Dysautonomia explained: what it is, how it connects to Long COVID, and the full range of symptoms and treatments.
Dr. Groysman provides a comprehensive overview of dysautonomia and its role in Long COVID. He explains the two branches of the autonomic nervous system, walks through the full symptom list from orthostatic intolerance to cognitive dysfunction, and covers the medical conditions and infections that cause autonomic damage. He compares the symptom overlap between dysautonomia, POTS, chronic fatigue syndrome, and Long COVID, explains how to test for POTS vs. orthostatic hypotension, and discusses treatment options including medications, lifestyle modifications, stellate ganglion block, and vagus nerve stimulation.
What You'll Learn:
- What dysautonomia is: damage or inflammation to part or all of the autonomic nervous system
- How the sympathetic and parasympathetic nervous systems control opposite bodily functions
- The full symptom range: orthostatic intolerance, tachycardia, GI issues, temperature dysregulation, fatigue, sleep disorders, cognitive symptoms, urinary/sexual dysfunction, vision and hearing changes
- Medical conditions that cause dysautonomia: diabetes, chronic alcoholism, amyloidosis, lupus, Parkinson's, Ehlers-Danlos syndrome, low vitamin D
- Infections that damage the autonomic nervous system: HIV, herpes family viruses, Lyme, COVID-19
- The striking symptom overlap between dysautonomia, POTS, CFS/ME, and Long COVID
- How to test for POTS vs. orthostatic hypotension using tilt-table testing
- Heart rate variability, deep breathing test, sweat tests, Valsalva maneuver, and QSART
- Treatment options: hydration and salt, compression garments, beta blockers, ivabradine, midodrine, fludrocortisone, pyridostigmine, SGB, and vagus nerve stimulation
[00:00] Introduction: what is dysautonomia
[00:30] Definition: dysfunction of the autonomic nervous system, primary vs. secondary causes
[01:00] Forms of dysautonomia: POTS, vasovagal syncope, orthostatic hypotension
[01:30] The two branches: sympathetic vs. parasympathetic nervous system
[02:00] Parasympathetic functions: pupil constriction, salivation, digestion, bladder, heart rate
[02:30] Sympathetic functions: pupil dilation, airway dilation, glucose release, adrenaline
[03:15] Dysautonomia symptoms: orthostatic intolerance, tachycardia, hypotension
[04:00] GI symptoms, temperature regulation, fatigue and exercise intolerance
[04:45] Sleep disorders, cognitive and emotional symptoms, urinary and sexual dysfunction
[05:15] Vision and hearing changes: photophobia, tinnitus
[05:30] Conditions that cause dysautonomia: diabetes, alcoholism, amyloidosis, lupus, Parkinson's
[06:15] EDS, low vitamin D, and infections: HIV, herpes viruses, Lyme, COVID-19
[07:00] What is POTS: hallmark rapid heart rate, testing criteria
[07:30] CFS/ME: persistent fatigue lasting 6+ months, post-exertional malaise
[08:15] Symptom overlap across dysautonomia, POTS, CFS, and Long COVID
[09:00] Testing: tilt-table test for orthostatic hypotension (systolic drop 20+ mmHg or diastolic drop 10+ mmHg within 3 min)
[10:00] POTS criteria: 30+ bpm heart rate increase within 10 min of standing, no BP drop
[10:45] Additional tests: HRV, deep breathing, sweat tests, Valsalva, QSART
[11:30] No direct way to measure autonomic function: all tests are indirect
[12:00] Treatment: address the underlying cause first
[12:30] Hydration and salt intake (oral or IV), compression garments
[13:00] Medications: beta blockers, calcium channel blockers, ivabradine
[13:45] Midodrine, fludrocortisone, pyridostigmine
[14:15] Dietary triggers, physical therapy, exercise
[14:30] Stellate ganglion block and vagus nerve stimulation
[15:00] Closing remarks
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Medical Disclaimer: This podcast is for educational purposes only and does not constitute medical advice. The views expressed are Dr. Groysman's clinical opinions based on available evidence. Always consult with your healthcare provider before making changes to your treatment plan.
