[Nnwom] aseda hi aseda sɛ mobɛka dysautonomia International webinar a ɛfa nnianim asɛm a ɛfa koma ne ntini mu nipadua ho no ho yɛn ani agye ankasa sɛ yɛn afie mu abenfo no mu biako Dr Amanda Miller Dr Miller yɛ PhD wɔ neuroscience mu na ɔyɛ postdoctoral fellow wɔ Penn State College of Medicine a bere nyinaa me nya mfomso social correct me sɛ me run no wrong um nanso uh ɔyɛ ɔkannifo ankasa wɔ nkuku nhwehwɛmu mu na uh yɛn ani agye ankasa sɛ yɛwɔ no wɔ ha ɔyɛ De Santa no International ɔyarefo no mu
ni a ɔyɛ nnam yiye Advisory Board na ɛno akyi no mɛdan no ama Dr Miller hi Lauren uh aseda wɔ nnianim asɛm no ho na meda mo nyinaa ase sɛ mobɛka yɛn ho nnɛ I’m gonna give um a really basic course today on cardiovascular physiology na makyerɛkyerɛ nea peop nea misusuw mu nnipa a wɔwɔ pot no ɛsɛ sɛ wohu uh first disclosures Me nni Financial conflicts of interest biara a basically kyerɛ sɛ obiara mma me sika sɛ mɛka nneɛma nnɛ nanso sɛ wopɛ sɛ woma me sika a mɛgye atom sɛ mewɔ a kakra grant from th
e NIH the National Institute of Health to study um aging na ɛnyɛ nea ɛfa dysautonomia ho ankasa na ɛno nnya nea mɛka ho asɛm no so nkɛntɛnso uh botae ahorow a ɛwɔ hɔ ma nnɛ ne sɛ mɛpɛ sɛ obiara te nsakrae ahorow a ɛba no ase wɔ dysautonomia mu na sɛnea ɛbɛyɛ yiye no mɛpɛ sɛ wusua ayaresa bi a wofa anaa ebia ayaresa bi a wopɛ sɛ wosɔ hwɛ ma wo dysautonomia na wote sɛnea ɛno ka koma ne ntini nhyehyɛe no ase enti nea edi kan no mɛka nipadua mu nneɛma ho asɛm na makɔ so controls blood pressure heart
rate brain blood flow and different vascular changes that occur in dysautonomia nso ka nsuo kari pɛ ne nea enti a yɛhia nkyene ne nsuo pii afei ɔfa a ɛtɔ so mmienu wɔ saa nkyerɛkyerɛmu yi mu no mɛka pharmacology ho asɛm titiriw ɛno ne ɔfa a rekɔkasa sɛ yɛbɛkɔ sɛnea nnuru ahorow pii a wɔde di dwuma ma dysautonomia yɛ adwuma ne nea uh te sɛ molecular targets a ɛka enti ebia woakyerɛw wo din wɔ adesua yi mu na uh ebia wunnim nea cardiovascular physiology wɔ mu very basic terms ɛyɛ abɔdeɛ ho adesua
a ɛyɛ deɛ uh physis yɛ wɔ Hela kasa mu uh mogya ntini ne koma no ɛno na yɛrebɛsua no afã mmienu na ɛwɔ mogya mmoroso um mogya mmorosoɔ wɔ diastole berɛ mu ne berɛ a koma no relaxes na ɛhyɛ mogya ma na uh wɔ Sicily koma no twetwe na pumps mogya fi nipadua no mu diastole yɛ ase nɔma bere a wofa mogya mmoroso kyerɛwtohɔ na systole yɛ soro nɔma na eyi ne nea ɛrekɔ so ara kwa bere a wo uh inflate sɛ cuff shall kyerɛkyerɛ mu seesei ɔkwan titiriw a yɛfa so susuw mogya mmoroso wɔ nnipa mu ne sɛ yɛbɛma
cuff a ɛwɔ abasa no so ayɛ eyi nso wɔ nan no so nanso mpɛn pii no wɔyɛ no wɔ abasa no so wo mframa no ma ɛyɛ suprastystolic pressure enti nhyɛso a ɛkorɔn sen wo systolic pressure na afei wotwɛn um wo twɛn sɛ wobɛte nnyigyei bi a ɛbɛyɛ ntini no bue na sɛ ɛyɛ bere a edi kan te saa nnyigyei no a ɛyɛ systole sɛnea ɛbɛyɛ a wubetumi de stethoscope atie saa bere a woabɔ cuff no mu na afei woakɔ fam nhyɛso no anaasɛ wubetumi anya automated mogya mmoroso cuff a ɛbɛ um ha a ɛbɛkyere saa dede ahorow yi na
ama wo automatic akenkan kɛkɛ sɛnea ɛbɛyɛ a aduruyɛ ho nimdefo anaa ɔyarehwɛfo betumi afa mogya mmoroso no saa kwan yi so anaasɛ automatic an automated cuff betumi ayɛ wɔde di dwuma wɔ aduruyɛ adwumayɛbea anaa fie ne saa akwan no uh wo nya mogya mmoroso kyerɛwtohɔ biako nanso mogya mmoroso nyɛ biribi a ɛtra hɔ pintinn bere kɔ so no ɛntra hɔ pintinn bere tenten anaa bere tiaa bi mpo ankasa mogya mmoroso sesa bere biara a koma bɔ no yebetumi asusuw eyi wɔ nhwehwɛmu um akwan horow kakraa bi so ɛtɔ
mmere bi a wɔde ntini mu nhama bi hyɛ mu na eyi ne bere a wɔde catheter ketewaa bi a ɛte sɛ IV catheter hyɛ ntini bi mu mpɛn pii no um radial artery a ɛwɔ abasa no mu uh wɔtaa yɛ eyi wɔ ICU de hwɛ ayarefo mogya mmoroso so daa ɛyɛ invasive paa enti yɛmfa eyi nni dwuma wɔ nhwehwɛmu mu pii kan no na wɔde di dwuma mpɛn pii nanso seesei mogya mmoroso mfiri pii wɔ hɔ a ɛkyerɛ mogya a ɛkɔ to nsateaa no so na ebetumi anya pulse pressure beat to beat sɛnea ɛbɛyɛ a wubetumi ahu saa asorɔkye kwan yi a anka
wubenya ne arterial line a ɛyɛ mogya mmoroso a ɛkɔ so kyerɛwtohɔ sɛnea ɛbɛyɛ a wubetumi ahu systole wɔ soro ne diastole wɔ ase na woanya saa asorɔkye a ɛkɔ so yi wɔ koma bɔ biara a wɔakyerɛ wɔ EKG no so wɔ soro saa nsateaa mogya mmoroso cuff mfiri yi bo yɛ den yiye ɛnyɛ Wireless mprempren nanso nnwumakuw pii reba ne mfiri a wɔhyɛ na eyi betumi ayɛ ɔkwan a yebetumi afa so ahwɛ um nnipa a wɔwɔ dysautonomia wɔ fie ama wɔn ankasa um kɔ akyiri enti wobɛtumi ahwɛ w'ankasa wo mogya mmoroso anaasɛ nso
sɛ wo ne nhwehwɛmu ne ne nnuruyɛfoɔ bɛyɛ adwuma abom nanso saa mfiri no da so ara reyɛ nokware na uh mprempren deɛ ɛwɔ hɔ a ɛsusu koma bɔ yie yie enti dɛn ne mogya mmorosoɔ a ɛyɛ daa saa chart yi firi American Heart Association wɔde saa anohyeto yi nyinaa sii hɔ maa mogya mmoroso wɔsesaa ankasa bɛyɛ mfe asia a atwam ni no na ɛyɛ ɔkwan bi so bere a mifii ase me postdoctoral fellow mprempren wofi ase sa mogya mmoroso ntɛm wɔ bɛyɛ 130 um systolic ne 8 anaa 80 diastolic na ɛno kan no be the pre-hype
rtensive range um nanso wubetumi ahu sɛ zone biara nni hɔ ma hypotension a ɛyɛ nea ayarefo pii a wɔwɔ dysautonomia di ho dwuma titiriw bere a wɔte hɔ um enti wobu biribiara a ennu 120 boro 80 kɛkɛ sɛ ɛyɛ nea ɛfata nanso Amerikani no Heart Association ani nnye autonomic dysfunction ho ankasa wɔn na wɔn ani gye mogya mmoroso ne koma ne ntini mu yare ho kɛse enti nnipa a wɔwɔ dysautonomia te sɛ nea mekae sɛ nkyerɛase pa biara nni hɔ a ɛfa mogya mmoroso a ɛba fam ho mpɛn pii no nkurɔfo ka sɛ ɛyɛ uh
90 over 60. Nanso hypotension yɛ nea ɛkyerɛ ankasa denam sɛnkyerɛnne ahorow a wubetumi ahu sɛ wɔde ahyɛ saa nhyehyɛe a ɛtaa ba a ɛkyerɛ mogya mmoroso ho sɛnkyerɛnne a ɛtaa ba yi mu no, ebia ɛbɛyɛ te sɛ nea wunim saa sɛnkyerɛnne ahorow yi yiye sɛ wowɔ dysautonomia uh a, ɛyɛ fɛ a ɛtaa ba sɛ ebia wowɔ mogya mmoroso anaasɛ ɛnte saa uh mogya mmoroso a ɛba fam is not really well defined in the research and scientific community and medical community next Mepɛ sɛ meka biribi a wɔfrɛ no pulse pressure ho
asɛm titiriw titiriw eyi yɛ systolic blood pressure minus diastolic blood pressure enti normal pulse pressure bɛyɛ bɛyɛ 40 sɛ wo ne adesua nhoma no kɔ a normal blood pressure of 120 over 80. uh biribiara a ɛboro 50 no wɔkyerɛ sɛ ɛkyerɛ komayare enti sɛ wowɔ wide a wɔfrɛ no wide pulse pressure nanso ɛte sɛ pressure a ɛkɔ soro ankasa eyi yɛ ade bɔne na wɔkyerɛ sɛ pulse pressure sɛ ɛbɛyɛ indicative of the stiffness or compliance of the arteries so sɛnea artery no tumi trɛw um no, wɔde pulse pressu
