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How can you tell the difference in PAF and POTS?

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The difference may lie in the physiological processes--what's actually going on inside the body--and not in the symptoms. Have you checked out the handbook on the NDRF.org Web site? If not, go to the ndrf.org home page, click on reference, and then download the pdf version of it (unless you want to order and pay for a hard copy of the book). You'll find excellent descriptions of all the dysautonomias there.

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It's actually funny that this is posted because I typed this exact topic out yesterday with the same question.

I have wondered the same thing and have the NDRF handbook but am wondering at what point they make the jump from POTS to PAF? I'm starting to wonder if this would be my severe hypotension problem?

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Briarrose, the online handbook is a little bit tricky to use, but check the table of contents in the window on the left and you'll see Pure Autonomic Failure listed there with page numbers (if I'm getting this wrong, click on "the dysautonomias" and then paf will be listed as a subcategory ... I'm sorry, but I don't have time this morning to double check! :) ) What's tricky, tho, is that the page listed on your computer screen doesn't match the actual page of the book. You have to just scroll, keeping an eye on the book pages to find what you're looking for. Good luck!

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Hi all, here's the direct link to the handbook:


and, here are links to PAF info on DINET:


Nina :)

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This is the Pure Autonomic Failure chapter written by Irwin J. Shatz in "Primer on the Autonomic Nervous System":

PAF patients have extraordinarily low recumbment plasma norepinephrine levels, whereas these should be near normal in MSA or IP patients. This is a valuable and relatively commonplace method of laboratory confirmation of the diagnosis.

Upon standing there will be little increase in plasma norepinephrine; this indicates an inability in PAF patients to stimulate the release of catecholamines.

Some of the symptoms listed for PAF in this book include the following: Orhtostatic Hypotension that causes unsteadiness, dizziness, or fainting upon standing. It is worse in the morning, after meals, exercise, or hot weather. Patients often have aching in the neck or occiput when dizzy. Lying down often relieves these symptoms. Men may have urinary tract symptoms including hesitancy, urgency, dribbling, and occasional incontinence. They may also have impotence, erectile and ejaculatory dysfunction, an inability to appreciate orgasm and retrograde ejaculation. Women may experience urinary retention or incontinence.

In the same book under the Postural Tachycardia Syndrome chapter written by Low and Schondorf it says:

Plasma norepinephrine is normal supine and normal or or increased with the patient erect.

So there are clearly differences in norepinephrine levels between POTS & PAF patients. Click here to read some of the main symptoms listed in a study on PAF and MSA patients. Note this sentence: Compensatory autonomic symptoms, such as palpitations and sweating, did not occur in either group. Tachycardia is not listed as a symptom.


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