Hypermobility and Dysautonomia
11th January 2023 | Dr Melanie Dani & Dr Boon Lim
Introduction
Hypermobility and dysautonomia are two conditions that often coexist and can significantly impact an individual’s daily life. Hypermobility refers to increased joint flexibility, while dysautonomia involves dysfunction of the autonomic nervous system. This article aims to provide an overview of these conditions, explaining their associated symptoms, including palpitations, chest pain, shortness of breath, sweatiness, insomnia, and the tendency to develop postural orthostatic tachycardia syndrome (POTS). It will also cover the diagnosis and management options available for individuals with hypermobility and dysautonomia.
Understanding Hypermobility and Dysautonomia
Hypermobility:
Hypermobility is a condition characterized by increased joint mobility beyond the normal range. It is often caused by a genetic variation in collagen, a protein that provides structure and support to connective tissues. Individuals with hypermobility may have joints that move beyond the expected range of motion, leading to joint pain, instability, and an increased risk of joint dislocation.
What is Ehlers Danlos Syndrome?
Dysautonomia:
Dysautonomia refers to dysfunction of the autonomic nervous system, which is responsible for regulating involuntary bodily functions such as heart rate, blood pressure, digestion, and body temperature. In dysautonomia, the autonomic nervous system does not function properly, leading to a wide range of symptoms affecting various body systems.
Associated Symptoms
Palpitations: Individuals with hypermobility and dysautonomia may experience palpitations, which are sensations of a rapid or irregular heartbeat. This can be related to the dysregulation of the autonomic nervous system and increased sensitivity to changes in heart rate.
Chest Pain: Chest pain can be a common symptom in individuals with hypermobility and dysautonomia. It may be related to musculoskeletal issues, such as joint instability or costochondritis (inflammation of the cartilage that connects the ribs to the sternum). However, chest pain may also be caused by an increasing demand of oxygen by the heart – typically during an episodes of palpitations, typically due to autonomic dysfunction, there is heightened cardiac contractility (i.e. the heart beat is stronger) associated with the increased heart rate, and together, these 2 factors cause the heart to demand more oxygen due to the heart muscle pump having to work harder for a sustained period. This form of chest pain is often worsened by standing up and relieved by lying down.
Shortness of Breath: Dysautonomia can affect the regulation of breathing, leading to episodes of shortness of breath. This symptom may be triggered by changes in posture, exercise, or emotional stress. One reason why this may occur is because excess adrenaline (or epinephrine), which is released in response to blood pooling, causes an increased breathing rate. This abnormal autonomic response may also lead to a tendency to shallow, rapid and chest breathing, in a pattern known as breathing pattern disorder.
Sweatiness: Excessive sweating, even in non-strenuous situations, can be a manifestation of dysautonomia. The autonomic nervous system plays a role in regulating sweat production, and dysregulation can result in abnormal sweating patterns.
Insomnia: Many individuals with hypermobility and dysautonomia experience sleep disturbances and insomnia. This can be due to pain, discomfort, anxiety, or disruptions in the autonomic regulation of sleep patterns.
Postural Orthostatic Tachycardia Syndrome (POTS): POTS is a specific form of dysautonomia commonly seen in individuals with hypermobility. It is characterized by an abnormal increase in heart rate upon standing, often accompanied by dizziness, lightheadedness, and fainting. POTS can significantly impact daily activities and quality of life.
Diagnosis
The diagnosis of hypermobility and dysautonomia typically involves evaluation by healthcare professionals, including rheumatologists, neurologists, and cardiologists. The diagnostic process may include:
Medical history review: Providing a detailed account of symptoms, medical history, and family history.
Physical examination: Assessing joint flexibility, autonomic functions, and other relevant signs.
Diagnostic tests: These may include electrocardiogram (ECG), echocardiogram, tilt table testing, and genetic testing for hypermobility-related conditions.
Management
Symptom management: Addressing individual symptoms is an important aspect of management. This may involve pain management strategies, physical therapy for joint stability, and medications to control specific symptoms like palpitations or sleep disturbances.
Lifestyle modifications: Adopting lifestyle changes can help manage symptoms. These may include regular exercise, maintaining a balanced diet, staying hydrated, avoiding triggers, and practicing stress-reduction techniques.
Medications: Medications may be prescribed to manage specific symptoms or underlying conditions. These can include pain relievers, beta-blockers to regulate heart rate, or medications to improve autonomic functioning.
Rehabilitation and therapy: Physical therapy, occupational therapy, and psychological counseling may be beneficial in managing hypermobility and dysautonomia. These therapies can help improve joint stability, enhance physical function, and address psychological aspects such as anxiety or depression.
Patient education and support: Understanding the conditions and learning self-management techniques are crucial. Patient education programs and support groups can provide valuable information, guidance, and emotional support.
In the video below, Dr Boon Lim, from Imperial College London, explains to a patient about why hypermobility may lead to hypervigilance, POTS and immune dysfunction, including Mast Cell Activation.
Conclusion
Hypermobility and dysautonomia are conditions that often coexist, leading to a range of symptoms affecting multiple body systems. Understanding the associated symptoms, including palpitations, chest pain, shortness of breath, sweatiness, insomnia, and the tendency to develop POTS, is essential for individuals with hypermobility and dysautonomia. Through proper diagnosis and management, including symptom-specific strategies, lifestyle modifications, and targeted therapies, individuals can improve their quality of life and effectively manage the impact of these conditions. Collaboration with healthcare professionals and patient education are key in developing personalized management plans and providing necessary support for individuals with hypermobility and dysautonomia.