re na ebu akontaa enti sɛ artery no stiff a pulse waves no bɛsan aba ntɛmntɛm yiye a ɛbɛba sɛ systolic pressure a ɛkorɔn na a high pulse pressure and lower diastolic pressure um nanso sɛ ntini no yɛ elastic kɛse a ɛnde wobɛhwɛ sɛ ntini no bɛtrɛw kɛse there’s a lower systolic pressure efisɛ ɛwɔ less resistance to the flow and a higher diastolic flow efisɛ ntini no gye bere tenten to close um so for pots nkurɔfo taa nya pulse pressure a ɛba fam enti uh wubetumi ahu sɛ Mr perfect mogya mmoroso bɛyɛ
bɛyɛ 120 over 80. ɛte sɛ textbook normal obi a ɔwɔ hypertension betumi anya pulse pressure 140 over 90. the recent uh nnansa yi ara wɔpaw no sɛ senator wɔ Pennsylvania na wɔkasa tiaa no bere nyinaa efisɛ na ɔwɔ stroke na nkurɔfo dii aseresɛm sɛ ne mogya mmoroso nam ɔdan atifi ebia ɛnyɛ yennim ankasa nanso obi a ɔrebɛnya stroke no benya um malignant hypertension ɛno betumi ayɛ 190 wɔ 120 so na wɔn pulse pressure bɛyɛ kɛse koraa efisɛ nsonsonoe a ɛte saa wɔ saa dodow no ntam enti ɛnonom kyerɛ ank
asa sɛ wowɔ ntini a ɛyɛ den efisɛ nsonsonoe a ɛte saa wɔ systolic ne diastolic flow no mu nanso obi a ɔwɔ nkuku um a average mogya pressure could be 90 over 60. enti ɛyɛ ebetumi ayɛ wɔ line of hypotension nanso um sɛnea mekae sɛ ɛno yɛ ill-defined nanso wubetumi ahyɛ no nsow sɛ pulse pressure no sua there’s a there’s a less difference usually in people with dysautonomia between the systolic ne diastolic pressure na eyi betumi abata ntini no a ɛyɛ elastic kɛse ne sɛ ebia ɛno ye anaasɛ enye um no
nsi gyinae ankasa enti adesua nhoma bɛka sɛ wopɛ sɛ ntini no yɛ elastic kɛse wonyɛ den sɛ wubenya stroke wonyɛ den sɛ wubenya hypertension nanso sɛ ebia eyi boa ma wodi mogya mmoroso so wɔ ɔkwan a ɛnteɛ so um no mu nna hɔ nanso ebetumi aba enti nea ɛkyerɛ nea wo mogya mmoroso yɛ classic formula ne sɛ mogya mmoroso a wɔsusuw sɛ nhyɛso wɔ milimita mu Mercury yɛ aba a efi rate a mogya no resen a wɔabɔ ho ban denam resistance to the flow so ma rate a wo mogya no sen no yɛ a wo koma bɔ ne wo mogya do
dow na ɛkyerɛ enti dodow dodow a ɛwɔ saa ntini no mu ankasa na afei nea ɛko tia nsu a ɛsen no yɛ nneɛma te sɛ mogya ntini no beae sɛnea ɛsõ anaa ketewaa um um mogya ntini no nwene enti te sɛ sɛ ɛwɔ plaque anaa te sɛ akwanside bi wɔ Wo Ntini mu a ɛbɛko atia nsuo a ɛsen no na afei nso mogya no mu duru enti nsuo a ɛyɛ den bɛfa ntini bi mu brɛoo versus nsuo a ɛyɛ tratraa ankasa te sɛ nsuo bɛkɔ ntɛmntɛm ankasa um nanso ɛte saa nokwarem no ɛyɛ den sɛ wobɛsesa mogya viscosity eyi nkutoo sesa wɔ um te s
ɛ komayare a emu yɛ den yiye na texture a mogya ntini no yɛ kɛse asɛm wɔ vascular yare nanso stretchiness betumi asesa nhyɛso no nso ne resistance okay yeah enti menyɛ kɔ kɔbɔ wɔn ho nkɔmmɔ kɔ akyiri okay enti nea ɛba mogya mmoroso wɔ nkuku mu enti wɔ nkuku mu no yenya nkɔanim wɔ koma bɔ mu a ɛno ne nkyerɛase ankasa wɔ nkuku mu um na afei mogya dodow nyinaa wo mogya dodow nyinaa ne mogya dodow a ɛkɔ no koma ne mfinimfini akwaa no so tew efisɛ wunya mogya pii a ɛboaboa ano wɔ gut vasculature ne n
an no mu um wo hɔ nso mogya ntini a ɛtrɛw efisɛ wontumi nkɔ vasoconstrict yiye um enti wunya resistance kakraa bi wɔ flow no ho nanso esiane sɛ saa nneɛma yi yɛ ɔkwan bi so nti balance out efisɛ mogya dodow a ɛba fam ne The Wider vessels um wo mogya no mogya mmoroso ne nkuku betumi ayɛ ketewaa betumi ayɛ kɛse kakra nanso ɛtaa yɛ fɛ yiye na sɛ wokɔ oduruyɛfo nkyɛn a wɔbɛka sɛ wo mogya mmoroso yɛ eye ɛwom mpo sɛ wonhu nsakrae a ɛhyɛ ase a ɛrekɔ so nyinaa a ɛbɛma saa nhyɛso no ayɛ nea ɛfata um wɔ d
ysautonomia ahorow afoforo a syncope anaa hypotension ka ho um nsakrae titiriw no ne sɛ mogya mmoroso kɔ fam na eyi te saa efisɛ koma bɔ ɛnkɔ soro ɛtɔ da bi a ɛkɔ fam ɛno na ɛba wɔ faint anaa syncope event mu sɛ wo koma bɔ kɔ fam na ɛno nti na wuntumi nkura um mogya a ɛkɔ koma ne amemene no mu na wo nipadua no hwe ase kɛkɛ um enti nanso ɛte sɛ nkuku a ɛwɔ hɔ no mogya dodow a ɛba fam ne mogya ntini a ɛtrɛw na uh sɛ wokɔ oduruyɛfo te sɛ Dr Yaz a ɔyɛ kɛse sɛ obi hwɛ no wɔ Tick Tock so a uh ɔyɛ fɛw
kɛkɛ a ɔyɛ koma ho ɔyaresafo a uh pokes fun at Medical gas lighting na ɔte sɛ ebia wuhia sɛ wobɛdi nkyene kakra na ɛno ne classically deɛ wɔbɛka sɛ wowɔ mogya mmorosoɔ a ɛba fam a ɛwom mpo sɛ saa koma ne ntini mu nsakraeɛ a ɛwɔ aseɛ yi nyinaa wɔ hɔ a oduruyɛfoɔ ntumi nhunu yie enti seesei yɛbɛka koma bɔ um so normal heart ho asɛm rate yɛ defined sɛ 60 to 100 biribiara a ɛboro saa ma ahomegye koma rate eyi te sɛ tra anaa da fam uh anka wobebu no sɛ tachycardia nanso wɔn a wɔwɔ nkuku uh 120 nokwar
em no ɛnyɛ te sɛ nea ɛkorɔn saa ma wo ebia okay oh ne biribiara a ennu 60 yɛ nea wobu no sɛ bradycardia nanso nokwarem no ebetumi aba sɛ wo koma bɔ betumi ayɛ nea ɛfata titiriw ahomegye mpo wɔ saa range no mu okay enti nea ɛyɛ koma bɔ koma bɔ no wɔkyerɛkyerɛ mu denam um so enti kan no ɛyɛ rate a wɔsusuw beats per minute enti ɛyɛ dodow a ɛyɛ ankasa te sɛ koma no ntɛmntɛm a ɛbɔ um na wɔkyerɛkyerɛ mu denam koma no mu nsu a ɛba a wɔakyekyɛ mu denam akisikuru dodow ne koma a ɛba no yɛ mogya dodow a k
oma no bɔ simma biara na sɛ wɔkyekyem pɛpɛɛpɛ a, eyi yɛ bɛyɛ lita anum simma biako mu akisikuru dodow ne mogya dodow a wo koma yi koma bɔ biara enti bere biara a koma no bɛbɔ no um soma mogya bɛyɛ mililita 70 fi koma no mu kɔ akwaa ahorow no mu um enti sɛ woyɛ eyi sɛnea ɛte sɛ akontaabu nsɛso uh lita anum yɛ mililita mpem anum saa nsakrae no um na sɛ wokyekyɛ saa mu 70 millilitres simma biara a wunya bɛyɛ 71 koma bɔ simma biara enti saa na saa equation yi yɛ adwuma ma obiara any math fans out he
re okay enti nneɛma a ɛsakra koma bɔ no yɛkaa ho asɛm uh cardiac output ne stroke volume ɛyɛ nokwarem no ɛyɛ den sɛ wobɛsesa cardiac output nanso wubetumi asesa stroke volume a ɛyɛ mogya dodow um a koma no ejects biara beat na eyi gyina sɛnea eye of a pump wo koma yɛ enti koma no hia sɛ ɛtrɛw yiye na ahyɛ pii ma mogya na afei piapia denneennen de yi mogya no fi mu yiye um enti koma no yɛ ntini na ɛhyɛ ntini no den ɛno nti na woyɛ koma ne ntini mu apɔw-mu-teɛteɛ de teɛteɛ koma ntini no wɔ eyi mu
sɛ koma bɔ ntamgyinafo a um gonna ankasa bɛma koma no ayɛ adwuma saa deep breath yɛrebɛka apɔmuden ho asɛm kakra wɔ nkukuo mu um nhwehwɛmu no puei wɔ bɛyɛ afe 2011 mu Mesusu sɛ uh kaa sɛ uh wɔhunuu sɛ Koma sua wɔ nnipa a wɔwɔ nkukuo mu sɛ wɔde toto nnipa a wɔwɔ apɔmuden ho na ɛno akyi no ayarefoɔ faa apɔmuden bi mu program wɔn koma nyin na wonni nkuku bio ɛno ne nea saa asɛm yi kae na wɔfrɛɛ nkuku Grinch syndrome efisɛ wɔ sini no mu no ne koma yɛ abien sizes sua dodo na nhoma no mu no wunim odur
