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Dysautonomia
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<h2 id="signs-and-symptoms">Signs and symptoms</h2> <p>Dysautonomia, a complex set of conditions characterized by autonomic nervous system (ANS) dysfunction, manifests clinically with a diverse array of symptoms of which postural orthostatic tachycardia syndrome (POTS) stands out as the most common.<a class="footnote-ref" id="fnref:9" href="#fn:9"><sup>9</sup></a> </p><p>The symptoms of dysautonomia, which are numerous and vary widely for each person, are due to inefficient or unbalanced <a href="/facts/Efferent_nerve_fiber/x9jxpzVq">efferent</a> signals sent via both systems.[<i>medical citation needed</i>] Symptoms in people with dysautonomia include: </p> <ul><li><a href="/facts/Anhydrosis/jnyH2MGl">Anhydrosis</a> or <a href="/facts/Hyperhidrosis/koG3nCEn">hyperhidrosis</a><a class="footnote-ref" id="fnref:10" href="#fn:10"><sup>10</sup></a></li> <li>Blurry or <a href="/facts/Diplopia/wYoJ9Khj">double vision</a><a class="footnote-ref" id="fnref:11" href="#fn:11"><sup>11</sup></a></li> <li><a href="/facts/Bowel_incontinence/Yhhl6fCL">Bowel incontinence</a><a class="footnote-ref" id="fnref:12" href="#fn:12"><sup>12</sup></a></li> <li><a href="/facts/Clouding_of_consciousness/4qY1aaVf">Brain fog</a><a class="footnote-ref" id="fnref:13" href="#fn:13"><sup>13</sup></a></li> <li><a href="/facts/Constipation/l4DHHM6L">Constipation</a><a class="footnote-ref" id="fnref:14" href="#fn:14"><sup>14</sup></a></li> <li><a href="/facts/Dizziness/eI8UvmS5">Dizziness</a><a class="footnote-ref" id="fnref:15" href="#fn:15"><sup>15</sup></a></li> <li><a href="/facts/Dysphagia/vgfd6FpV">Difficulty swallowing</a><a class="footnote-ref" id="fnref:16" href="#fn:16"><sup>16</sup></a></li> <li><a href="/facts/Exercise_intolerance/IPWLfqs6">Exercise intolerance</a><a class="footnote-ref" id="fnref:17" href="#fn:17"><sup>17</sup></a></li> <li><a href="/facts/Low_blood_pressure/BhrdVVRS">Low blood pressure</a><a class="footnote-ref" id="fnref:18" href="#fn:18"><sup>18</sup></a></li> <li><a href="/facts/Orthostatic_hypotension/pkeTyF8w">Orthostatic hypotension</a><a class="footnote-ref" id="fnref:19" href="#fn:19"><sup>19</sup></a><a class="footnote-ref" id="fnref:20" href="#fn:20"><sup>20</sup></a></li> <li><a href="/facts/Syncope_(medicine)/AqU1whYh">Syncope</a><a class="footnote-ref" id="fnref:21" href="#fn:21"><sup>21</sup></a></li> <li><a href="/facts/Tachycardia/ycmyzP7q">Tachycardia</a><a class="footnote-ref" id="fnref:22" href="#fn:22"><sup>22</sup></a></li> <li><a href="/facts/Tunnel_vision/nSb32ltd">Tunnel vision</a><a class="footnote-ref" id="fnref:23" href="#fn:23"><sup>23</sup></a></li> <li><a href="/facts/Urinary_incontinence/1hNsKRn9">Urinary incontinence</a> or <a href="/facts/Urinary_retention/YvTCprKk">urinary retention</a><a class="footnote-ref" id="fnref:24" href="#fn:24"><sup>24</sup></a></li> <li><a href="/facts/Sleep_apnea/mstY43ok">Sleep apnea</a><a class="footnote-ref" id="fnref:25" href="#fn:25"><sup>25</sup></a></li></ul> <h2 id="causes">Causes</h2> <p>Dysautonomia may be due to <a href="/facts/Heredity/t0aMmRWx">inherited</a> or degenerative <a href="/facts/Neurologic_diseases/eQKKs7jX">neurologic diseases</a> (primary dysautonomia)<a class="footnote-ref" id="fnref:26" href="#fn:26"><sup>26</sup></a> or injury of the autonomic nervous system from an acquired disorder (secondary dysautonomia).