Multiple System Atrophy

Heart rate bpm -

Fig. 1. Blood pressure and heart rate before, during and after head-up tilt in a normal subject (upper panel), and in a patient with autonomic failure due to multiple system atrophy (MSA; lower panel). In the normal subject there is no fall in blood pressure during head-up tilt, unlike the patient with MSA in whom blood pressure falls promptly and remains low with a blood pressure overshoot on return to the horizontal. In the patient with MSA there is only a minimal change in heart rate despite the marked blood pressure fall, because of cardiac parasympathetic failure. In each subject continuous blood pressure and heart rate was recorded with the Portapress II

non-pharmacological and pharmacological measures, based on understanding of provoking factors and the mechanisms involved (Mathias, 2003).

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