Skip to content

Journeys of Life StoryMD Health Communities

Multiple System Atrophy

Table of Contents

Multiple System Atrophy

Cavum septi pellucidi / Cavum vergae in magnetic resonance imaging, T2 axial

Image by Hellerhoff

Overview

Unhealthy Cerebral Cortex cross section

Image by TheVisualMD

What Is Multiple System Atrophy?

Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized by a combination of symptoms that affect both the autonomic nervous system (the part of the nervous system that controls involuntary action such as blood pressure or digestion) and movement. The symptoms reflect the progressive loss of function and death of different types of nerve cells in the brain and spinal cord.

Symptoms of autonomic failure that may be seen in MSA include fainting spells and problems with heart rate, erectile dysfunction, and bladder control. Motor impairments (loss of or limited muscle control or movement, or limited mobility) may include tremor, rigidity, and/or loss of muscle coordination as well as difficulties with speech and gait (the way a person walks). Some of these features are similar to those seen in Parkinson’s disease, and early in the disease course it often may be difficult to distinguish these disorders.

MSA is a rare disease, affecting potentially 15,000 to 50,000 Americans, including men and women and all racial groups. Symptoms tend to appear in a person’s 50s and advance rapidly over the course of 5 to 10 years, with progressive loss of motor function and eventual confinement to bed. People with MSA often develop pneumonia in the later stages of the disease and may suddenly die from cardiac or respiratory issues.

While some of the symptoms of MSA can be treated with medications, currently there are no drugs that are able to slow disease progression and there is no cure.

MSA includes disorders that historically had been referred to as Shy-Drager syndrome, olivopontocerebellar atrophy, and striatonigral degeneration.

Source: National Institute of Neurological Disorders and Stroke (NINDS)

Additional Materials (9)

Cavum septi pellucidi / Cavum vergae in magnetic resonance imaging, T2 axial

Cavum septi pellucidi / Cavum vergae in magnetic resonance imaging, T2 axial

Image by Hellerhoff

Brain Gray Matter

Grey matter is distributed at the surface of the cerebral hemispheres (cerebral cortex) and of the cerebellum (cerebellar cortex). Grey matter is composed of cell bodies (neurons) as opposed to white matter (cell axons). Grey matter routes sensory or motor stimulus to interneurons of the CNS

Image by TheVisualMD

Human Head with Visible Brain

the brain is the control center of the central nervous system, responsible for behavior.

Image by TheVisualMD

Healthy Brain Highlighting Cerebral Cortex

The cerebral cortex makes up the outer covering of the brain, and is critical for intelligence, personality, planning and motor functions. In Alzheimer's disease the cortex shrinks dramatically because of the loss of neurons.

Image by TheVisualMD

Brain Structure

Major depressive disorder comprises multiple symptoms. Each symptom may be mediated by separate and distinct neuronal circuits.

Image by TheVisualMD

Healthy Brain Highlighting White Matter Tracts

Nerve tissue is divided into two types-white and gray matter. White matter makes up the bulk of nerve cell volume, and includes the axons and their protective layer, known as myelin. Alzheimer's patients show signs of reduced white matter in relation to gray matter, particularly in regions important to memory, which suggests that as the disease progresses, nerve cells are losing their axonal links to one another.

Image by TheVisualMD

Healthy Brain Highlighting Hippocampus

The hippocampus (from the Greek for \"sea horse,\" which it resembles in shape) is a region in the brain that plays a crucial role in the creation and consolidation of memories. Damage to the hippocampus results in severe deficits in memory formation. In a landmark early study involving a patient who would become thereafter famously known among neuroscientists as H.M., the intentional surgical destruction of the 27-year-old man's hippocampus, intended to remedy the debilitating seizures he suffered from, rendered him unable to form new memories for the remaining 55 years of his life.

Image by TheVisualMD

Healthy Brain Highlighting Basal Ganglia

The basal ganglia is a grouping of nerve cells located on each side of the brain's hemispheres is critical to coordinating cognition and voluntary movement; in Alzheimer's patients, their activity on both sides of the brain is no longer even, resulting in difficulty organizing thoughts and movements.

Image by TheVisualMD

Healthy Brain Highlighting Ventricles

The ventricles are four large cavities within the brain, each filled with fluid that flows between the brain and the spinal cord. Because Alzheimer's causes nerve cells to die, Alzheimer's patients tend to have larger ventricles since more of their brain tissue is destroyed.