uyɛfo no enti uh yɛn nkuku no yɛ wo grinch um ebia minnim gyina wo suban so I guess nanso caveats bi wɔ eyi ho uh enti ebia wo koma bɛyɛ ketewa dodo a nokwarem no ɛyɛ nhwehwɛmu a wɔasan ayɛ a ɛkyerɛ sɛ nnipa a wɔwɔ nkuku taa nya Koma nketewa mmea wɔ ɔkwan a ɛkɔ akyiri so no wɔ Koma nketewa nso sɛ wɔde toto mmarima ho a ɛnkyerɛ sɛ mekyerɛ sɛ koma no yɛ pɔmpɛ ɛndɔ enni te sɛ ɛnsɛ sɛ ɛwɔ negative connotation a ɛwɔ sɛ wowɔ koma ketewa a ɛyɛ bɔne ankasa sɛ wubenya koma kɛse dodo um enti nso apɔw-mu-t
eɛteɛ rensa wo yare ɛnyɛ sɛ ɛbɛsa nkuku Mekyerɛ sɛ nnipa a wɔwɔ adesua no mu no nyaa tachycardia mmuae kakraa bi akyi a wobetumi ayɛ apɔw-mu-teɛteɛ nhyehyɛe no nanso wɔansusuw sɛnkyerɛnne ahorow ankasa wɔ nhwehwɛmu no mu um enti ɔkwan a koma ne ntini mu apɔw-mu-teɛteɛ no fa so adwuma ne hyɛ wo koma den sɛ ɛbɛyɛ pɔmpɛ a etu mpɔn kɛse a ebetumi aboa wo sɛnkyerɛnne bere tenten nanso ɛnyɛ adwuma mma obiara te sɛ ayaresa biara a nnipa binom bua nnipa binom nyɛ na ebetumi aba pii a side effects extras
size betumi ayɛ wo te nka sɛ ɛyɛ hu ɛnyɛ nkonyaayi aduru okay yɛrenka apɔw-mu-teɛteɛ ho asɛm bio ma yɛnkɔ autonomic nervous system a migye di sɛ obiara a ɔwɔ ha ate um ho asɛm efisɛ ɛhwɛ biribiara a wunsusuw ho ankasa fi wo home so kosi wo koma bɔ kɔ wo digestion um ne bɔne mpo nna mu dwumadi a misusuw sɛ woyɛ susuw ɛtɔ mmere bi a um enti koma no yɛ regulated denam sympathetic ne parasympathetic nervous system no nyinaa so enti ɛno ne wimhyɛn a ɛko no na nkae no na digest um sympathetic nervous
system no kɔ soro koma bɔ ne stroke volume mogya dodow a koma no Jacks na afei parasympathetic nervous system no hwɛ koma bɔ so nso denam no a ɛba fam so um mogya ntini no pɔtee no nkutoo na ɛhwɛ so denam sympathetic nervous system uh nuclei a ɛwɔ amemene no mu stem uh project to the spinal cord biribi a wɔfrɛ no intramural lateral cell column sɛ w’ani gye ho pɔtee na enti ɛnonom ne pre-ganglionic sympathetic nerves na afei postganglionic sympathetic nerves project to the blood vessels I’m gonn
a go a little bit more in depth on this so mfonini okay enti sɛ wopɛ sɛ wuhu pɔtee nuclei a ɛwɔ medulla a ɛyɛ amemene no stem no fã no dorsal motor Vegas ne nucleus accumbens project denam cranial nerve 10 a wɔsan frɛ no vagus nerve um so kɔ koma no so denam cholinergic receptors so a eyi ne vagus Branch Ɛyɛ adwuma denam cholinergic nhyehyɛe um na ɛma koma bɔ brɛoo na afei ɛwɔ feedback nhyehyɛe bi a ɛfa nkate ntini ahorow ho denam vagus ne glossopharyngeal ntini a synapse wɔ no dose ganglia no s
o san kɔ nucleus a ɛwɔ tractosolitarius no mu eyi fi reviewer bi a mekyerɛwee a couple years ago wɔ renan Angiotensin system ne autonomic nervous system so okay ɛhɔ na yɛkɔ okay enti seesei mɛka sympathetic projections bi a efi amemene no mu ho asɛm um ɛwɔ hɔ a rostral ventral lateral medulla a projects uh wɔ sympathetic preganglionic neurons na afei uh nam sympathetic chain ganglia a ɛwɔ spinal cord no so um projects kɔ koma no so na synapses wɔ beta 1 adrenergic receptors so kɔ koma no bɔ so n
kɛntɛnso na eyinom yɛ norepinephrine um secreting neurons afei ɛhɔ yɛ nso projections to tẽẽ kɔ mogya ntini a ɛno nso yɛ norepinephrine releasing neurons um a synapse onto alpha-1 adrenergic receptors to induce vasoconstriction na afei uh wɔyɛ nso beta biako adrenergic receptors wɔ asaabo a ɛkanyan renin release na mɛka ho asɛm sɛ more in depth a little later okay now I’m going to discuss some vascular changes that happens in dysautonomia um enti mpo wɔ nnipa a wɔwɔ apɔwmuden mu no ɛwɔ redistrib
ution of blood volume a ɛba bere a wosakra fi supine anaa da fam kɔ gyinabea mu no wunya drop wɔ mogya a ɛkɔ amemene no mu a ɛnyɛ drastic ankasa wɔ nnipa a wɔwɔ apɔwmuden mu um nanso wɔ nnipa dysautonomia mu no eyi betumi ayɛ kɛse koraa mogya mmoroso so tew bere tiaa bi anyɛ yiye koraa no um mogya pii wɔ hɔ a ɛboaboa ano wɔ wɔ nan no mu ne saa ara nso na wɔ awotwaa a ɛwɔ fam no mu um mogya a ɛsan kɔ koma no mu no sua na koma no mu nsu a ɛba no so tew efisɛ mogya a koma no de rebɔ no sua enti s
ɛnea mekae no, sympathetic nervous system no di mogya ntini ahorow so denam saa sympathetic neurons yi a synapse wɔ um no so Mekɔɔ Alpha One adrenergic receptors na ɛwɔ hɔ nso beta adrenergic receptors wɔ mogya ntini no so titiriw beta 2 receptors wɔyɛ soronko wɔ nea ɛwɔ koma no mu no ho um na mɛka ho asɛm pii akyiri yi nso epinephrine ne um neurotransmitter titiriw a ɛkyekyere beta receptors ne norepinephrine binds more to the alpha receptors so uh eyinom alpha-1 adrenergic receptor no yɛ adwum
a denam norepinephrine a wɔayi afi sympathetic nerves no mu te sɛ nea mekyerɛe denam um so sɛ project fi amemene no ntini no mu fa akyi berɛmo no mu kɔ fam kɔ saa receptors yi so na saa ntini yi yɛ nokwarem no nhama nketewa a ɛyɛ mmerɛw yiye sɛ ɛbɛsɛe alpha adrenergic receptor activation no so tew wɔ nnipa a wɔwɔ nkuku mu wɔ ɔkwan a ɛkɔ akyiri so na afei beta adrenergic receptors no yɛ adwuma denam epinephrine anaa adrenaline a ɛredi akɔneaba wɔ mogya mu um na nnipa a wɔwɔ nkuku no wɔ eyi pii
na uh eyi ne botae ma non-selective beta blockers a mɛka ho asɛm nso akyiri yi enti saa adwinnade yi yɛ nokwarem no ma ɛboro so wɔ nnipa a wɔwɔ nkuku mu efisɛ yɛtaa nya catecholamines a ɛkɔ soro a ɛkyinkyini sen nnipa a wɔwɔ apɔwmuden enti uh Nhwehwɛmu pii ada no adi mprempren sɛ Auto wɔ hɔ antibodies to these adrenergic receptors specifically to the alpha one in this study which was the largest one I think by Dr Grubbs group yeah um nanso nhwehwɛmu foforo bi wɔ hɔ um a Dr kem kuw no yɛe a na ɛy
ɛ kuw a edi kan a wohuu saa abusuabɔ yi ne auto antibodies ne nkukuo hunuu sɛ plots ayarefoɔ a wɔsɔɔ hwɛeɛ nyinaa wɔ Auto antibodies to the beta one adrenergic receptor a ɛkyerɛkyerɛ tachycardia piece to this Me nso mayɛ nhwehwɛmu bi wɔ ehlers-danlos syndrome a um titiriw obiara a ɔwɔ stamina Syndrome foforo wɔ autonomic dysfunction bi na yehui wɔ saa ayarefo yi mu no nokwarem no na wɔwɔ elasticity a ɛkɔ soro wɔ ntini ahorow no mu no wɔayɛ nhwehwɛmu nketenkete bi wɔ ayarefo a wɔwɔ nkuku mu a won
