ØORTHOSTATIC INTOLERANCE

Postural orthostatic tachycardia syndrome, orthostatic tachycardia, Da Costa syndrome, soldier’s heart, effort syndrome, mitral valve prolapse, neurocirculatory asthenia, idiopathic hypovolemia, chronic fatigue syndrome, vasoregulatory asthenia, partial dysautonomia, Irritable heart

ü      Associated conditions

Small fiber neuropathy, excessive venous pooling, deconditioning, prolonged bedrest, weightlesness, hypovolemia, brain stem dysregulation, Arnold-Chiary Malformation, cervical  stenosis, b receptor supersensitivity

ü      Signs and symptoms

Lightheadedness, dizziness, fainting, blurred vision, fatigue, weakness, tremulousness, nausea, constipation/ diarrhea, palpitations, shortness of breath, hyperventilation, dyspnea, headache. Symptoms are triggered by standing or activity and relieved by lying down.

ØSYNCOPE (FAINTING)  vs  EPILEPSY (SEIZURES)

Neurocardiogenic, cardiovagal, vasodepressor syncope

ART can help to differentiate loss of consciousness due to fainting vs epileptic seizures.

ØFIBROMYALGIA

Discomfort, muscle and weakness with pain and fatigue.

ØORTHOSTATIC AND POSTPRANDIAL  HYPOTENSION

Fall of blood pressure after standing-up or after meal often indicates disorder of autonomic nervous system.

ü      Associated conditions

Central and peripheral neuropathies, diabetes, hypovolemia, multiple system atrophy (Shy-Drager syndrome), parkinson's disease  etc.

ü      Signs and  symptoms

Lightheadedness, dizziness, fainting, headache, shoulder pain.

ØCENTRAL AND PERIPHERAL AUTONOMIC NEUROPATHIES

ART can diagnose the presence of progressive autonomic neuropathy and determine its severity, distribution, and prognosis. Autonomic neuropathy may occur with diabetes; amyloidosis; Sjogren's syndrome, the immune-mediated neuropathies (idiopathic and paraneoplastic), including panautonomic neuropathies; pure autonomic failure. The development of generalized autonomic failure may affect a person’s prognosis. Differentiation among related disorders, such as separating Parkinson's disease from multiple system atrophy and Shy-Drager syndrome, is important for the patient’s prognosis.  

ØSMALL FIBER NEUROPATHY

Diagnosis of small fiber neuropathy is often difficult. This disorders affects unmyelinated nerve fibers and EMG and nerve conduction studies are usually normal. ART can yield abnormal results in up to 80% of patients.

ü     Signs and symptoms

Painful, cold or burning hands or feet, lack of sweating, dry eyes, mouth or impotence may be the first signs of cholinergic neuropathy.

ØPAIN-REFLEX SYMPATHETIC DYSTROPHY/COMPLEX REGIONAL PAIN SYNDROMES

ART can identify sympathetically maintained pain such as in complex regional pain syndromes (CRPS)  or reflex sympathetic dystrophy (RSD).

ü    Signs and symptoms

 Chronic painful limb or body area, sensitivity to touch, hot or cold.

ØMONITORING OF DISEASE COURSE  AND RESPONSE TO THERAPY