Image by TheVisualMD

Cavum septi pellucidi / Cavum vergae in magnetic resonance imaging, T2 axial

Hellerhoff

Brain Gray Matter

TheVisualMD

Human Head with Visible Brain

TheVisualMD

Healthy Brain Highlighting Cerebral Cortex

TheVisualMD

Brain Structure

TheVisualMD

Healthy Brain Highlighting White Matter Tracts

TheVisualMD

Healthy Brain Highlighting Hippocampus

TheVisualMD

Healthy Brain Highlighting Basal Ganglia

TheVisualMD

Healthy Brain Highlighting Ventricles

TheVisualMD

What Is MSA?

Multiple System Atrophy

Image by Jensflorian

What Is Multiple System Atrophy?

Multiple system atrophy (MSA) causes the progressive loss of nerve cells in the brain (a neurodegenerative disease). MSA affects several areas of the brain, including the cerebellum, which is involved in controlling movement and some emotions, as well as certain types of learning and memory, and the autonomic nervous system, which controls your body’s automatic, or regulating functions, such as blood pressure, digestion and temperature.The initial symptoms of MSA start around age 50, and are very similar to the initial symptoms of Parkinson’s disease. These symptoms may include slowness of movement, tremor, or rigidity (stiffness), clumsiness or coordination problems, difficulties with speech, orthostatic hypotension (a condition in which blood pressure drops when rising from a seated or lying down position), and bladder control problems. Other symptoms of MSA may include muscle contractures, abnormal posture, bending of the neck, involuntary sighing, trouble sleeping and emotional problems. As MSA progresses, breathing problems while sleeping (sleep apnea) and irregular heart rhythms may develop.

MSA may be divided in 2 subtypes, depending on the main symptoms at the time when a person with MSA is evaluated:

the parkinsonian type (MSA-P), which have Parkinson disease-like symptoms, such as moving slowly, stiffness, and tremor, along with problems of balance, coordination, and autonomic nervous system dysfunction
the cerebellar type (MSA-C), with primary symptoms of cerebellar ataxia (cerebellum is the part of the brain that is responsible for movement coordination) such as problems with balance and coordination, difficulty swallowing and speaking, and abnormal eye movements

The cause of MSA is unknown, although environmental toxins, trauma, and genetic factors may be involved. Most cases occur at random, without any other cases in the family. Diagnosis of MSA is suggested by a combination of symptoms, physical examination, lab test results, and response to certain medications. However, no laboratory or imaging studies are able to confirm the diagnosis.

Treatment may include medication, physical, occupational, and speech therapy, and nutritional support. There is no cure for MSA, and there is no known way to prevent the disease from getting worse. The goal of treatment is to control symptoms. Most people with MSA survive between 6-15 years after symptoms first begin.

Source: Genetic and Rare Diseases (GARD) Information Center

Additional Materials (3)

Striatonigral Degeneration

Jensflorian

2:01

What is Multiple System Atrophy (MSA)?

MSAcoalition/YouTube

59:06

PSP and Multiple System Atrophy: Signs, Symptoms and Treatment

Parkinson Canada/YouTube

What You Need To Know

Autonomic nervous system

Image by Scientific Animations, Inc.

Multiple System Atrophy Information

What is multiple system atrophy?

Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized by symptoms of autonomic nervous system failure such as fainting spells and bladder control problems, combined with motor control symptoms such as tremor, rigidity, and loss of muscle coordination. MSA affects both men and women primarily in their 50s. Although what causes MSA is unknown, the disorder's symptoms reflect the loss of nerve cells in several different areas in the brain and spinal cord that control the autonomic nervous system and coordinate muscle movements. The loss of nerve cells may be due to the buildup of a protein called alpha-synuclein in the cells that support nerve cells in the brain.

Is there a treatment?

There is no cure for MSA. Currently, there are no treatments to delay the progress of neurodegeneration in the brain. But there are treatments available to help people cope with some of the more disabling symptoms of MSA. In some individuals, levodopa may improve motor function, but the benefit may not continue as the disease progresses.

What is the prognosis?

The disease tends to advance rapidly over the course of 5 to 10 years, with progressive loss of motor skills, eventual confinement to bed, and death. There is no remission from the disease. There is currently no cure.

Source: National Institute of Neurological Disorders and Stroke (NINDS)

Additional Materials (2)

Brain Gray Matter

TheVisualMD

1:04

Multisystem Atrophy

CTisus/YouTube

Causes

Lewy bodies (alpha synuclein inclusions) 1

Image by Suraj Rajan/Wikimedia

What Causes Multiple System Atrophy?