nya nhuu nsonsonoe nanso um minnye nni sɛ eyi nyɛ adwinnade wɔ nkuku mu nso enti sɛ ntini no yɛ elastic kɛse wɔrekɔtwe mogya pii ɛnyɛ vasoconstrict yiye na ebia eyi yɛ physiology fã a nkuku um asɛmfua bi kɛkɛ fa fibrinopathy nketewa ho nnipa pii susuw eyi ho sɛ ɛte sɛ fifiri mmuae no ara pɛ sɛ woayɛ a ever had a q-start test nanso ɛho hia sɛ yɛhyɛ no nsow saa neurons yi a mekaa ho asɛm sɛ uh control the blood vessel vasoconstriction the tightening of your blood vessels nso yɛ fibers nketewa a ɛy
ɛ sensitive kɛse wɔ nerve damage ho enti sɛnea mekae no Q start susuw the fifiri mmuaeɛ ɛfiri sɛ saa pseudomotor ntini yi bɛn honam ani paa ɛnyɛ den sɛ wobɛsusu non-invasively denam fifiri sɔhwɛ no so nso wobɛtumi biopsy wɔn ɛyɛ den ankasa sɛ um nya nteaseɛ wɔ ntini a ɛredi so no ho mogya ntini efisɛ emu dɔ kɛse nanso ɛsan nso yɛ sensitive to small fiber neuropathy okay mɛka cerebral blood flow ho asɛm kakra enti eyi ne mogya a ɛkɔ amemene no mu ɔkwan a wɔtaa fa so susuw eyi no wɔfrɛ no transcra
nial Doppler baabi a wode Doppler probe no to ultrasound probe titiriw wɔ asɔredan no so baabi a wowɔ mfɛnsere ketewaa bi a wobɛfa dompe no mu ultrasound no nyɛ papa ankasa sɛ wobɛfa dompe mu enti ɛsɛ sɛ wohwehwɛ mfɛnsere kakra um na wɔresusuw mogya flow wɔ mfinimfini amemene ntini a ɛyɛ ntini atitiriw no mu biako wɔ saa kurukuruwa yi mu a ɛde mogya ma amemene no um akwan foforo bi nso wɔ hɔ te sɛ uh um fmri reyɛ agye din kɛse ɛyɛ nea ne bo yɛ den kakra na ɛyɛ den sɛ wɔbɛyɛ nkurɔfo nso de ahwehw
ɛ redi dwuma near infrared spectroscopy titiriw wɔ moma so na ɛno de hann nhyehyɛe di dwuma de bɔ mmɔden sɛ ɔbɛhwɛ mogya a ɛsen kɛse wɔ amemene no anim nanso enti ɛno ye ma te sɛ adwene mu adesua um enti ade titiriw biako a wɔahu wɔ nkuku mu ne sɛ mogya a ɛsen to amemene no so tew kɛse saa wɔ nnipa a wɔwɔ apɔwmuden mu nanso sɛ wodan wɔn a mogya a ɛkɔ mfinimfini amemene no mu ntini no so tew bɛyɛ 10 na ɛkɔ fam mmɔho abien sen nnipa a wɔwɔ nkuku um enti mogya a ɛkɔ amemene no mu a ɛso tew no yɛ ak
yinnye biara nni ho sɛ emu yɛ den kɛse wɔ nnipa nkuku mu um oh nso biribi wɔ hɔ a wɔfrɛ no cerebral autoregulation enti mpɛn pii no sɛ wobɛnya mogya a ɛkɔ amemene no mu no so tew a ɛyɛ sɛ wowɔ mogya mmoroso a ɛkɔ fam kɛse te sɛ te sɛ wo ho adwiriw wo anaasɛ mogya retu anaa biribi um wo nipadua no kyerɛ sɛ ɛbɛbɔ mogya a ɛkɔ amemene no mu ne akwaa a ɛwɔ mfinimfini no ho ban ankasa um nanso ɛwom mpo sɛ mogya mmoroso kɔ so yɛ pɛ anaasɛ ɛkɔ soro mpo wɔ nnipa binom adwene mu bere a wɔkɔ bere a wɔadan
wɔn ho akɔ soro nifa um mogya a ɛkɔ amemene no mu no da so ara kɔ fam saa adwinnade yi a ɛma mogya kɔ w’amemene mu no ayɛ basaa ankasa mɛka kɛkɛ sɛ enti nokwarem no ne nyinaa wɔ wo tirim um ntease bi wɔ hɔ a enti ebia wowɔ amemene mu sum ka eyi yɛ ebia akwan no mu biako efisɛ um mogya yɛ ɔkwan bi so ɛho hia efisɛ ɛde oxygen ne aduannuru kɔ amemene no mu enti sɛ wo nnya mogya a ɛdɔɔso nkɔ w’amemene mu a ɛyɛ den sɛ wobɛpɛ uh susuw sɛ wunim enti ne nyinaa wɔ wo tirim saa amemene mu mframa yi ne plu
g ketewaa bi pɛ ma a adesua a mereyɛ sɛ woyɛ a mɛka sɛ wɔ nnɔnhwerew abien mu wɔ Hershey Pennsylvania efisɛ adesua ahorow no yɛ den sɛ ɛwɔ nsrahwɛ abiɛsa yɛreyɛ fmri adesua de ahwɛ akwan horow a amemene mu sum kabii wɔ nnipa a wɔwɔ nkuku mu enti ɛwɔ hɔ the contact info for our nurse coordinator na wobɛtumi email no sɛ w'ani gye adesua no ho a mede ne email nso bɛto chat no mu akyiri yi okay enti organ a ɛtwa toɔ a yɛbɛka ho asɛm no wunim amemene no koma no ankasa anigye nanso asaabo no nso ho hi
a ankasa ma koma ne ntini nipadua ne nsu kari pɛ a wɔbɛkɔ so akura mu titiriw wɔ nnipa a wɔwɔ dysautonomia anaa nnipa wɔ ɔkwan a ɛkɔ akyiri so no ɛyɛ basabasa kakra kɛkɛ na ɛbu wɔn animtiaa nanso um na asaabo no atifi no mefrɛ wɔn te sɛ kyɛw nketewa a wɔyɛ 're adrenal glands um wɔ afã abien medulla ne cortex medulla no te sɛ mu cortex no yɛ um akyi te sɛ gland um enti asaabo no yɛ Green wɔ mu a ɛho hia ankasa ma nsu homeostasis na um medulla no secretes catecholamines te sɛ epinephrine norepinep
hrine a wɔsan frɛ no um enti wɔsan frɛ epinephrine adrenaline norepinephrine adamfo no wɔfrɛ no noradrenaline ɛnonom ne Britania nsɛmfua a egyina wiase no fã bɛn na wowɔ um na afei cortex no yɛ aldosterone a ɛho hia ankasa ma kɔ so kura nkyene ne nsu nso cortisol a ɛyɛ stress hormone ne sex hormones bi nso okay saa nsuo kari pɛ nneɛma yi nyinaa ma me sukɔm de me I guess enti Adrenal medulla no gyae catecholamines eyinom yɛ sympathetic nerves a efi hypothalamus a ɛwɔ brain stem no atifi pɛɛ no
m’ani nnye ho sɛ mɛkɔ akyiri dodo kɔ amemene no mu ankasa um soma tema ntini fa akyi berɛmo a afei ɛkanyan um yiyi catecholamines fi Adrenal medulla enti epinephrine ne norepinephrine yɛ nneɛma pii um wɔma koma bɔ kɔ soro ɛno yɛ adeɛ baako enti ɛno yɛ akwan a nkukuo fa so no mu baako um um wɔsan nso siw secretion of stomach acid a ɛyɛ kwan no fã ma gastroparesis enti eyi yɛ saa um ko ne wimhyɛn mmuaeɛ yi bi ɛfiri sɛ wo ne wo don't digest as well sɛ wo sympathetically activated um saa constrictio
n of blood vessel ade yi nkɔ yiye koraa kɔ autoonomia mu na mekyerɛkyerɛɛ saa akwan no mu kan no esiane neuropathy ne nsakrae a ɛba The receptors with auto antibodies it this mechanism just doesn'. t ɛte sɛ nea ɛyɛ adwuma yiye paa um yɛwɔ oh na nso saa hype hyperglycemia anaa pre-diabetic State yi nhwehwɛmu nhwehwɛmu ahorow bi reba abɛka sɛ ɛno abu so kɛse wɔ nnipa a wɔwɔ dysautonomy mu nso okay enti next yɛrebɛka adrenal cortex ho asɛm which um releases Al aldosterone as well as cortisol and ot
her hormones but really going to focus on aldosterone efisɛ ɛno yɛ hormone a um ka kyerɛ asaabo ne nso srade dwensɔtwaa sɛ wɔntwe nsu pii ne sodium na ama mogya dodow akɔ soro enti there’s this pituitary hormone called antidiuretic hormone a ɛyɛ pɛpɛɛpɛ sɛnea ɛte sɛ um wɔsan frɛ no vasopressin na ɛka kyerɛ asaabo no ampa sɛ momma yɛntow yɛn mogya nyinaa yehia mogya pii um na afei ɛno kyerɛ sɛ aldosterone fi adrenal glands mu bere a woayi pituitary no te sɛ up wɔ amemene no mu no ɔkwan bi so wɔ h
ypothalamus ase enti ɛte sɛ amemene to asaabo adrenal gland mmuae okay merekyerɛ eyi bio efisɛ afei yɛde yɛn adwene besi kit no fã a ɛwɔ asaabo no fã a meyɛ no so kɛkɛ circling eyi ne me nsateaa te sɛ mo guys wɔ ha na mutumi hu sɛ um enti asaabo no gyae renin ankasa a ɛdannan Angiotensin kɔ Angiotensin biako na afei angiotensin abien a uh ho hia ma saa feedback loop yi a ɛkɔ so wɔ asaabo no mu eyi yɛ kakra a ɛyɛ den nanso Andrew taa kɔ nea edi kan koraa no ɛkyekyere mogya ntini a ɛma mogya mmoro
