Symptoms | Signs |
---|---|
Postural tachycardia or hypotension | |
Palpitations, dizziness, syncope Symptoms worse with vasodilatation: standing, fatigue, hot environment, menstruation, exercise, meals, infections ‘Coat hanger’ shoulder pain, orthostatic headache | Baseline tachycardia, lying and standing pulse differential 30 bpm*; orthostatic hypotension Deterioration of neurological function when upright Acrocyanosis |
Sympathetic overactivity | |
Abnormal sweating Nausea, premature satiety, vomiting, diarrhoea, constipation, abdominal pain, distension Nocturia, urgency, frequency Sleep disturbance, vivid dreams, fatigue, unrefreshing sleep Tremor Blurred vision, ‘floaters’ Generalised pain, migraine, ‘growing pains’ Hypersensitivity to light, sound, touch, odour Concentration difficulty Emotional dysregulation, anxiety, panic Symptoms worse with physical or psychological stress | Pallor, cold peripheries, bruising, blotchy skin, abnormal sweating, puffy hands, dermatographia Abdominal distension, increased or decreased bowel sounds, succussion splash, ‘squelchy’ bowel Unstable temperature Distended bladder Dilated pupils Pain trigger points Hyperreflexia, tremor Prominent startle |
Indicators of hypermobility | |
Previous congenital dislocation of hip Late walking; bottom shuffling ‘Double jointedness’ (eg, unusual gymnastic ability) Joint dislocations and sprains | Hypermobility: for example, ability to touch nose with the tongue, put hands flat on the floor with straight legs; Beighton and Brighton criteria27 Unusual sitting posture (eg, legs curled up on the chair) Stretchy skin, abnormal scarring |
Associated symptoms | |
Ineffective local anaesthetic Poor ball skills | Impaired proprioception, positive Romberg sign |
*Orthostatic tachycardia may be apparent only after standing for up to 10 min, after meals, exercise etc.43
ANS, autonomic nervous system.