Multiple system atrophy is a complex condition that is likely caused by the interaction of multiple genetic, environmental, and lifestyle factors. Some of these factors have been identified, but many remain unknown.

Changes in several genes are being studied as possible risk factors for multiple system atrophy. The genetic risk factors with the most evidence are variants in the SNCA and COQ2 genes. The SNCA gene provides instructions for making a protein called alpha-synuclein, which is abundant in normal brain cells but whose function is unknown. Studies suggest that several common variations in the SNCA gene are associated with an increased risk of multiple system atrophy in people of European descent. It is unclear whether these variations also affect disease risk in other populations. The COQ2 gene provides instructions for making a protein called coenzyme Q2. This enzyme carries out one step in the production of a molecule called coenzyme Q10, which has a critical role in energy production within cells. Variations in the COQ2 gene have been associated with multiple system atrophy in people of Japanese descent, but this association has not been found in other populations. It is unclear how changes in the SNCA or COQ2 gene increase the risk of developing multiple system atrophy.

Researchers have also examined environmental factors that could contribute to the risk of multiple system atrophy. Initial studies suggested that exposure to solvents, certain types of plastic or metal, and other potential toxins might be associated with the condition. However, these associations have not been confirmed.

In all cases, multiple system atrophy is characterized by clumps of abnormal alpha-synuclein protein that, for unknown reasons, build up in cells in many parts of the brain and spinal cord. Over time, these clumps (which are known as inclusions) damage cells in parts of the nervous system that control movement, balance and coordination, and autonomic functioning. The progressive loss of cells in these regions underlies the major features of multiple system atrophy.

Source: MedlinePlus Genetics

Additional Materials (2)

Alpha-synuclein Genetic Model

Mónica Gómez Benito, Noelia Granado, Patricia García-Sanz, Anne Michel, Mireille Dumoulin and Rosario Moratalla

1:03:47

MSA Problems and Solutions

CurePSP/YouTube

COQ2 Gene

Ideogram of human chromosome 4

Image by Office of Biological and Environmental Research of the U.S. Department of Energy Office of Science, the Biological and Environmental Research Information System, Oak Ridge National Laboratory.

COQ2 Gene: Coenzyme Q2, Polyprenyltransferase

Normal Function

The COQ2 gene provides instructions for making an enzyme that carries out one step in the production of a molecule called coenzyme Q10, which has several critical functions in cells throughout the body. In cell structures called mitochondria, coenzyme Q10 plays an essential role in a process called oxidative phosphorylation, which converts the energy from food into a form cells can use. Coenzyme Q10 is also involved in producing pyrimidines, which are building blocks of DNA, its chemical cousin RNA, and molecules such as ATP and GTP that serve as energy sources in the cell. In cell membranes, coenzyme Q10 acts as an antioxidant, protecting cells from damage caused by unstable oxygen-containing molecules (free radicals), which are byproducts of energy production.

Health Conditions Related to Genetic Changes

Multiple system atrophy

Several variations in the COQ2 gene have been suggested to increase the risk of multiple system atrophy, a progressive brain disorder that affects movement and balance and disrupts the function of the autonomic nervous system. The autonomic nervous system controls body functions that are mostly involuntary, such as regulation of blood pressure.

The identified variations alter single protein building blocks (amino acids) in the COQ2 enzyme. Most of the variations are very rare, but a genetic change that replaces the amino acid valine with the amino acid alanine at position 393 (written as Val393Ala or V393A) is relatively common. Studies suggest that these variations, including V393A, are associated with an increased risk of developing multiple system atrophy in the Japanese population. However, studies have not found a correlation between COQ2 gene variations and multiple system atrophy in other populations, including Koreans, Europeans, and North Americans. It remains unclear whether COQ2 gene variations represent a significant risk factor for this disease.

Researchers speculate that changes in the COQ2 gene could impair the activity of the COQ2 enzyme, which would affect the production of coenzyme Q10. Levels of coenzyme Q10 are reduced in the brains of people with multiple system atrophy. However, the COQ2 gene variations associated with an increased risk of this disorder are thought to affect coenzyme Q10 levels less severely than the COQ2 gene mutations that cause primary coenzyme Q10 deficiency (described below). A reduction in the amount of coenzyme Q10 may impair cellular energy production from oxidative phosphorylation and increase the vulnerability of cells to damage from free radicals. However, it is unknown how these changes are related to the specific features of multiple system atrophy.

