Taneja Indu, Marney Annis, Robertson David
Autonomic Dysfunction Center, Vanderbilt University, Nashville, Tennessee 37232-2195, USA.
Am J Med Sci. 2004 May;327(5):281-3. doi: 10.1097/00000441-200405000-00030.
Autonomic dysfunction and aortic stenosis share several clinical characteristics, including, in severe cases, syncope. Both illnesses tend to manifest later in life, and most cases are idiopathic in origin. In a short period of 4 weeks, the authors noted that three patients out of 36 referrals for autonomic dysfunction also had histories of aortic valve replacement due to stenosis. In each case, similar presenting symptoms of fatigue, light-headedness, and syncope were attributed to aortic stenosis without mention of autonomic failure as a possible contributor. The authors propose that patients for whom symptoms of aortic valve stenosis are not relieved by surgical intervention may have concomitant autonomic dysfunction contributing significantly to their symptoms. Furthermore, the two conditions may comprise a dangerous combination, aortic stenosis causing physical obstruction of ventricular outflow, and autonomic dysfunction causing decreased venous return and insufficient cardiac filling. It may be beneficial for patients with aortic stenosis who present with syncope to be considered for possible autonomic dysfunction to address both potential pathophysiologies contributing to the syncope.
自主神经功能障碍和主动脉瓣狭窄有若干共同的临床特征，在严重病例中包括晕厥。这两种疾病往往在生命后期出现，且大多数病例病因不明。在短短4周内，作者注意到在36例因自主神经功能障碍前来就诊的患者中，有3例有因狭窄而行主动脉瓣置换术的病史。在每一例中，类似的疲劳、头晕和晕厥症状均归因于主动脉瓣狭窄，而未提及自主神经功能衰竭可能是一个促成因素。作者提出，那些经手术干预后主动脉瓣狭窄症状仍未缓解的患者，可能同时存在自主神经功能障碍，这对其症状有显著影响。此外，这两种情况可能构成一种危险组合，主动脉瓣狭窄导致心室流出道的物理性梗阻，而自主神经功能障碍导致静脉回流减少和心脏充盈不足。对于出现晕厥的主动脉瓣狭窄患者，考虑其可能存在自主神经功能障碍，以解决导致晕厥的两种潜在病理生理机制，可能是有益的。
