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neurally mediated hypotension

  What exactly is NMH?  I have read about the use of a tilt table in diagnosis...is this similar testing that neuro-otologists use to check for neurological vertigo?  I had a stroke at 22 that has left lasting residual problems (i.e. constant neurological vertigo, fatigue, and constant pain in my head).  My active pulse rate gets low (50's) and my resting pulse rate gets down under 50.  I am not on any meds. that would cause this (only 2 aspirin/day for stroke prevention).  I have MVP with atrial fib., and have been off beta blockers for over a year because they lowered my pulse too much.  My BP is also low, and I am constantly tired.  Can chronic pain and chronic vertigo cause one's body to stay fatigued?  Lately I have had some joint pains, and have had problems with remembering little things (foggy).  I am falling asleep early and yawning all during the day.  Any feedback would be greatly appreciated.  I just moved, and am scheduling an appointment with a neurologist here...is this something I need to bring up during a routine visit?  Thanks so much!
Thanks for your question.  NMH is an autonomic dysfunction where an inbalance
between the sympathetic (pressor elevator) and parasympathetic (pressor
depressor) system results in inappropriate cardiac and peripheral vasculature
response to postural changes.  In normal subjects, a posture change, such
as standing up, will result in relative tachycardia (acceleration of the
heart rate), and peripheral vasoconstriction.  These events occur primarily
to compensate for the gravitational pooling of blood towards the lower
The tilt-table exam consist in the continuous measurement of hemodynamic
parameters (heart rate, and blood pressure) as a patient is gradually
moved from a complete supine (horizontal) position up to different degrees
of inclination while lying on the table.
A persistent state of discomfort (pain and vertigo) can certainly result
in significant distress and fatigue, as well as daytime sleepiness.
I hope this information is helpful.  Best of luck.
This information is provided for general medical education purposes only.
Please consult your doctor regarding diagnostic and treatment options.

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