Primary coenzyme Q10 deficiency

At least nine mutations in the COQ2 gene have been found to cause a disorder known as primary coenzyme Q10 deficiency. This rare disease usually becomes apparent in infancy or early childhood, but it can occur at any age. It can affect many parts of the body, most often the brain, muscles, and kidneys. The COQ2 gene mutations associated with this disorder greatly reduce or eliminate the production of the COQ2 enzyme, which prevents the normal production of coenzyme Q10. Studies suggest that a shortage (deficiency) of coenzyme Q10 impairs oxidative phosphorylation and increases the vulnerability of cells to damage from free radicals. A deficiency of coenzyme Q10 may also disrupt the production of pyrimidines. These changes can cause cells throughout the body to malfunction, which may help explain the variety of organs and tissues that can be affected by primary coenzyme Q10 deficiency.

Other Names for This Gene

4-HB polyprenyltransferase
4-hydroxybenzoate decaprenyltransferase
4-hydroxybenzoate polyprenyltransferase, mitochondrial
CL640
coenzyme Q2 4-hydroxybenzoate polyprenyltransferase
coenzyme Q2 homolog, prenyltransferase
COQ10D1
FLJ26072
MSA1
para-hydroxybenzoate-polyprenyltransferase, mitochondrial
PHB:polyprenyltransferase
PHB:PPT

Genomic Location

The COQ2 gene is found on chromosome 4.

Source: MedlinePlus Genetics

SNCA Gene

Ideogram of human chromosome 4

Image by Office of Biological and Environmental Research of the U.S. Department of Energy Office of Science, the Biological and Environmental Research Information System, Oak Ridge National Laboratory.

SNCA Gene: Synuclein Alpha

Normal Function

The SNCA gene provides instructions for making a small protein called alpha-synuclein. Alpha-synuclein is abundant in the brain, and smaller amounts are found in the heart, muscles, and other tissues. In the brain, alpha-synuclein is found mainly at the tips of nerve cells (neurons) in specialized structures called presynaptic terminals. Presynaptic terminals release chemical messengers, called neurotransmitters, from compartments known as synaptic vesicles. The release of neurotransmitters relays signals between neurons and is critical for normal brain function.

Although the function of alpha-synuclein is not well understood, studies suggest that it plays an important role in maintaining an adequate supply of synaptic vesicles in presynaptic terminals. It may also help regulate the release of dopamine, a neurotransmitter that is critical for controlling the start and stop of voluntary and involuntary movements. Alpha-synuclein may also play a role in the movement of structures called microtubules that help cells maintain their shape.

Health Conditions Related to Genetic Changes

Multiple system atrophy

Several common variations in the SNCA gene have been found to increase the risk of multiple system atrophy, a progressive brain disorder that affects movement and balance and disrupts the function of the autonomic nervous system. The autonomic nervous system controls actions that are mostly involuntary, such as regulation of blood pressure.

The identified gene variations each change a single DNA building block (nucleotide) in the SNCA gene. Researchers are working to determine whether these changes alter the function of alpha-synuclein and how they influence the risk of developing multiple system atrophy. Variations in the SNCA gene appear to affect disease risk in people of European descent; however, studies suggest that changes in this gene are not associated with multiple system atrophy in the Chinese population or in South Koreans. It is unclear whether SNCA gene variations are a risk factor for this condition in people of other geographic and ethnic backgrounds.

Dementia with Lewy bodies

At least six mutations in the SNCA gene have been found to cause dementia with Lewy bodies. This condition is characterized by intellectual decline (dementia); visual hallucinations; sudden changes in attention and mood; and movement problems characteristic of Parkinson's disease (described below) such as rigidity of limbs, tremors, and impaired balance and coordination. A characteristic feature of this condition is Lewy bodies, which are abnormal clusters of alpha-synuclein protein in the brain. Lewy bodies also occur in Parkinson's disease, but they tend to be more widespread in the brain in dementia with Lewy bodies.

In dementia with Lewy bodies, SNCA gene mutations lead to the production of an alpha-synuclein protein with an abnormal shape. The misshapen proteins cluster together, forming the main component of Lewy bodies. These protein clusters are present throughout the brain where they impair neuron function and ultimately cause cell death. Over time, the loss of neurons increasingly impairs intellectual and motor function and the regulation of emotions, resulting in the signs and symptoms of dementia with Lewy bodies.

