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Autonomic Failure Syndromes (Pure Autonomic Failure)

Osman Z. Abbasi, DO and Michael Nguyen, MD, FACEP Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Blood pressure drop with inadequate compensatory rise in heart rate while standing attributed to autonomic system impairment (1)

  • Maintaining upright posture is difficult for patients ...

DIAGNOSIS

HISTORY

  • Dizziness or near syncope within seconds after standing, after a large meal, or in hot weather

  • Hypertension when lying flat

  • Decreased sweating

  • Men: Initial feature is typically erectile ...

TREATMENT

GENERAL MEASURES

  • Encourage physical exercise.

  • Consider compression stockings (1).

  • No specific blood pressure goals (1)

  • Avoid high altitudes due to risk of hyperventilation and subsequent hypoten...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Work with primary care doctor to achieve symptom control and functional improvement. 

Patient Monitoring

Monitor for signs of weakness and light-headedness at home....

REFERENCES

1
Shibao C, Okamoto L, Biaggioni I. Pharmacotherapy of autonomic failure. Pharmacol Ther.  2012;134(3):279–286. {L-End} [View Abstract on OvidMedline]
2
Vanderbilt Autonomic Dysfunction ...

CODES

ICD10

G90.8 Other disorders of autonomic nervous system 

ICD9

337.9 Unspecified disorder of autonomic nervous system 

SNOMED

  • 84438001 Pure autonomic failure

  • 15241006 Disorder of autonomic nervous syst...

CLINICAL PEARLS

  • Orthostatic hypotension defined by systolic BP drop of >20 mm Hg or diastolic BP drop >10 mm Hg within 3 minutes of standing or head-up tilt test of at least 60-degree angle (1)

  • P...

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