<a class="footnote-ref" id="fnref:27" href="#fn:27"><sup>27</sup></a><a class="footnote-ref" id="fnref:28" href="#fn:28"><sup>28</sup></a> Its most common causes include: </p> <ul><li><a href="/facts/Alcoholism/KGPzpChp">Alcoholism</a><a class="footnote-ref" id="fnref:29" href="#fn:29"><sup>29</sup></a><a class="footnote-ref" id="fnref:30" href="#fn:30"><sup>30</sup></a></li> <li><a href="/facts/Amyloidosis/FeuTXVdn">Amyloidosis</a>[<i>better source needed</i>]<a class="footnote-ref" id="fnref:31" href="#fn:31"><sup>31</sup></a></li> <li><a href="/facts/Autoimmune_disease/sojBeQ7t">Autoimmune disease</a>, such as <a href="/facts/Sj%25C3%25B6gren%2527s_syndrome/U1p9IbFU">Sjögren's syndrome</a><a class="footnote-ref" id="fnref:32" href="#fn:32"><sup>32</sup></a><a class="footnote-ref" id="fnref:33" href="#fn:33"><sup>33</sup></a><a class="footnote-ref" id="fnref:34" href="#fn:34"><sup>34</sup></a><a class="footnote-ref" id="fnref:35" href="#fn:35"><sup>35</sup></a> or <a href="/facts/Systemic_lupus_erythematosus/kfHYawre">systemic lupus erythematosus</a> (lupus), and <a href="/facts/Autoimmune_autonomic_ganglionopathy/FseKJp2G">autoimmune autonomic ganglionopathy</a></li> <li><a href="/facts/Craniocervical_instability/ShApffC8">Craniocervical instability</a><a class="footnote-ref" id="fnref:36" href="#fn:36"><sup>36</sup></a></li> <li><a href="/facts/Diabetes/2xeHXbsI">Diabetes</a><a class="footnote-ref" id="fnref:37" href="#fn:37"><sup>37</sup></a></li> <li><a href="/facts/Eaton-Lambert_syndrome/8VnbUurs">Eaton-Lambert syndrome</a>[<i>medical citation needed</i>]</li> <li><a href="/facts/Ehlers-Danlos_syndrome/UyXa1bJ5">Ehlers-Danlos syndrome</a><a class="footnote-ref" id="fnref:38" href="#fn:38"><sup>38</sup></a></li> <li><a href="/facts/Guillain-Barr%25C3%25A9_syndrome/013kC53b">Guillain-Barré syndrome</a><a class="footnote-ref" id="fnref:39" href="#fn:39"><sup>39</sup></a><a class="footnote-ref" id="fnref:40" href="#fn:40"><sup>40</sup></a><a class="footnote-ref" id="fnref:41" href="#fn:41"><sup>41</sup></a></li> <li><a href="/facts/HIV/ulY2rgzu">HIV</a> and <a href="/facts/AIDS/RqLIEMuJ">AIDS</a><a class="footnote-ref" id="fnref:42" href="#fn:42"><sup>42</sup></a></li> <li><a href="/facts/Long_COVID/9YQdUEE2">Long COVID</a><a class="footnote-ref" id="fnref:43" href="#fn:43"><sup>43</sup></a><a class="footnote-ref" id="fnref:44" href="#fn:44"><sup>44</sup></a></li> <li><a href="/facts/Multiple_sclerosis/vghXl0IQ">Multiple sclerosis</a>, <a href="/facts/Meningitis-retention_syndrome/LGbR6B2D">meningitis-retention syndrome</a><a class="footnote-ref" id="fnref:45" href="#fn:45"><sup>45</sup></a></li> <li><a href="/facts/Paraneoplastic_syndrome/Dvqdu7QX">Paraneoplastic syndrome</a><a class="footnote-ref" id="fnref:46" href="#fn:46"><sup>46</sup></a></li> <li><a href="/facts/Spinal_cord_injury/D0vo3ArR">Spinal cord injury</a><a class="footnote-ref" id="fnref:47" href="#fn:47"><sup>47</sup></a> or <a href="/facts/Traumatic_brain_injury/DTq110vw">traumatic brain injury</a><a class="footnote-ref" id="fnref:48" href="#fn:48"><sup>48</sup></a></li> <li><a