Parkinson's disease

At least 30 mutations in the SNCA gene have been found to cause Parkinson's disease, a condition characterized by progressive problems with movement and balance. SNCA gene mutations are associated with the early-onset form of the disorder, which typically appears before age 50. Other variations in the SNCA gene have been found to increase the risk of developing Parkinson's disease, although they do not appear to be a direct cause of the disease.

Researchers have described two types of alterations of the SNCA gene in people with Parkinson's disease. One type changes single protein building blocks (amino acids) used to make alpha-synuclein. In some cases, the amino acid alanine is replaced with the amino acid threonine at protein position 53 (written as Ala53Thr or A53T) or with the amino acid proline at position 30 (written as Ala30Pro or A30P). These alterations cause the alpha-synuclein protein to take on an incorrect 3-dimensional shape (misfold). In the other type of alteration, one of the two SNCA genes in each cell is inappropriately duplicated or triplicated. The extra copies of the SNCA gene lead to an excess of alpha-synuclein protein.

It is unclear how alterations in the SNCA gene cause Parkinson's disease. This condition involves the selective death or impairment of neurons that produce dopamine. Misfolded or excess alpha-synuclein proteins may cluster together to form Lewy bodies and impair the function of these neurons in specific regions of the brain. Lewy bodies may disrupt the regulation of dopamine, which allows dopamine to accumulate to toxic levels and eventually kill neurons. Researchers also suspect that Lewy bodies stall or shut down the cell machinery that removes unneeded proteins. As a result, unneeded proteins may clog neurons and impair their functions. Symptoms of Parkinson's disease appear when dopamine-producing neurons become impaired or die. The loss of these cells weakens communication between the brain and muscles, and ultimately the brain becomes unable to control muscle movement. The presence of Lewy bodies in a region of the brain called the substantia nigra, which controls balance and movement, are a characteristic feature of Parkinson's disease.

Other Names for This Gene

alpha-synuclein
NACP
nonA-beta component of AD amyloid
PARK1
PARK4
PD1
synuclein, alpha (non A4 component of amyloid precursor)
SYUA_HUMAN

Genomic Location

The SNCA gene is found on chromosome 4.

Source: MedlinePlus Genetics

Symptoms

Anatomy of Upper Digestive Tract Involved in Swallowing

Image by TheVisualMD

What Are the Common Signs or Symptoms of MSA?

The initial symptoms of MSA are often difficult to distinguish from the initial symptoms of Parkinson’s disease and include:

slowness of movement, tremor, or rigidity (stiffness)
clumsiness or incoordination
impaired speech, a croaky, quivering voice
fainting or lightheadedness due to orthostatic hypotension, a condition in which blood pressure drops when rising from a seated or lying down position
bladder control problems, such as a sudden urge to urinate or difficulty emptying the bladder

Doctors divide MSA into two different types, depending on the most prominent symptoms at the time an individual is evaluated:

the parkinsonian type (MSA-P), with primary characteristics similar to Parkinson’s disease (such as moving slowly, stiffness, and tremor) along with problems of balance, coordination, and autonomic nervous system dysfunction
the cerebellar type (MSA-C), with primary symptoms featuring ataxia (problems with balance and coordination), difficulty swallowing, speech abnormalities or a quavering voice, and abnormal eye movements (“cerebellar” reflects a part of the brain involved with coordination)

MSA tends to progress more rapidly than Parkinson’s disease, and most people with MSA will require an aid for walking, such as a cane or walker, within a few years after symptoms begin.

Additional symptoms of MSA include:

contractures (chronic shortening of muscles or tendons around joints, which prevents the joints from moving freely) in the hands or limbs
Pisa syndrome, an abnormal posture in which the body appears to be leaning to one side like the Leaning Tower of Pisa
antecollis, in which the neck bends forward and the head drops down
involuntary, uncontrollable sighing or gasping
sleep disorders, including a tendency to act out dreams (called REM/ (Rapid Eye Movement sleep behavior disorder)

Some people with MSA may experience feelings of anxiety or depression.

Source: National Institute of Neurological Disorders and Stroke (NINDS)

Additional Materials (5)

Zenker's diverticulum

Bernd Bragelmann Braegel. Mit freundlicher Genehmigung von Dr. Martin Steinhoff.