so kɔ soro enti ɛno yɛ adwinnade biako a ebia ɛnyɛ ne kwan so na plots wɔ hɔ awarefo nhwehwɛmu wɔ sɛ Julian Stewart um ɛsan nso kanyan aldosterone a woyi fi adrenal gland a ɛho hia ma retaining nkyene ne nsu um na afei bere a uh fã bi a saa feedback bere a mogya mmoroso Falls ɛkɔ soro akenkan na gyae a afei ɛsan kɔ nhyehyɛe no mu kɔ catalyze reaction um of angiotensinogen to Angiotensin biako enti nnipa a wɔte ase te sɛ me kae sɛ ɛwɔ hɔ saa feedback loop baabi a wowɔ mogya dodow a ɛba fam na afe
i woma renin ne aldosterone kɔ soro na afei saa sɛnkyerɛnne no ma mogya dodow kɔ soro nanso wɔ nnipa a wɔwɔ nkuku mu no eyi te sɛ nea ɛnyɛ adwuma no na ɛyɛ nhwehwɛmu biako pɛ wɔ eyi ho na minnim nea enti a enni hɔ t been more since this is actually back in 2005 really should be common knowledge but a lot of doctors bisa me te sɛ nea enti a nnipa a wɔwɔ nkukuo no dehydrated na me te sɛ yie wɔn nni renin a ɛdɔɔso na wɔnni aldosterone a ɛdɔɔso ɛwom mpo sɛ wɔyɛ plasma volume's low enti the um asaabo
no ankasa ntumi nkɔ signal getting more fluid wɔreka bere nyinaa sɛ mmoa nanso wontumi nyɛ efisɛ wonnya saa hormones yi a ɛdɔɔso enti wo na afei esiane sɛ akenkan ne aldosterone sua nti saa feedback yi wɔ hɔ a ɛbɛma plasma volume akɔ fam efisɛ nipadua no kɛkɛ mfa saa hormone nhyehyɛe yi nni dwuma yiye enti feedback loop no nyinaa abubu menim sɛ ɛsu okay enti uh nkukuo akwan no oh yɛyɛ doing great for time good ebia mekasae ntɛmntɛm dodo um the mechanisms I just went over are first the heart nea
wobɛtumi ayɛ ne sɛ wobɛma wo koma ayɛ pump yie uh mogya ntini there’s neuropathy that uh kills nerves that control the blood vessels we got those Auto antibodies that damage The receptors that signal vasoconstriction and the arteries betumi ayɛ stretchy dodo esiane pulse pressure a ɛba fam nti na ebia esiane collagen nsɛm nti um sɛ mogya boaboa ano wɔ ntini ahorow mu sɛ um efisɛ mogya a ɛboaboa ano no ntumi nsan nkɔ koma no mu na the Amemene baabi a wuhia no ankasa enti amemene no mu no mogya a
ɛsen bere a wote hɔ a ɛyɛ ɔhaw efisɛ wuhia mogya de oxygen glucose aduannuru akɔ w’amemene mu sɛnea ɛbɛyɛ a wubetumi asusuw um na afei wɔ renal system no mu no asaabo ne adrenal glands um a yɛhunuu sɛ catecholamine production a ɛkɔ soro a ɛde tachycardia ba plus saa um sympathetically activated systems afoforɔ no nyinaa na ɛwɔ hɔ nso low renin ne aldosterone a ɛbubu signal no ma nsuo a ɛkura mu kɔ soro enti uh ɛwɔ hɔ anan categories I 'm going to talk about for the different pharmacological the
rapies for pots there's I'm going to talk about blood volume expanders akwan a wobɛfa so ama wo mogya mmoroso vasoconstrictors akwan a wobɛfa so ayɛ ntini no mu den sympatholytics enti akwan a wobɛfa so asiw tema dwumadi ano na afei akwan foforo a wobɛfa so atew koma so rate okay uh this presentation part of the presentation is largely on a review I wrote back in 2008 with Dr Raj about pharmacological therapy for pots enti momma yɛnkɔ akwan a yɛbɛfa so ama mogya dodoɔ akɔ soro ɛfiri sɛ yɛkaa asa
abo ho asɛm nkyɛreeɛ enti deɛ ɛdi kan no me m kɔka ho asɛm ne fluticortisone anaa anan a ɛdɔɔso um eyi yɛ glucoordinate cordochord enti ɛnyɛ steroid per se te sɛ prednisone ɛnyɛ nea ɛfa saa HPA access a um te sɛ pituitary gland sɛnea mekaa ho asɛm no boa ma sodium ne sparus potassium sie enti ɛma potassium fi adi wɔ ɛka a wɔbɔ no mu a ɛno nti na ɛtɔ da bi a ɛsɛ sɛ wofa potassium supplements sɛ wofa fluorine f um a egye adapɛn pii na woahu mfaso na wɔansua ho ade denneennen wɔ nkuku mu enti ɔkwan
a eyi yɛ adwuma ne sɛ ɛsuasua aldosterone enti ɛyɛ titiriw no ɛyɛ nea ɛsɛ sɛ aldosterone yɛ na aldosterone sua dodo wɔ nkuku mu ayarefo anyɛ yiye koraa no wɔ saa nhwehwɛmu no mu enti um ɛboa ma nkyene kɔ so na ɛma mogya mmoroso kɔ soro denam saa kwan yi so um ne yeah enti wɔansua ho ade denneennen wɔ nkuku mu na ɛwɔ hɔ a etu mpɔn bi of this drug in pediatric nausea and adult hypotension but not in syncope there was a whole uh post to study which showed it wasn’t effective in syncope nanso ɛda a
di sɛ ɛno yɛ nhwehwɛmu ara kwa ɛboa ayarefo binom um enti aduru a ɛte saa ara bi a ɛyɛ to Florida yɛ desmopressin anaa ddavp um eyi suasua vasopressin anaa ADH a mekaa ho asɛm no gyae fi pituitary gland eyi nkyerɛ sɛ ɛba fam wɔ plots per se ɛwom sɛ minsusuw sɛ obiara ankasa daa sɔhwɛ no um nanso eyi yɛ a aduru a wɔtaa de di dwuma de siw mpa so nsu ano enti ɛyɛ uh gyae mogya dodow a ɛdannan kɔ nsu mu pii te sɛ mmofra a wɔanyinyin a wɔwɔ ɔhaw wɔ mpa so mmirikatu ho no betumi afa eyi anadwo um no s
ɛnea mekae sɛ ɛsuasua vasopressin na ɛyɛ um soronko wɔ fluorine f ebetumi wɔde di dwuma sɛnea ɛho hia enti ɛsɛ sɛ wɔfa fluorinef da biara da egye adapɛn pii na ayɛ adwuma ɛtɔ mmere bi a nanso eyi um betumi Desmond Preston betumi adi dwuma ɔkwan bi so te sɛ sɛnea ɛho hia sɛ wowɔ te sɛ da bi a ɛsɛ sɛ wugyina pii anaasɛ um pɛ sɛ wopɛ a kɔ apontow anaa biribi a wubetumi afa eyi kɛkɛ sɛ da a wode nnubɔne um na adanse wɔ hɔ a ɛkyerɛ sɛ ɛboa ma kuku mu sɛnkyerɛnne tu mpɔn nanso sɛnea Dr Yaz wɔ Tick Toc
k kae no ebia ɛsɛ sɛ wudi nkyene kakra na menyɛ saa kɔka eyi ho asɛm kɔ akyiri efisɛ migye di sɛ mo nyinaa nim nkyene ho asɛm na ɛsɛ sɛ mudi pii sɛ wowɔ nkuku anaasɛ dysautonomia biara a ebia gye sɛ wowɔ yiye there’s some debate on if you have high blood pressure if wodi nkyene nkɔ saa mu pii nanso ɔkwan a nkyene fa so yɛ adwuma no ɛboa ma mogya dodow kɔ soro um nhwehwɛmu bi wɔ hɔ a efii kuw a ɛwɔ Vanderbilt no mu bae a ɛkae sɛ ɛtew norepinephrine a wɔayi no so sɛnea ɛte biara no na plasma norep
inephrine sua na koma bɔ no decreased after I think it was four days of high salt diet okay so why does saline work better Me dɔ me IV saline Megye di sɛ mo mu pii yɛ nso um enti nhwehwɛmu wɔ hɔ sɛ acute infusion of IV saline boa nkukuo symptoms a kakraa bi Nhwehwɛmu ada no adi sɛ um na ɛwɔ hɔ bere tenten nhwehwɛmu bi a ɛka sɛ kosi asram asia dapɛn dapɛn IV po so hyɛn a wɔde di dwuma um betumi aboa ma wɔatew kuku sɛnkyerɛnne so eyinom nyinaa yɛ akyi nhwehwɛmu nhwehwɛmu enti wɔhwɛɛ chart nhwehwɛm
u kɛkɛ wɔ ayarefo a na wɔanya saa ayaresa ahorow yi ho ɔkwan biara so na na nsakraeɛ kɛseɛ wɔ saa nhwehwɛmu yi mu enti nnipa binom nyaa po so hyɛn nna mmiɛnsa biara na ebinom nyaa pɛnkoro pɛ wɔ adapɛn anan biara mu um nanso ɛho hia paa sɛ wɔde adanseɛ ma sɛ saa ayaresa yi yɛ adwuma ɛfiri sɛ nnipa pii susu sɛ IV po so hyɛn ne nsa a wɔnom yɛ pɛ nsuo a ɛnyɛ saa nnipa pii ka kyerɛ wo sɛ wunhia IV nsu sɛ wobɛnom nsu mprempren dɛn nti na ɛyɛ soronko nea edi kan koraa no ɛyɛ adeyɛ a ɛyɛ ntɛmntɛm efisɛ