href="/facts/Synucleinopathy/LTJUrVu2">Synucleinopathy</a>, a group of neurodegenerative diseases including <a href="/facts/Pure_autonomic_failure/RkEAhDCg">pure autonomic failure</a>, <a href="/facts/Parkinson%2527s_disease/xpekKj6x">Parkinson's disease</a>, <a href="/facts/Dementia_with_Lewy_bodies/Sw6vTGkh">dementia with Lewy bodies</a> and <a href="/facts/Multiple_system_atrophy/ndcFsMjn">multiple system atrophy</a><a class="footnote-ref" id="fnref:49" href="#fn:49"><sup>49</sup></a></li> <li><a href="/facts/Surgery/fG8tWf5Y">Surgery</a> or <a href="/facts/Injury/PJ7CbnMQ">injury</a> involving the <a href="/facts/Nerves/q7GsAfYV">nerves</a><a class="footnote-ref" id="fnref:50" href="#fn:50"><sup>50</sup></a></li> <li><a href="/facts/Toxicity/qa96rs60">Toxicity</a> (<a href="/facts/Vincristine/GJWrGMkH">vincristine</a>)<a class="footnote-ref" id="fnref:51" href="#fn:51"><sup>51</sup></a></li></ul> <p>In the <a href="/facts/Sympathetic_nervous_system/hs8psNRd">sympathetic nervous system</a> (SNS), predominant dysautonomia is common along with <a href="/facts/Fibromyalgia/aNSBfaJJ">fibromyalgia</a>, <a href="/facts/Chronic_fatigue_syndrome/UwTEusF5">chronic fatigue syndrome</a>, <a href="/facts/Irritable_bowel_syndrome/FW24EYbP">irritable bowel syndrome</a>, and <a href="/facts/Interstitial_cystitis/B9lHbIQc">interstitial cystitis</a>, raising the possibility that such dysautonomia could be their common clustering underlying <a href="/facts/Pathogenesis/o9kHHK0U">pathogenesis</a>.<a class="footnote-ref" id="fnref:52" href="#fn:52"><sup>52</sup></a> </p><p>In addition to sometimes being a symptom of dysautonomia, <a href="/facts/Anxiety/Geekl883">anxiety</a> can sometimes physically manifest symptoms resembling autonomic dysfunction.<a class="footnote-ref" id="fnref:53" href="#fn:53"><sup>53</sup></a><a class="footnote-ref" id="fnref:54" href="#fn:54"><sup>54</sup></a><a class="footnote-ref" id="fnref:55" href="#fn:55"><sup>55</sup></a> A thorough investigation ruling out physiological causes is crucial, but in cases where relevant tests are performed and no causes are found or symptoms do not match any known disorders, a primary anxiety disorder is possible but should not be presumed.<a class="footnote-ref" id="fnref:56" href="#fn:56"><sup>56</sup></a> For such patients, the <a href="/facts/Anxiety_sensitivity/wfLPrG65">anxiety sensitivity</a> index may have better predictivity for anxiety disorders while the <a href="/facts/Beck_Anxiety_Inventory/aRsxgNjW">Beck Anxiety Inventory</a> may misleadingly suggest anxiety for patients with dysautonomia.<a class="footnote-ref" id="fnref:57" href="#fn:57"><sup>57</sup></a> </p><p><a href="/facts/Mitochondrial_cytopathies/r79sg24J">Mitochondrial cytopathies</a> can have autonomic dysfunction manifesting as <a href="/facts/Orthostatic_intolerance/zA0L1a6b">orthostatic intolerance</a>, sleep-related <a href="/facts/Hypoventilation/ruqIr4oa">hypoventilation</a>, and <a href="/facts/Arrhythmia/ooEpr46Q">arrhythmias</a>.