Orthostatic Hypertension Demonstration

RadioSmith

Blurred Vision (in the Mirror)

noniq

59:06

PSP and Multiple System Atrophy: Signs, Symptoms and Treatment

Parkinson Canada/YouTube

Swallowing food exposing the Upper Digestive Tract

TheVisualMD

Diagnosis

PET Scan

Image by Jens Langner

How Is MSA Diagnosed?

Making a diagnosis of MSA can be difficult, particularly in the early stages, in part because many of the features are similar to those observed in Parkinson’s disease.

After taking a clinical history and performing a brief neurological examination, a doctor may order a number of tests to help make the diagnosis. These tests might include autonomic testing (such as blood pressure control, heart rate control), assessment of bladder function, and/or neuroimaging such as an MRI (magnetic resonance imaging) or PET scan. An MRI of the brain may identify changes which might suggest MSA or rule out other causes of the observed symptoms.

A PET scan (positron emission tomography, which allows doctors to see how organs and tissues are functioning) is sometimes used to see if metabolic function is reduced in specific parts of the brain. DaTscan can assess the dopamine transporter in a part of the brain called the striatum and can help physicians determine if the condition is caused by a dopamine system disorder; however this test cannot differentiate between MSA and Parkinson’s disease. Individuals with MSA typically do not have sustained improvement in their symptoms with levodopa (a drug used to treat Parkinson’s disease), a finding that often supports the diagnosis of MSA.

Source: National Institute of Neurological Disorders and Stroke (NINDS)

Additional Materials (6)

Comparison of Healthy Brain and Depressed Brain

Functional changes are often found in the brains of depressed individuals, as is shown in this comparison of images based on positron emission tomography (PET). A PET scan measures vital functions such as blood flow, oxygen use and blood sugar metabolism. The image on the right exhibits a depressed brain with a non-depressed brain on the left showing increased brain metabolism. Current theory does hold that changes in function eventually lead to changes in structure. In healthy individuals, this means the development of more complexity in the brain. For those with depression, negative functional changes lead to unhealthy alterations in structure. Some of these are completely reversible with treatment. This will depend on the severity of the depression, how long it lasts, and whether it recurs and how often.

Image by TheVisualMD

Single-photon emission computed tomography

Brain SPECT transaxial images showing diffuse patchy cortical distribution of 99 mTc-ECD, in particular significant cortical hypoperfusion in the left frontal lobe and in both temporal lobes (arrows).

Image by Alberto Bocchetta, Giorgio Tamburini, Pina Cavolina, Alessandra Serra, Andrea Loviselli and Mario Piga

Male with visible brain scans showing various specialized diagnostic imaging techniques for Alzheimer's ( from left to right: FDG PET, PiB-PET, CT, MRI)

Until very recently, we have had frustratingly few tools when it comes to screening our neurological health. That may be about to change. Imaging technologies are poised to make it possible to predict the onset of degenerative brain diseases, as well as guide early interventions. Diagnostic screening that is showing promise includes computerized tomography (CT), which is good at ruling out tumors, strokes and head injuries; magnetic resonance imaging (MRI), which may be used to measure volume and determine whether brain tissue is shrinking; and positron emission tomography (PET), which shows particular potential in identifying the tell-tale plaques of Alzheimer's disease.

Image by TheVisualMD

PET-MRI

Computer screenshot showing a PET image (upper left), MRI image (upper right) and the combined PET-MRI image where PET data is overlaid over the MRI data (lower right)

Image by Mco44

The Brain and Spinal Cord

A PET scan is helpful for showing activity in different parts of the brain. (credit: Health and Human Services Department, National Institutes of Health)

Image by CNX Openstax (credit: Health and Human Services Department, National Institutes of Health)

Specialized Imaging

Doctors can get some idea of how much amyloid plaques have encroached on healthy brain tissue by taking sophisticated pictures of brain activity, which can highlight where nerve cells are becoming weaker and starting to deteriorate and may eventually affect brain function.

Image by TheVisualMD

Comparison of Healthy Brain and Depressed Brain

TheVisualMD

Single-photon emission computed tomography

Alberto Bocchetta, Giorgio Tamburini, Pina Cavolina, Alessandra Serra, Andrea Loviselli and Mario Piga

Male with visible brain scans showing various specialized diagnostic imaging techniques for Alzheimer's ( from left to right: FDG PET, PiB-PET, CT, MRI)

TheVisualMD

PET-MRI

Mco44

The Brain and Spinal Cord

CNX Openstax (credit: Health and Human Services Department, National Institutes of Health)

Specialized Imaging

TheVisualMD

Tilt-Table Test

Tilt-Table Test

Also called: TTT, Tilt-Table Exam, Tilt Tests

A tilt-table test monitors blood pressure, heart rate, and symptoms while positioned at different angles on a table. The test is used to evaluate the cause of unexplained fainting.