wode nkyene aduru no rehyɛ wo ntini mu tẽẽ a ɛne sɛ wobɛnom no bɔ abira um bypass the gut which is um particularly important sɛ wowɔ absorption nsɛm anaa gastroparesis ɛyɛ den ankasa sɛ wobɛtwe nsuo afa gut um mu nsonsonoeɛ wɔ rehydration ne volume expansion ntam enti mpɛn pii sɛ wonom nsuo a ɛyɛ wo sukɔm na ɛkanyan ankasa na woresesa wo nsuo volume kɛkɛ sɛ opposed to creating more fluid volume a nokwarem no ɛsɛ sɛ woko tia wo sukɔm te sɛ wo te nka sɛ hydrated nanso ɛsɛ sɛ wonom pii na ɛno betum
i ayɛ den ankasa sɛ wobɛyɛ enti ɛhɔ na IV saline betumi ayɛ mfaso ankasa nso ɛwɔ nkyene pii kɛkɛ te sɛ gram akron wɔ lita biara mu wɔ IV po so hyɛn bag mu a ɛne sɛ wubedi pickles akɛse ason mũ nyinaa yɛ pɛ enti ɛyɛ den sɛ wobɛyɛ saa daa um nanso asiane ankasa wɔ IV saline therapy mu um sɛ wo sɛ woabisa wo provider for this na wɔkaa sɛ dabi ebia ɛfiri sɛ asiane kɛseɛ wɔ hɔ sɛ wobɛnya ɔyareɛ sɛ ɛhia sɛ wobɛnya central line te sɛ pick anaa pork titiriw permanent central line anaa long not permanent
long term um na ɔhaw a ɛwɔ yei mu ne wo 're de saa catheters yi ahyɛ vena cava a woresoma clots ne infections tẽẽ akɔ wo koma mu sɛnea ɛbɛyɛ a eyi betumi de tebea a emu yɛ den a ɛde nkwa to asiane mu aba enti ebia IV saline mfata wɔ saa asɛm yi mu um mekyerɛ sɛ menkɔ sɛ wobɛgye akyinnyeɛ nnipa binom yɛ wɔ picks ne ports nanso uh eyi nyɛ recommended nanso um ahyehyɛde biara a wɔbɛyɛ ama nkuku enti dɛn na wubetumi ahyɛ nyansa sɛ ntease mu nya IV sailing treatment um nea edi kan koraa no nkutoo fa
peripheral access di dwuma kɛkɛ fa IV wɔ wo basa mu ma bere tenten biara a ɛbɛyɛ yiye um ma frequency no nkɔ fam sɛnea ɛbɛyɛ a worensa ntini um nnipa a wotumi kura ayaresa mu kosi asram asia wɔ adesua ahorow no mu um yɛɛ IV po so hyɛn pɛnkoro dapɛn biara anaa nea ennu saa ebia ɛsɛ sɛ wode di dwuma wɔ mu combination with other treatments M’ani gye ho sɛ mɛdwene Ivy salmon ho sɛ ɛte sɛ bere tiaa mu patch enti bere a woresɔ ayaresa afoforo te sɛ um apɔw-mu-teɛteɛ anaa um pharmacological Therapies
ahorow a wubetumi ayɛ agoru bi ne wɔn bere a worenya mfaso a ɛwɔ IV saline so de ama wo extra energy na na wosa wo symptoms bere tiaa bi na afei wopɛ sɛ woyɛ nhyehyɛe ma nea wobɛyɛ bere a woahwere access a ennya daa line efisɛ nnipa pii kɔ IV saline therapy mu ka sɛ me nko ara na wɔbɛkɔ de IVs um adi dwuma wɔ peripheral vein mu nanso afei wɔhwere veins na wɔwie a wonya central line enti gonna gyaw no wɔ sɛ pros ne cons okay enti dɛn ne options afoforo no um enti ɛwɔ hɔ oral rehydration Solutions
um eyinom yɛ soronko formulated to have a molar concentration that transports um sodium through the um got lumen na saa um ORS Solutions yi yɛ uh Brands titiriw a minim no yɛ nsu IV normalite na afei nso ɛwɔ hɔ a plain ORS a ɛyɛ dɛ kɛkɛ te sɛ nkyene nsu nanso mekyerɛ Nnipa binom pɛ nea ɛnyɛ dɛ na wubetumi de te sɛ um asikre afrafra te sɛ Mio aka ho bere nyinaa sɛ wopɛ na wopɛ sɛ wokwati asikre a ɛba fam anaasɛ asikre afrafra efisɛ wonni saa glucose dodow a ɛfata no ma sodium um mfomso biara nni
asikre nsu ho te sɛ nea mefrɛ no Gatorade anaa electoral afoforo Menom asikre nsu um mekyerɛ sɛ nsu biara ye sen biara nanso sɛ wopɛ ampa sɛ absorption power of of a rehydration salt low sugar isn’t gonna do it and you don 't want to over dilute the drinks next I actually like ran into um so na wɔrema nsuo IV samples wɔ Costco ne onipa a ɛyɛ dɛ ma me no mu baako a ɛyɛ flavors a na me ntaa mpɛ na ɔkaa sɛ oh yeah wopɛ to like dilute it by two to three times na mekae sɛ uh yeah ɛnyɛ saa na wodi ho
dwuma enti nokwarem no na nhwehwɛmu bi wɔ hɔ a wɔde oral rehydration salts di dwuma wɔ mmofra nkuku mu na wohui sɛ ɛso tew tachycardia sen IV sailing did um so fa saa nea ɛyɛ no wɔansusuw sɛnkyerɛnne biara wɔ nhwehwɛmu no mu na ɛyɛ nhwehwɛmu ketewaa bi a ɛfa ayarefo 14 ho um enti ebetumi ayɛ adwuma um mɛka sɛ ayarefo dodow no ara nhu sɛ ɛboa te sɛ IV po so hyɛn nanso ɛfata sɛ wosɔ hwɛ enti aduru a edi hɔ a mɛka ho asɛm no yɛ asiane bi a wɔfrɛ no EPO ɛyɛ uh nea Lance Armstrong nyaa ɔhaw mu sɛ ɔd
e dii dwuma maa mogya doping no adwinnade no ne sɛ ɛkanyan mogya mu nkwammoaa kɔkɔɔ a wɔyɛ fi nnompe mu ntini mu nanso ɛno is quite effective it’s really only use in refractory pods patients because this does have a lot of risks to it ɛyɛ nso ankasa bo yɛ den enti option sɛ wo dii nkogu wɔ ayaresa pii mu na wohu cardiologist a ɔwɔ ɔpɛ sɛ ɔbɛsɔ ahwɛ enti seesei mewɔ kɔka nnuru ho asɛm a ɛba fam koma bɔ titiriw titiriw a ebia mo nyinaa ate ho asɛm ne beta blockers eyinom tew koma bɔ ne contractili
ty anaa tumi a ɛtwetwe koma no enti uh eyinom yɛ adwuma denam epinephrine bind to the beta 1 adrenergic receptors in koma no um na fa saa G protein-coupled receptor mechanism yi mu nim sɛ ɛyɛ ntɛm kakra sɛ yɛbɛpɛ sɛ yɛdi Buronya yɛnkɔɔ Thanksgiving nanso uh ɛyɛ bere a ɛfata bere nyinaa ma beta blockers ma me mefrɛ eyinom LOL nnuru efisɛ wɔn basically all end in LOL um Megye di sɛ obiara wɔ favourite mine ne propranolol na mɛka akyerɛ wo nea enti a Propranolol yɛ non-selective beta adrenergic rec
eptor antagonist ɛtew koma bɔ ne contractility so sɛnea mekyerɛɛ wo denam saa beta 1 receptors no so nanso ɛsan nso kyekyere beta 2 receptors a ɛwɔ mogya ntini so um na merekyerɛ wo sɛ ɛte sɛ epinephrine na ɛsiw saa receptors no ano enti wo nnyɛ vasodilate pii enti ɛsan nso de ka ho sɛ uh stabilization to the elasticity of the blood vessels as yie a ɛnyɛ ankasa asua wɔ dysautonomia nanso yɛsua no wɔ nyarewa afoforo mu na yenim sɛ nnuru no yɛ adwuma saa kwan yi so enti me nanso ɛnyɛ anigye yeah e
nti esiw The Binding of epinephrine afei to these receptors um ɛho hia sɛ yɛhyɛ no nsow propranol less is more so mfitiaseɛ nhwehwɛmu a Dr Raj yɛeɛ no enti ɛkyerɛɛ sɛ uh 20 milligrams of Propranolol yɛ adwuma yie sene 80 milligrams um nso na nhwehwɛmu bi a Dr Foo yɛeɛ a ɛkyerɛ sɛ extended release Propel anyɛ adwuma yie mma symptoms enti there’s all those cardio selective beta blockers a ɛyɛ titiriw afoforo no nyinaa gye Propranolol um wɔyɛ adwuma titiriw wɔ saa beta 1 receptor yi mu wɔyɛ activat
e saa beta2 receptors ne mogya ntini no wɔ doses a ɛkorɔn yiye de, nanso na nhwehwɛmu a wɔayɛ ama eyinom no nyɛ papa ankasa sɛ um wɔ hɔ ankasa adanse biara nni hɔ a ɛkyerɛ sɛ wɔboa ma nkuku nanso nnipa pii fa wɔn nnipa pii wɔ mfaso nhwehwɛmu no kɛkɛ nhyɛ akyi sɛ aduru foforo anyɛ yiye koraa no wɔ U.S. yɛ babardine anaasɛ culinary a ɛyɛ adwuma wɔ serew akwan wɔ koma mu a ɛyɛ ankasa selective to decreasing heart rate so nnipa binom a wɔwɔ um side effects pii wɔ beta blockers ho no hu sɛ um evapora