<a class="footnote-ref" id="fnref:58" href="#fn:58"><sup>58</sup></a><a class="footnote-ref" id="fnref:59" href="#fn:59"><sup>59</sup></a><a class="footnote-ref" id="fnref:60" href="#fn:60"><sup>60</sup></a> </p> <h2 id="mechanism">Mechanism</h2> <p>The <a href="/facts/Autonomic_nervous_system/hdmEY1Ay">autonomic nervous system</a> is a component of the <a href="/facts/Peripheral_nervous_system/KjVpVnHU">peripheral nervous system</a> and comprises two branches: the sympathetic nervous system (SNS) and the <a href="/facts/Parasympathetic_nervous_system/eNzCI8Yu">parasympathetic nervous system</a> (PSNS). The SNS controls the more active responses, such as increasing heart rate and blood pressure. The PSNS, for example, slows down the heart rate and aids digestion. Symptoms typically arise from abnormal responses of either the sympathetic or parasympathetic systems based on situation or environment.<a class="footnote-ref" id="fnref:61" href="#fn:61"><sup>61</sup></a><a class="footnote-ref" id="fnref:62" href="#fn:62"><sup>62</sup></a><a class="footnote-ref" id="fnref:63" href="#fn:63"><sup>63</sup></a> </p> <h2 id="diagnosis">Diagnosis</h2> <p>Diagnosis of dysautonomia depends on the overall function of three autonomic functions—cardiovagal, adrenergic, and sudomotor. A diagnosis should at a minimum include measurements of <a href="/facts/Blood_pressure/VtqqSM2J">blood pressure</a> and <a href="/facts/Heart_rate/YngB0bzg">heart rate</a> while lying flat and after at least three minutes of standing. The best way to make a diagnosis includes a range of testing, notably an autonomic reflex screen, <a href="/facts/Tilt_table_test/5IdYlKeX">tilt table test</a>, and testing of the <a href="/facts/Sudomotor/hxlF88LB">sudomotor</a> response (<a href="/facts/Electrochemical_skin_conductance/fN8KzEMm">ESC</a>, QSART or thermoregulatory sweat test).<a class="footnote-ref" id="fnref:64" href="#fn:64"><sup>64</sup></a> </p><p>Additional tests and examinations to diagnose dysautonomia include: </p> <ul><li>Ambulatory blood pressure and EKG monitoring[<i>better source needed</i>]<a class="footnote-ref" id="fnref:65" href="#fn:65"><sup>65</sup></a></li> <li><a href="/facts/Cold_pressor_test/D0IBBgBS">Cold pressor test</a><a class="footnote-ref" id="fnref:66" href="#fn:66"><sup>66</sup></a></li> <li>Deep breathing<a class="footnote-ref" id="fnref:67" href="#fn:67"><sup>67</sup></a></li> <li>Electrochemical skin conductance</li> <li>Hyperventilation test<a class="footnote-ref" id="fnref:68" href="#fn:68"><sup>68</sup></a></li> <li><a href="/facts/Nerve_biopsy/RNG4G4vs">Nerve biopsy</a> for <a href="/facts/Small_fiber_peripheral_neuropathy/AVqKKprp">small fiber neuropathy</a><a class="footnote-ref" id="fnref:69" href="#fn:69"><sup>69</sup></a></li> <li>Quantitative <a href="/facts/Sudomotor/hxlF88LB">sudomotor</a> <a href="/facts/Axon/5DCd4wLo">axon</a> reflex test (QSART)<a class="footnote-ref" id="fnref:70" href="#fn:70"><sup>70</sup></a></li> <li>Testing for <a href="/facts/Orthostatic_intolerance/zA0L1a6b">orthostatic intolerance</a><a class="footnote-ref" id="fnref:71" href="#fn:71"><sup>71</sup></a></li> <li>Thermoregulatory sweat test<a class="footnote-ref" id="fnref:72" href="#fn:72"><sup>72</sup></a><a class="footnote-ref" id="fnref:73" href="#fn:73"><sup>73</sup></a></li> <li><a href="/facts/Tilt_table_test/5IdYlKeX">Tilt table test</a><a class="footnote-ref" id="fnref:74" href="#fn:74"><sup>74</sup></a></li> <li><a href="/facts/Valsalva_maneuver/hS2NN1GA">Valsalva maneuver</a><a class="footnote-ref" id="fnref:75" href="#fn:75"><sup>75</sup></a><a