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Autonomic Dysfunction (Specific Syndromes (Spinal Cord injury (Injury >…
Autonomic Dysfunction
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Clinical
CVS
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Prolonged QTc due to altered cardiac sympathetic innervation via imbalance of L and R stellate ganglion
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Vaso and sudomotor
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Sweating: nocturnal, gustatory
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Causes
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Acquired
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Metabolic
Diabetes
Vascular endothelial damage
Degeneration due to hyperglycaemia
Auto-immune mediated damage #
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Toxins
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Chemotherapy (Vincristine, platinoids)
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Diagnosis
Parasympathetic Tests
HR (R-R) variation during 6 deep breaths over 1 min
Normal >15 b/min
Borderline 11-14
Abnormal <10 b/min
HR response to standing (30:15 ratio)
Ratio of longest R-R around 30th beat to shortest R-R interval around 15th beat
Normal >1.04
Abnormal <1.00
HR in Valsalva - ratio of longest R-R interval to shortest RR (fastest to shortest HR)
Normal >1.21
Abnormal <1.10
Sympathetic Tests
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Arterial pressure response to sustained handgrip (diastolic)
Mean three diastolic before - highest diastolic during
Normal >16mmHg
Abnormal <10mmHg
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