Tilt-Table Test

Also called: TTT, Tilt-Table Exam, Tilt Tests

A tilt-table test monitors blood pressure, heart rate, and symptoms while positioned at different angles on a table. The test is used to evaluate the cause of unexplained fainting.

{"label":"Tilt table reference range","scale":"lin","step":0.25,"hideunits":true,"items":[{"flag":"negative","label":{"short":"Negative","long":"Negative","orientation":"horizontal"},"values":{"min":0,"max":1},"text":"A negative tilt table test is characterized by a moderate increase in heart rate and the maintaining of the systolic blood pressure above 90 mmHg without symptoms during the planned duration of the study.","conditions":[]},{"flag":"positive","label":{"short":"Positive","long":"Positive","orientation":"horizontal"},"values":{"min":1,"max":2},"text":"A positive tilt table test is characterized by a drop of systolic blood pressure below 90 mmHg with the test ending in syncope (fainting) or in presyncope (symptoms of fainting, such as lightheadedness, decreased vision or trouble hearing, nausea, and vomiting).","conditions":["Autonomic neuropathy","Bradycardia","Heart arrhythmia","Low blood pressure","Multiple system atrophy","Orthostatic hypotension","Tachycardia","Vasovagal syncope"]}],"value":0.5}[{"negative":0},{"positive":0}]
Use the slider below to see how your results affect your health.
Your result is Negative.
A negative tilt table test is characterized by a moderate increase in heart rate and the maintaining of the systolic blood pressure above 90 mmHg without symptoms during the planned duration of the study.
Related conditions
This test measures your blood pressure and heart rate as you change your posture and position. During the test:
- You will lie flat on a motorized table that has a footrest.
- Soft safety straps will be placed across your body.
- A health care provider will put electrodes on your chest and blood pressure cuffs on one of your arms and a finger. An IV line may also be placed in your arm or hand to inject medicine or fluids if needed.
- You will remain flat on the table for about 15 minutes.
- A health care provider will tilt the table to an almost standing position for up to 45 minutes.
- Your provider will check your blood pressure and heart rate.
- If the test causes you to faint, the table will be quickly returned to the flat position.
1. Autonomic Testing: MedlinePlus Medical Test [accessed on Mar 30, 2024]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (4)

4:34

British Heart Foundation - Your guide to tilt test - YouTube

British Heart Foundation/YouTube

5:36

Autonomic Test - About your Mayo Clinic Test

Mayo Clinic/YouTube

1:33

What is a tilt table test?

Premier Health/YouTube

1:27

Tilt Table Testing - Diagnostic Procedure

South Texas Health System/YouTube

PET Scan

PET Scan

Also called: PET Imaging, Positron Emission Tomography, Positron Emission Testing

A PET scan is an imaging test that uses a radioactive substance (tracer) to check for changes in chemical activity in the body. This activity may be a sign of cancer, heart disease, or a brain disorder.

PET Scan

Also called: PET Imaging, Positron Emission Tomography, Positron Emission Testing

A PET scan is an imaging test that uses a radioactive substance (tracer) to check for changes in chemical activity in the body. This activity may be a sign of cancer, heart disease, or a brain disorder.