class="footnote-ref" id="fnref:76" href="#fn:76"><sup>76</sup></a></li></ul> <p>Tests to elucidate the cause of dysautonomia can include: </p> <ul><li>Evaluation for <a href="/facts/Acute_intermittent_porphyria/yqXjz2mu">acute (intermittent) porphyria</a><a class="footnote-ref" id="fnref:77" href="#fn:77"><sup>77</sup></a></li> <li>Evaluation of <a href="/facts/Cerebrospinal_fluid/tcWG7hhv">cerebrospinal fluid</a> by <a href="/facts/Lumbar_puncture/uKwxHqpd">lumbar puncture</a><a class="footnote-ref" id="fnref:78" href="#fn:78"><sup>78</sup></a> for infectious/ inflammatory diseases</li> <li>Evaluation of <a href="/facts/Nerve_conduction_velocity/zzu3pwmF">nerve conduction study</a> for autonomic neuropathy</li> <li>Evaluation of brain and spinal <a href="/facts/Magnetic_resonance_imaging/Vh9yG9qq">magnetic resonance imaging</a> for <a href="/facts/Myelopathy/MtyTxXTw">myelopathy</a>, <a href="/facts/Stroke/DwpjdzY0">stroke</a> and <a href="/facts/Multiple_system_atrophy/ndcFsMjn">multiple system atrophy</a></li> <li>Evaluation of <a href="/facts/Iobenguane/B4CBGCKg">MIBG myocardial scintigraphy</a> and <a href="/facts/DaT_scan/Gs99wubg">DaT scan</a> for <a href="/facts/Parkinson%2527s_disease/xpekKj6x">Parkinson's disease</a>, <a href="/facts/Dementia_with_Lewy_bodies/Sw6vTGkh">dementia with Lewy bodies</a> and <a href="/facts/Pure_autonomic_failure/RkEAhDCg">pure autonomic failure</a></li></ul> <h3>Vegetative-vascular dystonia</h3> <p>Particularly in the Russian literature,<a class="footnote-ref" id="fnref:79" href="#fn:79"><sup>79</sup></a> a subtype of dysautonomia that particularly affects the vascular system has been called vegetative-vascular dystonia.<a class="footnote-ref" id="fnref:80" href="#fn:80"><sup>80</sup></a> The term "vegetative" reflects an older name for the autonomic nervous system: the <a href="/facts/Vegetative_nervous_system/hdmEY1Ay">vegetative nervous system</a>. </p><p>A similar form of this disorder has been historically noticed in various wars, including the <a href="/facts/Crimean_War/v163wdr8">Crimean War</a> and <a href="/facts/American_Civil_War/A9FT3ksD">American Civil War</a>, and among British troops who <a href="/facts/Colonial_India/FzUNtytR">colonized India</a>. This disorder was called "irritable heart syndrome" (<a href="/facts/Da_Costa%2527s_syndrome/UnN58t5y">Da Costa's syndrome</a>) in 1871 by American physician <a href="/facts/Jacob_Mendes_Da_Costa/gakIx7dn">Jacob DaCosta</a>.<a class="footnote-ref" id="fnref:81" href="#fn:81"><sup>81</sup></a> </p> <h2 id="management">Management</h2> <p>Treatment of dysautonomia can be difficult; since it is made up of many different symptoms, a combination of drug therapies is often required to manage individual symptomatic complaints. In the case of autoimmune neuropathy, treatment with immunomodulatory therapies is done. If <a href="/facts/Diabetes_mellitus/2xeHXbsI">diabetes mellitus</a> is the cause, control of <a href="/facts/Blood_glucose/I4SkNzrm">blood glucose</a> is important.<a class="footnote-ref" id="fnref:82" href="#fn:82"><sup>82</sup></a> Treatment can include <a href="/facts/Proton-pump_inhibitor/JIpwabbk">proton-pump inhibitors</a> and <a href="/facts/H2_receptor_antagonists/Ra6UHBGy">H2 receptor antagonists</a> used for digestive symptoms such as <a href="/facts/Acid_reflux/8YhncnDz">acid reflux</a>.