/Topofpage.gif " width= " 100 "

height= " 20 " ></a> </h5>

<hr>

<h3><a name= " History " >History</a></h3>

<p>The inappropriate response to an upright position

has been

observed and given a variety of names in medical

literature.

These names have included:</p>

<ul>

<li>

<p align= " left " >Soldier's Heart</li>

<li>

<p align= " left " >Irritable Heart</li>

<li>

<p align= " left " >

Neurocirculatory Asthenia</li>

<li>

<p align= " left " >

Partial Dysautonomia</li>

<li>

<p align= " left " >

Hyperadrenergic Orthostatic Hypotension</li>

<li>

<p align= " left " >Vasoregulatory Asthenia</li>

</ul>

<p align= " left " >Currently, there are three main

categories used

to describe Orthostatic Intolerance Conditions:</p>

<ul>

<li><p align= " left " >Postural Tachycardia

Syndrome (POTS)</p>

</li>

<li><p align= " left " >Mitral Valve Prolapse

Dysautonomia</p>

</li>

<li><p align= " left " >Idiopathic Hypovolemia</p>

</li>

</ul>

<p align= " left " >These conditions are similar in

presentation, and

in the ensuing treatment plans. The underlying

mechanisms will

have to become better understood in order to alleviate

some of

the overlap in the terminology used for these

conditions.</p>

<p align= " left " >Individualized treatment plans are

often

necessary to manage these conditions.<br>

</p>

<h5 align= " left " ><a href= " #Definitions " ><img

border= " 0 " src= " images/Topofpage.gif " width= " 100 "

height= " 20 " ></a></h5>

<hr>

<h3 align= " left " ><a name= " Symptoms " >Symptoms</a></h3>

<p align= " left " >The symptoms for these conditions may

include the

following:</p>

<ul>

<li><p align= " left " >Excessive Fatigue</p>

</li>

<li><p align= " left " >Exercise Intolerance</p>

</li>

<li><p align= " left " >Recurrent Syncope or Near

Syncope</p>

</li>

<li><p align= " left " >Dizziness</p>

</li>

<li><p align= " left " >Nausea</p>

</li>

<li><p align= " left " >Tachycardia</p>

</li>

<li><p align= " left " >Palpitations</p>

</li>

<li><p align= " left " >Visual Disturbances</p>

<blockquote>

<blockquote>

<ul>

<li><p align= " left " >Blurred Vision

</p>

</li>

<li><p align= " left " >Tunnel

Vision</p>

</li>

<li><p align= " left " >Graying

Out</p>

</li>

</ul>

</blockquote>

</blockquote>

</li>

</ul>

<ul>

<li><p align= " left " >Tremulusness</p>

</li>

<li><p align= " left " >Weakness - most noticeable in

the legs</p>

</li>

<li><p align= " left " >Chest Discomfort</p>

</li>

<li><p align= " left " >Shortness of Breath</p>

</li>

<li><p align= " left " >Mood Swings</p>

</li>

<li><p align= " left " >Migraines and Other

Headaches</p>

</li>

<li><p align= " left " >Gastrointestinal Problems<br>

</p>

</li>

</ul>

<h5><a href= " #Definitions " ><img border= " 0 "

src= " images/Topofpage.gif " width= " 100 "

height= " 20 " ></a></h5>

<hr>

<h3 align= " left " ><a

name= " Management " >Management</a></h3>

<p align= " left " >There has been much new insight gained

as to the

mechanisms of these disorders in the past several

years, and as a

result, it can be confusing for both the affected

individual, as

well as the physician, to get a clear understanding of

these

conditions, and how to effectively manage them.</p>

<p align= " left " >As a result, management of these

conditions needs

to be highly individualized, and may include both

pharmocologic

and non-pharmocologic methods.<br>

</p>

<h5 align= " left " ><a href= " #Definitions " ><img

border= " 0 " src= " images/Topofpage.gif " width= " 100 "

height= " 20 " ></a></h5>

<hr>

<h3><a name= " Prognosis " >Prognosis</a></h3>

<p>The majority of individuals affected with

Orthostatic

Intolerance Syndromes see an improvement in their

condition, and

only experience mild symptoms. However, for some, the

disorder

can be a debilitating condition, that poses a

significant

challenge for effective treatment. Additional research

into the

underlying causes of these disorders will be necessary

to develop

more effective treatment plans. </p>

<p align= " left " >For many, the effect of these

disorders will be

short lived, while others tend to show a progressive

nature to

their disorder, and a worsening of symptoms may occur.

</p>

<p align= " left " >In most cases, a well defined,

individualized,

treatment plan needs to be developed. Since the

underlying causes

for these disorders are not yet completely understood,

no one

approach can be defined as the sole treatment plan.

The

underlying causes for these disorders are probably

multiple, and,

for some, may include an underlying autonomic nervous

system

disease. </p>

<p align= " left " >Continued research into these

disorders will

result in more effective diagnostic tools and

treatment plans.<br>

</p>

<h5><a href= " #Definitions " ><img border= " 0 "

src= " images/Topofpage.gif " width= " 100 "

height= " 20 " ></a></h5>

& nbsp;<!--msnavigation--></td></tr><!--msnavigation--></table><!--msnavigation--\

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width= " 100% " ><tr><td>

<hr align= " center " >

<h5>The National Dysautonomia Research Foundation

(NDRF) has

established this site to help inform afflicted

patients, physicians and the general public

on the various forms of Dysautonomia. It is our desire

to give timely, as well as,

accurate information, however NDRF will not be

responsible for the misinterpretation of

the information provided.</h5>

<h4><b><font color= " #FF0000 " >Medical questions and

information, should be reviewed

with your physician.</font></b></h4>

<h5>

Questions or problems regarding this web site should

be directed to <a

href= " mailto:webmaster@... " >webmaster@...</a><br>

Copyright © 1999, 2000, 2001 & nbsp; NDRF. All rights

reserved.<br>

Last modified: Saturday June 24, 2000.</h5>

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