Overview of Autonomic Disorders, Dr Blair Grubb

Dr. Blair Grubb provides a clear overview of autonomic disorders with emphasis on POTS and related forms of dysautonomia. He reviews the autonomic nervous system’s role in heart rate, blood pressure, and other bodily functions, then outlines common syndromes (POTS, neurally mediated/vasovagal syncope, orthostatic hypotension, and autonomic failure). He describes typical symptom clusters (orthostatic intolerance, palpitations, lightheadedness/syncope, fatigue, brain fog, GI and temperature dysregulation) and common contributors in POTS (hypovolemia, peripheral denervation/neuropathic POTS, hyperadrenergic states, autoimmune associations, and deconditioning), noting frequent comorbidities such as migraine, GI dysmotility, and hypermobility/EDS. Diagnostic strategy centers on careful history, orthostatic vitals, tilt table testing, and selectively autonomic reflex testing and labs (e.g., catecholamines) to phenotype subtypes and rule out mimics. Management is multimodal: nonpharmacologic foundations include increased fluids and salt, compression garments, graded recumbent-to-upright exercise reconditioning, heat avoidance, and sleep and pain optimization. Medications are tailored to phenotype and may include volume expanders (e.g., fludrocortisone), vasoconstrictors (e.g., midodrine), heart rate control (low-dose beta-blockers, ivabradine), cholinergic enhancement (pyridostigmine), or sympathetic dampening (clonidine/methyldopa for hyperadrenergic features), with droxidopa for neurogenic orthostatic hypotension. He emphasizes setting realistic expectations, monitoring safety (electrolytes, BP/HR), and the generally favorable long-term outlook for many POTS patients with structured, individualized care.