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S Blitshteyn MD, FAAN, Dysautonomia Clinic Profile picture
@dysclinic
Feb 9, 2023 • 5 tweets • 3 min read • Read on X
On biomarkers: Patients with #Dysautonomia have preload failure. Invasive caridopulmonary testing or cardiac catheterization proves it. I just had a patient with post-Covid #POTS who had the tests done to rule out heart disease. She had no CAD, but did have preload failure. 1/🧵
Her excellent cardiologist @FudimMarat identified the problem and correctly diagnosed it. His findings were consistent with Dr. Systrom's study on preload failure. 2/🧵
onlinelibrary.wiley.com/doi/10.1086/68…
This patient was fortunate: she wasn't dismissed because her 2D cardiac echo & 24-hr Holter monitor were negative. Many patients with #Dysautonomia and #LongCovid are simply discounted as anxious or deconditioned when their routine cardiac & neurologic tests are unrevealing. 3/🧵
Physicians who are quick to label patients with #LongCovid, #Dysautonoima and #MECFS as "functional" or "medically unexplained" commonly employ these reasons: "routine tests are all normal" and "there is no biomarker." Clearly, they are wrong. 4/🧵
Invasive cardiac tests are far from ideal to confirm physiologic abnormalities but they are objective & reliable to serve as a model for simpler, non-invasive & cheaper tests that need to be developed for clinical use. #LongCoivd is not deconditioning! 5/5
onlinelibrary.wiley.com/doi/10.1086/68…

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More from @dysclinic

S Blitshteyn MD, FAAN, Dysautonomia Clinic Profile picture
Dec 31, 2023
🎉Happy New Year! Back by popular demand, here is my top 10 list of noteworthy #POTS studies of 2023! 🎉✍️

1/🧵

#NeuroTwitter #MedTwitter #MedEd
In no particular order:

1⃣ "Postural tachycardia was significantly less in the active arm compared with the sham arm at 2 months. Antiadrenergic autoantibodies & inflammatory cytokines were lower in the active arm compared with the sham arm at 2 month."
sciencedirect.com/science/articl…
2⃣ "Pelvic pain, interstitial cystitis, and dysautonomia were frequently found with chronic pelvic pain of venous origin and improved after venous treatment. EDS/HSD and IBS were common in these women."

journals.sagepub.com/doi/10.1177/02…
Read 11 tweets
S Blitshteyn MD, FAAN, Dysautonomia Clinic Profile picture
Sep 13, 2023
Here we go: a great teaching case from a patient I just saw a minute ago. 1/🧵

🧠 60-yo woman with diabetes type 2
🧠 complaints of chronic dizziness and lightheadedness for a year
👇 screenshot from a note by her local neurologist

#tweetorial #MedEd #NeuroTwitter #MedTwitter Image
✅ Pt denies vertigo and headache
✅ Pt denies falls or stumbling
✅ Pt denies tachycardia, chest pain or fluctuating BP
👉 Pt does have numbness in the feet, worse over the past few years
👉 Pt does walk less now, fearful of not being able to return home from a walk

2/🧵
‼️ On further questioning, patient does admit that she doesn't notice dizziness when she is supine, only when she is sitting or walking - 🎯 This is the key factor in considering autonomic dysfunction as the cause of chronic #dizziness in this patient

3/🧵
Read 6 tweets
S Blitshteyn MD, FAAN, Dysautonomia Clinic Profile picture
Jun 27, 2023
Reading the articles in the mainstream media on #LongCovid and mental health got me thinking: when did mental health become the basis of a disease process? Mental health is important in health and disease, but is not a substitution for scientific advancement. 1/n
We have zero FDA-approved treatment for #LongCovid. Nothing has been developed, everything is used off label. Talking about CBT and exercise for Long Covid is like talking about CBT and exercise for treatment of post-Covid diabetes before insulin was invented.
2/n
An overzealous group of physicians eager to jump on the "psychological" train and offer a biased opinion, often with little scientific evidence, & an equally overzealous group of journalists eager to make a name for themselves: a recipe for false narrative and zero facts. 🙄
3/n
Read 7 tweets
S Blitshteyn MD, FAAN, Dysautonomia Clinic Profile picture
Jun 13, 2023
Saw a patient for a 2nd opinion on "weakness" and rule out #myasthenia. Lots of medical records from different specialists that I had to review prior to her appointment.
1/🧵

#NeuroTwitter
Patient had a mediastinal mass found on CT, initially thought to be lymphoma, then fortunately, diagnosed as residual thymus tissue. Acetylcholine receptor antibodies and EMG were unremarkable. She did not have any bulbar weakness, only subjective arm and leg weakness.

2/🧵
While she was telling me about 9 surgeries that she's had in the past, most of which for joint problems, she was playing with her fingers by doing this:

3/🧵 Image
Read 6 tweets
S Blitshteyn MD, FAAN, Dysautonomia Clinic Profile picture
Jun 1, 2023
Participated in a very interesting multidisciplinary POTS conference at @HopkinsMedicine on the topic of #FND, #syncope and #POTS where we discussed and debated the numerous issues surrounding FND diagnosis in our patient population. 1/🧵
#MedTwitter #NeuroTwitter
@HopkinsMedicine After conference, saw a patient who highlighted the issues discussed at conference.
👩‍🦽30 yo woman with POTS/MCAS/EDS triad with one TTT positive for POTS, but a 2nd TTT negative
❌ A neurologist diagnosed her with FND
💉 She is on allergy shots & many H1/H2 blockers.
2/🧵
@HopkinsMedicine 🚫 Neurologist didn't take into consideration neurologic and psychiatric manifestations of SYSTEMIC DISEASE (MCAS)
❌ This is not FND because there is underlying systemic disorder driving symptoms and signs.
🧠 Patient needs to be treated for the SYSTEMIC DISORDER first.
3/🧵
Read 6 tweets
S Blitshteyn MD, FAAN, Dysautonomia Clinic Profile picture
Mar 8, 2023
This is a highly relevant study from Japan on #Dysautonomia, #gAchR antibodies and #FND!

I'll explain why it's important and what it means in clinical terms. 1/🧵

#MedTwitter #NeuroTwitter @Dysautonomia

frontiersin.org/articles/10.33…
@Dysautonomia What the study found:
✅ Out of 59 patients who qualified for #FND diagnosis by DSMV criteria, 88% had autonomic symptoms!!!
✅ 27% were positive for ganglionic acetylcholine receptor antibody (gAchR Ab) via LIPS assay.
✅ 50% had #POTS.
✅ 50% had orthostatic hypotension.
2/🧵
@Dysautonomia Why is this important?
✅ Our patients are often misdiagnosed with #FND, and this study proves that.
✅ When #FND is diagnosed, treatment is psychotherapy & physical therapy, which is not a treatment for #Dysautonomia.
✅ We MUST identify and treat #Dysautonomia symptoms.
3/🧵
Read 4 tweets

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