ting boa efisɛ ɛyɛ pɔtee ankasa sɛ ɛka koma no bɔ kɛkɛ wɔ SA node no mu na wɔayɛ nhwehwɛmu pii wɔ nkuku mu a ɛkyerɛ sɛ ɛnyɛ saa nkɛntɛnso mogya mmoroso te sɛ beta blockers yɛ um eyinom yɛ retrospective kɛkɛ nanso yɛwɔ ebinom te sɛ prospective controlled trials a ɛrekɔ so afei ɛwɔ hɔ nso alpha blockers a ɛwɔ pii side effects nanso wɔ um mediate norepinephrine release fi nerve Terminals na ɛtew so denam uh blocking The receptors enti norepinephrine ntumi nkyekyere um eyinom yɛ ɛtɔ mmere bi a ɛboa
ma nna ne nnipa a wɔwɔ hyper adrenergic nkuku a emu yɛ den baabi a wɔwɔ um supine hypertension okay afei nso vasoconstrictors te sɛ mitodrin a ɛyɛ pro aduru a wɔadan no saa molecule yi wɔ ha ama chemistry nerds biara wɔ atiefoɔ no eyi yɛ whole uh deglycination reaction sɛ wo sɛ wopɛ orgo a ɛntwa mogya-amemene akwanside no enti eyi yɛ nnuru no mu baako a ɛnyɛ adwuma wɔ amemene no mu nkutoo wɔ peripheral mogya ntini mu um yeah enti consensus no yɛ sɛ wobɛfa saa aduru yi a ɛyɛ adwuma tiawa paa enti
sɛ wobɛfa no nnɔnhwerew anan biara anaa mprɛnsa da biara na woakwati ansa na woada sɛ ebia wobɛnya supine hypertension a mpɛn pii no ɛnyɛ ɔhaw wɔ nkuku mu um enti ɛkyekyere alpha deɛ no akyi nerdic receptors ne mogya ntini sɛ constrict wɔn kɛse ɛyɛ recommended ma neuropathic nanso ɛnyɛ mpɛn pii hyperadronergic nkuku oh na me pɛe sɛ mekyerɛ kɛkɛ sɛ ɛyɛ ɔkwan bi so te sɛ norepinephrine na ɛno nti ɛhu saa receptor yi na ɛma ɛyɛ adwuma yie um octreotide yɛ aduru a ɛte sɛ somatostatin a ɛma blank va
soconstriction a ɛyɛ nokwarem uh ebia baabi a mogya dodow no ara atare ne nkuku na ebetumi ama woate nka sɛ wo ho yɛ wo yaw wɔ adidi akyi um the Splunk kɔn anaa gut vasculature yɛ pii more extensive than the like vascular is so eyi betumi ayɛ adwinnade pa a wɔde atoto ho ankasa sɛ miterate wɔ koma a ɛbɔ ne mogya mmoroso mmuae a ɛte saa ara um yeah mɛgyaw no ne sɛ stimulants no enti adanse pii nni hɔ ma eyi nanso ebia wɔbɛboa amemene mu sum wɔn ho wɔ mfaso titiriw wɔ nnipa a wɔwɔ ɔbrɛ a enni sabe
a mu na um ɔhaw biako pɛ ne sɛ sɛ wowɔ nkuku a wobetumi de tachycardia aba um binom Nhwehwɛmu ahorow de adi dwuma de aka beta blockers ho de asiw sɛ um ne modafinil yɛ aduru foforo a ebetumi aboa no nyɛ stimulant pɛpɛɛpɛ ɛboa ma nyane na ɛmma tachycardia mma sɛnea ɛtaa ba na sɔhwɛ ahorow wɔ hɔ a ɛrekɔ so wɔ nkuku mu apereperedi a etwa to ka ho asɛm uh ne dropsy dopa a wɔdan no norepinephrine wɔ periphery nanso ɛhɔ yɛ adesua binom wɔ nkuku mu nanso eyi yɛ aduru a mfaso wɔ so ankasa ma orthotic hy
po hypotension Mekyerɛwee wɔ editorial bi so wɔ eyi ho ne Dr Stewart mfe kakraa bi a atwam ni na ɛde ba a ɛte sɛ te sɛ norepinephrine dua efisɛ ɛyɛ nsakrae anaa epinephrine um ɛbɛma vasoconstriction akɔ soro wɔ mogya ntini no nanso ebetumi nso de tachycardia aba sɛ ɛkyekyere koma no okay enti afei mestanon wɔ hɔ a ɛma cholinergia dwumadi kɔ soro denam acetylcholine um a ɛpaapae a esiw ano so enti eyi yɛ nneɛma pii adwinnade titiriw no ne sɛ ɛbɛma koma no bɔ brɛoo nanso ɛsan nso betumi ayɛ constr
ict Airway enti ɛsɛ sɛ wɔde di dwuma wɔ ahwɛyiye mu ne nnipa ne Asthma ɛsan nso kanyan digestion enti ebetumi ayɛ ebetumi ayɛ mfaso ama gastroparesis titiriw sɛ wowɔ constipation um yep ɛhɔ na yɛkɔ me nhia me nsɛm mpo okay uh ɛwɔ hɔ nso a bagel nerve stimulation a ɛyɛ experimental kɛse nanso nhwehwɛmu bi wɔ hɔ wɔ comorbidities afoforo a ɛfa dysautonomia ho a wɔapene so te sɛ gamma chord devices a ɛwɔ ha wɔ kɔn no so no yɛ nea wɔde di dwuma ma migraines IB stim a ɛyɛ aso clip no wɔapene so ama Pe
diatric IBS um ebinom wɔ hɔ clinical trials ongoing in pots looking at acute effects on heart rate heart rate variability and symptoms nanso um na na awarefo bi wɔ hɔ ankasa a enni sabea nhwehwɛmu nanso eyi da so ara wɔ nhwehwɛmu fã ahorow no mu oduruyɛfo biara nkɔkyerɛw eyi mma wo mma nkuku pɔtee um na ɛyɛ nso implantable vagal nerve stimulators a ɛyɛ FDA apene so ama epilepsy ne ayaresa resistant adwenemhaw a nokwarem no ɛyɛɛ me nwonwa sɛ na minnim saa asɛm no kosii sɛ meyɛɛ saa nkyerɛkyerɛmu
yi um na nhwehwɛmu pii wɔ hɔ a ɛfoa eyinom a wɔde di dwuma wɔ um inflammatory bowel disease so pɛpɛɛpɛ ma eyi ntra w’adwenem sɛ wowɔ comorbidities biara na wopɛ sɛ wosɔ eyi hwɛ a eyi bɛma parasympathetic tone a ɛhome anaasɛ digest mmuae no akɔ soro um na anidaso wom sɛ yebenya data bi wɔ nkuku mu a ɛbɛboa ne dwumadie um Merenka eyi ho asɛm Lauren betumi aka ho asɛm titiriw wɔ hɔ a adanse wɔ hɔ sɛ nkuku nyɛ autoimmune tebea Minnim ankasa sɛnea immunoglobulin yɛ adwuma nanso uh wubetumi anya no ak
yerɛw sɛ wowɔ comorbid autoimmune yare a sɔhwɛ ahorow bi wɔ hɔ pɔtee wɔ sɛnea ɛka kuku symptoms um na case amanneɛbɔ pii wɔ hɔ a ɛkyerɛ bɔhyɛ enti eyi yɛ ayaresa a ɛsɛ sɛ yɛhwɛ yiye ɛno nkutoo na mɛka mprempren aseda guys sɛ woatie me kɛse aseda Amanda um nsɛmmisa pii momma yɛmmɔ mmɔden sɛ yɛbɛfa wɔn mu wɔ te sɛ ogya asɛmmisa nhyehyɛe a ɛkɔ ntɛmntɛm efisɛ yɛanya simma anan okay uh uh momma yɛnhwɛ nea ɛde coat hanger ɛyaw ba oh sɛ me yam a anka minim um ebia mogya a ɛsen kɔ soro kodu denam Caroti
d no so na ɛkɔ amemene no so yiw ɛno ne nea eye sen biara guess efisɛ ɛyɛ nokwarem no abu so wɔ autonomic disorders ahorow pii mu anka mɛka nso a ebetumi aba sɛ adwinnade foforo it wunim sɛ nneɛma pii wɔ hɔ a ɛde upper back ne kɔn mu yaw enti sɛ wowɔ EDS a ebetumi ayɛ binom joint issues binom spine kind of like compression wɔ nneɛma a ɛnsɛ sɛ wɔhyɛ no so sɛ wowɔ fibroneuropathy ketewaa bi a wubetumi anya ankasa a wunim sɛ nnipa pii susuw fiber nketewa ho neuropathy wɔ wo nan mu nanso nokwarem no
wubetumi anya fibroneuropathy nketewa wɔ w’akyi atifi ne wo nipadua atifi enti ɛno wɔ nyarewa bi mu wɔn wɔyɛ skin biopsy wɔ w’akyi atifi de hwehwɛ fibroneopathy nketewa nanso wonnya mfii ase nyɛ saa wɔ nkuku mu de besi nnɛ enti wo asɛmmisa a edi hɔ ni um uh oduruyɛfo bɛn na ɔbɛkyerɛw fam a ɛdɔɔso na so ɛsɛ sɛ wuhu urologist anaasɛ woyɛ nhwehwɛmu titiriw um mprempren Primary Care Cardiology oduruyɛfo biara a onim nkuku anaa orthostatic intolerance dysautonomia ho asɛm no ebia ɔbɛte nka sɛ ne ho
