Autonomic Nervous System Disorders: A Patient's Inquiry

Q: Autonomic Nervous System Disorders: A Patient's Inquiry

Hello Kris： Fatigue or anxiety can stimulate the sympathetic nervous system, affecting heart rate and blood pressure. <br>This is a normal response of the sympathetic nervous system to stress. <br>Treatment should focus on avoiding excessive fatigue and reducing anxiety. <br>Addi

Inquiry for clarification?

Hello Dr.
Tsai,
I would like to discuss my mother's condition.
For the past 2 to 3 years, she has experienced symptoms such as elevated blood pressure, palpitations, and increased heart rate during times of labor, fatigue, or anxiety.
Sometimes, resting while sitting helps alleviate these symptoms, but if they do not improve, she needs to take Alpraline to achieve "complete" relief.
Merely taking antihypertensive medications like Labtal, Diovan, or Norvasc provides only temporary relief, with a high recurrence rate and additional side effects such as headaches, dizziness, and nausea.
Additionally, my mother has undergone several tests, including routine blood tests, electrocardiograms, myocardial perfusion studies, brain CT scans, and carotid ultrasounds, all of which returned normal results.
I would like to ask Dr.
Tsai the following questions:
1) Given the above, my mother's symptoms have persisted for nearly 2 to 3 years, and she has undergone multiple physical examinations with normal results.
She can only manage her daily life with the help of Alpraline.
Do you believe her symptoms (elevated blood pressure, palpitations, and increased heart rate) are due to autonomic nervous system dysfunction rather than simple hypertension?
2) Is it safe for her to take Alpraline up to three times a day? (I am concerned about the potential for overdose and harm.)
3) Generally speaking, what kind of examinations should be conducted at a medical facility to appropriately diagnose autonomic nervous system dysfunction?
Thank you, Dr.
Tsai.

Kris, 40~49 year old female. Ask Date: 2024/05/02

Dr. Cai Zongzhang reply Neurology

Hello Kris: Fatigue or anxiety can stimulate the sympathetic nervous system, affecting heart rate and blood pressure.
This is a normal response of the sympathetic nervous system to stress.
Treatment should focus on avoiding excessive fatigue and reducing anxiety.
Additionally, in medical practice, blood pressure is measured in a resting state.
If blood pressure is measured without prior rest, such as in a rush, it can only be used as a reference and cannot be used to diagnose hypertension.

Reply Date: 2024/05/02

More Info

Hello! Thank you for your inquiry regarding your mother's health issues related to autonomic nervous system disorders. Based on the symptoms you've described, it seems that your mother may indeed be experiencing autonomic dysregulation, which can manifest as elevated blood pressure, palpitations, and increased heart rate, particularly during times of stress, fatigue, or anxiety.

1. Autonomic Nervous System Dysfunction: The symptoms your mother is experiencing—elevated blood pressure, palpitations, and increased heart rate—can be indicative of autonomic nervous system dysfunction rather than simply primary hypertension. The autonomic nervous system (ANS) regulates involuntary bodily functions, including heart rate, blood pressure, and stress responses. When the ANS is not functioning properly, it can lead to exaggerated responses to stressors, resulting in the symptoms you've described. Given that her extensive medical evaluations have returned normal results, it is plausible that her symptoms are linked to autonomic dysregulation rather than a primary cardiovascular issue.

2. Use of Alpraline (Alprazolam): Regarding the use of Alpraline (Alprazolam), it is important to follow the prescribing physician's guidance. Alprazolam is a benzodiazepine that is often prescribed for anxiety and panic disorders. While it can be effective in alleviating anxiety-related symptoms, long-term use can lead to dependence and tolerance, meaning that over time, higher doses may be needed to achieve the same effect. If your mother is taking it up to three times a day, it is crucial to have regular follow-ups with her healthcare provider to monitor her response to the medication and to discuss any potential side effects or concerns about dependency. It is also advisable to explore non-pharmacological interventions, such as cognitive-behavioral therapy (CBT) or mindfulness techniques, which can help manage anxiety and stress without the risks associated with long-term benzodiazepine use.

3. Diagnostic Evaluation for Autonomic Dysfunction: To assess for autonomic nervous system disorders, several tests can be conducted. These may include:
- Tilt Table Test: This test evaluates how the body responds to changes in position and can help diagnose conditions like orthostatic hypotension or postural orthostatic tachycardia syndrome (POTS).

- Heart Rate Variability (HRV) Analysis: This measures the variation in time between heartbeats and can provide insights into autonomic function.

- Sweat Tests: These assess the function of the sweat glands, which are controlled by the autonomic nervous system.

- Blood Pressure Monitoring: Continuous monitoring can help identify patterns related to stress or activity levels.

- Comprehensive Autonomic Testing: Some specialized centers offer a battery of tests to evaluate autonomic function more thoroughly.

In conclusion, it is essential for your mother to continue working closely with her healthcare providers to manage her symptoms effectively. If her symptoms persist or worsen, a referral to a specialist in autonomic disorders or a neurologist may be beneficial for further evaluation and management. Lifestyle modifications, stress management techniques, and possibly adjusting her medication regimen could also contribute positively to her overall well-being. Thank you for reaching out, and I hope this information helps clarify your concerns!

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