Dr. Andrew J. Maxwell, M.D. FACC | Pentad Assessment & Management Pearls

Dr. Andrew J. Maxwell discusses the concept of the "pentad super syndrome," which involves dysautonomia, mast cell activation, Ehlers-Danlos Syndrome, eventual autoimmune disease, and gastrointestinal dysmotility. He presents a grading system for dysautonomia symptoms, analogous to the NYHA scale for heart failure, to stratify patients based on symptom severity and needed interventions. Dr. Maxwell emphasizes the interconnectedness of these conditions, allowing clinicians to focus on relevant sub-syndromes depending on the predominant symptoms. He also covers treatment strategies, including pharmacologic options like beta-blockers (favoring nadolol) and mesenteric choline esterase inhibitors for vagal dysfunction, as well as non-pharmacologic approaches. Additionally, he provides insights into unique patient assessment methods, including biochemical markers, questionnaires, and heart rate variability analysis, to guide treatment and monitor outcomes. The talk highlights the importance of integrated management for patients with complex multisystem involvement.