tɔ no sɛ ɔbɛkyerɛw no yeah um adɛn nti na worempɛ sɛ wobɛ over dilute uh hydration products foreign anaa a rehydration salts wɔwɔ um osmolality pɔtee bi enti te sɛ concentration of sodium ne glucose yɛ specific ankasa enti sɛ wo over dilute wɔn a wɔrentwe wɔn ho yie yeah wɔn re wɔayɛ ama te sɛ rapid absorption right enti sɛ wo sesa saa ratio no wore messing sɛ up yeah um uh wobetumi de beta blockers adi dwuma wɔ combo ne ADHD meds anaasɛ wɔde di dwuma biako pɛ wɔ bere koro mu uh wobetumi be used
in combination and actually there there’s some studies that have combined stimulants with beta blockers to make the tolerability better efisɛ tachycardia yɛ side effect a ɛwɔ stimulants no bi mu yeah enti asɛmmisa bi ni a misusuw sɛ ebia ɛsɛ sɛ yɛka kɛkɛ sɛ wo ne wo duruyɛfo nkasa about this but Amanda wobɛtumi aka uh w'adwene wɔ yei nso obi se wɔn doctor rema wɔn propanolol na wɔpɛ sɛ wɔhunu sɛ ɛyɛ safe sɛ wɔbɛfa beta blocker berɛ a wɔn koma bɔ wɔ low 60s what is the bottom safe number for mog
ya mmoroso ne koma bɔ sɛ wobɛfa blocker II bi te nka sɛ wo ne wo duruyɛfo bɛkasa asɛm bi anka mɛbisa wo duruyɛfo um mekyerɛ sɛ ebetumi ayɛ ahobammɔ sɛ wobɛnya mogya mmoroso wɔ 50s mu nanso yeah bisa kɛkɛ bisa wo duruyɛfo me ɛnyɛ sɛ mɛka ampa sɛ egyina tebea no so yeah akyinnye biara nni ho sɛ egyina na ɛte sɛ uh sɛ worenya mfaso afi beta blocker mu nanso ɛrebrɛ wo mogya mmoroso ase dodo a wubetumi ne wo duruyɛfo akasa afa wo beta blocker a wobɛsesa ho uh the aduru no ankasa sesa dose sesa bere a
bere a wofa dose no anaasɛ ɛdan kɔ ivabridine a ɛma koma no bɔ a ɛmma mogya mmoroso no nkɔ fam um enti asɛmmisa bi ni um uh yɛyɛ uh adɛn nti na ɛsɛ sɛ yɛhwɛ yɛn aduan ne nkuku sɛnea ɛte wɔ asikre um enti ɛnyɛ nokware a wogye tom sɛ wobɛhwɛ asikre pɔtee te sɛ nea ɛnyɛ nyansahyɛ a emu yɛ den um nhwehwɛmu ahorow bi aba a ɛkyerɛ sɛ hyperglycemia wɔ nkuku mu ebia ɛyɛ ayamhyehye a ɛfa ho adwinnade enti autonomic nervous system no di wo insulin ne glucose a woyi gu no so na ɛno betumi be abnormal nso
um nnipa binom a wɔwɔ nkukuo kind of nya te sɛ sugar rush akyi a wɔadi uh te sɛ akyi a wodi sugar na wonya te sɛ more pooling of blood in the GI tract nanso enni hɔ I mean there isn't like a nyansahyɛ a emu yɛ den sɛ wobɛkwati asikre um a wode bɛka wo mmuae ho enti me tintim ne eyi so wɔ Cindy ne Dr chabau ne Satish Raj wɔ Vanderbilt na dishonomy amanaman ntam sika de yɛɛ nhwehwɛmu wɔ Vanderbilt a ɛkyerɛ sɛ um nkuku ayarefo bere a wɔwɔ glucose intake a ɛyɛ asikre yiye wonya ankasa excessive tach
ycardia in response to the sugar uh way more than a healthy person uh mpo te sɛ kind of small doses of sugar enti Dr chabau yɛ seesei ɛyɛ foforo koraa enti ɛnyɛ akwankyerɛ a wɔatintim no nyinaa mu yiye nanso Dr shabao reka sɛ eyi ye ankasa adanse a ɛkyerɛ nea enti a ɛsɛ sɛ nkuku ayarefo sɔ low carb aduan hwɛ ɛnyɛ ɔkwan biara a ɛyɛ obsessive so ɛnyɛ asiane sɛ wubenya asikre nanso ebia ɛbɛma woate nka sɛ ɛyɛ tachycardic kɛse na ɔsan nso hui sɛ nkuku ayarefo wɔ insulin resistance a ɛyɛ biribi a ank
a mɛhaw me ho wɔ ho long term na wunim sɛ worebɔ mmɔden sɛ wubedi a uh wunim ankasa apɔwmuden yiye-kari pɛ aduan a fiber ne nhabannuru pii wom sɛ wubetumi a ɛwom sɛ ɛno betumi ayɛ den bere a wowɔ gi nneɛma right um how about uh let’s see there’s so many questions I hwɛ asɛmmisa bi sɛnea eyi yɛ adwuma ma yɛn nyinaa a yɛwɔ Eller stanlos syndrome yeah ɛno ne wo ade koraa saa ara te sɛ nea mekae no wɔ hɔ sɛ saa adwinnade a ebia ɛyɛ pɔtee ma yɛn stamler nhyehyɛe syndrome no pɔtee the elasticity of th
e arteries with the um damaged collagen but uh esiane sɛ wowɔ EDS nti ɛnkyerɛ sɛ wunni saa akwan afoforo yi a ɛkɔ so sɛnea ɛte biara no pii ka bom yeah na anidaso wom sɛ nhwehwɛmu foforo bi a ɛyɛ nwini bɛba wɔ ho eyi uh ntɛm pa ara um sɛ ɛbɛboa yɛn ma yɛate ase yiye sɛnea saa mogya ntini a ɛtrɛw nneɛma no boa nkuku ne saa ara nso na so EDS ayarefo wɔ fiber neuropathy nketewa so wɔwɔ autoimmunity so wɔwɔ mogya dodow a ɛba fam na yesusuw sɛ mmuae no yɛ yiw nanso obiara deɛ nokwarem no , wɔayɛ te s
ɛ adesua a ɛkɔ akyiri a wɔbɛhwɛ saa parameters no nyinaa yiye enti mihu asɛmmisa bi a Levine protocol no si recumbent workouts so dua dɛn nti na apɔw-mu-teɛteɛ a ɛteɛ kanyan dysautonomia sɛnkyerɛnne so titiriw sɛ mogya dodow a wɔsan kyekyɛ a ɛba bere a wotena hɔ na wogyina um betumi ama woayɛ wo dishonomous symptoms flare enti wɔn bere a wohyɛ apɔw-mu-teɛteɛ nhyehyɛe ase no ebia ɛsɛ sɛ wufi ase kɔsra anaasɛ ɛtɔ mmere bi a wɔ ɔtare no mu efisɛ ɛno de compression ka ho um na afei wubetumi akɔ w’an
im bere a wofa um mu anaasɛ Levine protocol anaasɛ top protocol no graded nkakrankakra apɔw-mu-teɛteɛ protocol biara wo yɛ kɔ tena ase na afei gyina hɔ apɔw-mu- teɛteɛ bere a wo ma wo bere kɔ soro yeah eyi yɛ asɛmmisa fi mfiase uh so ɛwɔ hɔ ahorow bi a dysautonomia a ebetumi de nsɛm a ɛfa mogya mmoroso ho yeah enti um nneɛma te sɛ neurogenic orthostatic hypotension mpɛn pii nnipa do have supine hypertension titiriw sɛ wonom nnuru te sɛ midodrine a ebetumi ama ɛno mpo asɛe um hyper adrenergic pot
ɛtɔ mmere bi a nkurɔfo nya hypertension anaasɛ bere a wogyina hɔ ara kwa anaasɛ ɛtɔ mmere bi a wɔregye wɔn ahome nso um ɛtɔ mmere bi a nnipa a wɔwɔ syncope no wɔ mogya mmoroso ankasa nanso ɛkɔ fam um bere a wogyina hɔ mpofirim enti uh yeah wubetumi anya mogya mmoroso a ɛkɔ soro wɔ types of dysautonomia dysautonomia kyerɛ ara sɛ wowɔ dysregulation wɔ wo mogya mmoroso nanso mogya mmoroso yɛ kɛse Dynamic ɛnyɛ um stable wɔ gyinabea nyinaa da mũ no nyinaa bere kɔ so sɛnea ɛbɛyɛ a wubetumi anya high
mogya mmoroso ɛtɔ da bi a yeah yie yɛatwam uh dɔnhwerew awotwe no wɔ ha wɔ apuei fam mpoano na mempɛ sɛ mɛkura wo daa ɛfiri sɛ menim sɛ woanya mmofra nkumaa mmienu a wode bɛto mpa so na woahwɛ um biara any final closing thoughts you want to share with everybody um no I'm just m'ani agye sɛ na anigyeɛ pii wɔ hɔ ma eyi na uh ebia yɛbɛyɛ webinar foforo a egyina physiology so daakye II nokwarem no wo de wo IVIG slide yɛɛ me susu sɛ ebia ɛhia sɛ yɛyɛ IVIG webinar te sɛ ntɛm ɛfiri sɛ yɛn berɛ a ɛtwa t
oɔ a yɛ nyaa election yie no mede mo bɛba na wobɛtumi ne me agye akyinnyeɛ wɔ ho ɛbɛyɛ anigyeɛ [Laughter] so okay well thanks everybody for tuning in na hwɛ hu sɛ wobɛdi yɛn akyi wɔ social media uh sɛ wobɛte dasada nomina nhwehwɛmu updates a ɛtwa toɔ no ho asɛm na um hwɛ yɛn wɛbsaet ne yɛn mmoa akuo no wobɛtumi ahunu yɛn autonomia mmoa akuo wɔ aman 50 no nyinaa mu wɔ US ne UH 60 nyinaa mu aman foforɔ wɔ disadonomi international.org support enti yɛbɛhunu wo ntɛm na yɛbɛhunu wɔ intanɛt so hwɛ yie
anadwo pa [Nnwom].
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