<a class="footnote-ref" id="fnref:83" href="#fn:83"><sup>83</sup></a> </p><p>To treat <a href="/facts/Genitourinary/u262MFXg">genitourinary</a> autonomic neuropathy, medications may include <a href="/facts/Sildenafil/2NHe0pwM">sildenafil</a> (a <a href="/facts/Guanine_monophosphate/ex8VI4dR">guanine monophosphate</a> type-5 phosphodiesterase inhibitor). To treat <a href="/facts/Hyperhidrosis/koG3nCEn">hyperhidrosis</a>, <a href="/facts/Anticholinergic/9mDjo23r">anticholinergic</a> agents such as <a href="/facts/Trihexyphenidyl/TyCb4DuQ">trihexyphenidyl</a> or <a href="/facts/Hyoscine_hydrobromide/Fy2S6Lgf">scopolamine</a> can be used. Intracutaneous injection of <a href="/facts/Botulinum_toxin/F2LTx09G">botulinum toxin</a> type A can also be used in some cases.<a class="footnote-ref" id="fnref:84" href="#fn:84"><sup>84</sup></a> </p><p><a href="/facts/Balloon_angioplasty/j2ausFmb">Balloon angioplasty</a>, a procedure called <a href="/facts/Transvascular_autonomic_modulation/37qBc1UN">transvascular autonomic modulation</a>, is specifically not approved in the United States to treat autonomic dysfunction.<a class="footnote-ref" id="fnref:85" href="#fn:85"><sup>85</sup></a> </p> <h2 id="prognosis">Prognosis</h2> <p>The prognosis of dysautonomia depends on several factors; people with chronic, progressive, generalized dysautonomia in the setting of central nervous system degeneration such as Parkinson's disease or multiple system atrophy generally have poorer long-term prognoses. Dysautonomia can be fatal due to <a href="/facts/Pneumonia/Jw0KquTA">pneumonia</a>, <a href="/facts/Acute_respiratory_failure/R3GcdkJ1">acute respiratory failure</a>, or sudden <a href="/facts/Cardiopulmonary_arrest/HIAm9AWX">cardiopulmonary arrest</a>.<a class="footnote-ref" id="fnref:86" href="#fn:86"><sup>86</sup></a> Autonomic dysfunction symptoms such as orthostatic hypotension, <a href="/facts/Gastroparesis/pMmzKa79">gastroparesis</a>, and <a href="/facts/Gustatory_hyperhidrosis/X84dkYm3">gustatory sweating</a> are more frequently identified in mortalities.<a class="footnote-ref" id="fnref:87" href="#fn:87"><sup>87</sup></a> </p> <h2 id="see-also">See also</h2> <ul> <li>Medicine portal</li></ul> <ul><li><a href="/facts/Autonomic_neuropathy/TmXMfA7W">Autonomic neuropathy</a></li> <li><a href="/facts/Dopamine_beta_hydroxylase_deficiency/tDLFXbpp">Dopamine beta hydroxylase deficiency</a></li> <li><a href="/facts/Familial_dysautonomia/wcPb5Dd1">Familial dysautonomia</a></li> <li><a href="/facts/Reflex_syncope/cn33I5ww">Reflex syncope</a></li> <li><a href="/facts/Postural_orthostatic_tachycardia_syndrome/Xndeukmn">Postural orthostatic tachycardia syndrome</a></li> <li><a href="/facts/Orthostatic_intolerance/zA0L1a6b">Orthostatic intolerance</a></li></ul> <h2 id="further-reading">Further reading</h2> <ul><li>Brading A (1999). <i>The autonomic nervous system and its effectors</i>. Oxford: Blackwell Science. <a href="/facts/ISBN_(identifier)/15AdSPa9">ISBN</a> 978-0-632-02624-1.</li> <li>Goldstein D (2016). <a href="https://neuroscience.nih.gov/publications/PrinciplesofAutonomicMedicine30.pdf"><i>Principles of Autonomic Medicine</i></a> (PDF) (free online version ed.). Bethesda, Maryland: National Institute of Neurological Disorders and Stroke, National Institutes of Health. <a href="/facts/ISBN_(identifier)/15AdSPa9">ISBN</a> 978-0-8247-0408-7.</li> <li>Jänig W (2008). <i>Integrative action of the autonomic nervous system : neurobiology of homeostasis</i> (Digitally printed version. ed.). Cambridge: Cambridge University Press. <a href="/facts/ISBN_(identifier)/15AdSPa9">ISBN</a> 978-0-521-06754-6.</li> <li>Lara A, Damasceno DD, Pires R, Gros R, Gomes ER, Gavioli M, Lima RF, Guimarães D, Lima P, Bueno CR, Vasconcelos A, Roman-Campos D, Menezes CA, Sirvente RA, Salemi VM, Mady C, Caron MG, Ferreira AJ, Brum PC, Resende RR, Cruz JS, Gomez MV, Prado VF, de Almeida AP, Prado MA, Guatimosim S (April 2010). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2838086">"Dysautonomia due to reduced cholinergic neurotransmission causes cardiac remodeling and heart failure"</a>. <i>Molecular and Cellular Biology</i>. 30 (7): 1746–56. <a href="/facts/Doi_(identifier)/muM9Etpq">doi</a>:<a href="https://doi.org/10.1128%2FMCB.00996-09">10.1128/MCB.00996-09</a>. <a href="/facts/PMC_(identifier)/dX1zMt71">PMC</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2838086">2838086</a>. <a href="/facts/PMID_(identifier)/JlHAvMHt">PMID</a> <a href="https://pubmed.ncbi.nlm.nih.gov/20123977">20123977</a>.</li> <li>Schiffer RB, Rao SM, Fogel BS (2003-01-01). <a href="https://books.google.com/books?id=I2N9COt-4C0C&q=Dysautonomia%2520%2520cause&pg=PA288"><i>Neuropsychiatry</i></a>. Lippincott Williams & Wilkins. <a href="/facts/ISBN_(identifier)/15AdSPa9">ISBN</a> 978-0-7817-2655-9.</li></ul> <h2 id="external-links">External links</h2> Wikimedia Commons has media related to Dysautonomia. <h2 id="references">References</h2> <ol> <li id="fn:1"><p>"Dysautonomia". NINDS. Archived from the original on 2016-12-02. Retrieved 2012-04-03. <a href="https://web.archive.org/web/20161202234006/http://www.ninds.nih.gov/disorders/dysautonomia/dysautonomia.htm" target="_blank">https://web.archive.org/web/20161202234006/http://www.ninds.nih.gov/disorders/dysautonomia/dysautonomia.htm</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>Palma JA, Kaufmann H (March 2018). "Treatment of autonomic dysfunction in Parkinson disease and other synucleinopathies". Mov Disord (Review). 33 (3): 372–90. doi:10.1002/mds.27344. PMC 5844369. PMID 29508455. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844369" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844369</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>Castori M, Voermans NC (October 2014). "Neurological manifestations of Ehlers-Danlos syndrome(s): A review". Iranian Journal of Neurology. 13 (4): 190–208. PMC 4300794. PMID 25632331. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4300794" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4300794</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></p></li> <li id="fn:4"><p>Imamura M, Mukaino A, Takamatsu K, Tsuboi H, Higuchi O, Nakamura H, Abe S, Ando Y, Matsuo H, Nakamura T, Sumida T, Kawakami A, Nakane S (February 2020). "Ganglionic Acetylcholine Receptor Antibodies and Autonomic Dysfunction in Autoimmune Rheumatic Diseases". Int J Mol Sci (Review). 21 (4): 1332. doi:10.3390/ijms21041332. PMC 7073227. 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