{"label":"PET Scan Reference Range","scale":"lin","step":0.25,"hideunits":true,"items":[{"flag":"normal","label":{"short":"Normal","long":"Normal","orientation":"horizontal"},"values":{"min":0,"max":1},"text":"There are no problems detected in the size, shape, or function of the organ being scanned. There are no areas in which the tracer has abnormally collected.","conditions":[]},{"flag":"abnormal","label":{"short":"Abnormal","long":"Abnormal","orientation":"horizontal"},"values":{"min":1,"max":2},"text":"A PET scan can find abnormal activity and it can be more sensitive than other imaging tests. It may also show changes to your body sooner.","conditions":["Cancer","Heart disease","Brain disorder"]}],"value":0.5}[{"normal":0},{"abnormal":0}]
Use the slider below to see how your results affect your health.
Your result is Normal.
There are no problems detected in the size, shape, or function of the organ being scanned. There are no areas in which the tracer has abnormally collected.
Related conditions
A PET scan is most often used to:
- Diagnose or monitor certain cancers, including breast, thyroid, and lung cancers
- Find out how well your heart muscle is working
- Check blood flow to the heart
- Check for signs of certain brain disorders, such as Parkinson's disease, Huntington's disease, Alzheimer's disease, and types of dementia. Dementia is not a specific disease. It is a term used to describe a decline in mental function that is severe enough to affect daily living.
A PET scan is often done along with a CT scan, a type of x-ray that takes a series of pictures as it rotates around you.
You may need a PET scan to find out if you have cancer. If you've already been diagnosed with cancer, you may need this test to see if your cancer treatment is working.
A PET scan also helps diagnose and monitor heart and brain diseases. So you may need this test if you:
- Have a family history of heart disease
- Are being treated for heart disease. This test can show if the treatment is working.
- Have symptoms of a brain disease, such as tremors, memory problems, and/or seizures
Before the scan, you will change into a hospital gown. You may be asked to empty your bladder. During the scan:
- A health care provider will inject the radioactive tracer into your vein through an intravenous (IV) line. The tracer sends out a form of energy called gamma rays. The rays are picked up by the scanner to create images of the inside of your body.
- You will need to wait for the tracer to be absorbed by your body. This takes 45 to 60 minutes.
- You will then lie on a narrow, padded table, which will slide into a large, tunnel-shaped scanner.
- The scanner will move slowly across your body to capture images. You will need to be very still as this happens.
- The scanner will send images to a computer monitor for the provider to review.
- Your provider will then remove the IV line.
Depending on which part of the body was being scanned, your results may show:
- Cancer. Cancer cells show up as bright spots on a PET scan.
- Heart disease. The scan can show decreased blood flow to the heart.
- A brain disorder. The scan may show changes in certain brain chemicals that can indicate disease.
If you also had a CT scan, your provider will review the results of the two scans to help make a diagnosis.
If you have questions about your results, talk to your health care provider.
1. https://my.clevelandclinic.org/health/diagnostics/10123-pet-scan [accessed on Jul 27, 2021]
2. https://medlineplus.gov/ency/article/007341.htm [accessed on Jul 27, 2021]
3. https://medlineplus.gov/ency/article/007342.htm [accessed on Jul 27, 2021]
4. https://medlineplus.gov/ency/article/007343.htm [accessed on Jul 27, 2021]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (23)

What is it Like to Have a PET Scan? | Cancer Research UK

Video by Cancer Research UK/YouTube

PET Scan in 3 views

1

2

3

PET Scan in 3 views

PET Scan in 3 views

Interactive by TheVisualMD

PET/CT

1

2

3

PET/CT Scans of Colorectal Cancer 1) Pet/CT scan 2) CT Scan 3) Pet Scan

PET scans can often detect a tumor that can't be seen on CT scans or regular X-rays. Cancer tumors grow rapidly and so actively metabolize glucose. In a PET scan, the patient is injected with glucose containing a radioactive tracer. The PET scan image shows areas of the body that utilize the glucose. The brain, heart, and bladder all metabolize glucose and appear black in the image, along with any cancer tumors that are present.

Interactive by TheVisualMD

How Does a PET Scan Work?

Video by NIBIB gov/YouTube

UCSF Radiology: How does a PET scan help with cancer imaging?

Video by UCSF Imaging/YouTube

Your PET/CT scan at University College Hospital

Video by University College London Hospitals NHS Foundation Trust/YouTube

How X-rays see through your skin - Ge Wang

Video by TED-Ed/YouTube

PET Scans and CAT Scans

Video by Lee Health/YouTube

Having a PET-CT scan

Video by Design Science/YouTube

How does a PET scan work?

Video by Imperial College London/YouTube

Patient exercises

1

2

3

4

5

6

Myocardial perfusion scan

Myocardial perfusion imaging is a test that uses a low dose of a radioactive agent to evaluate the blood flow and function of the heart. This scan is done in conjunction with a cardiac stress test a diagnostic test in which a person walks on a treadmill or pedals (a stationary bicycle) while hooked up to equipment that monitors the heart. The test monitors heart rate breathing blood pressure electrical activity (on an electrocardiogram) and the person's level of tiredness. It shows if the heart's blood supply is sufficient and if the heart rhythm is normal. A stress test can detect the following problems: - Abnormal changes in heart rate or blood pressure - Symptoms such as shortness of breath or chest pain - Abnormal changes in the heart's rhythm or electrical activity

Interactive by TheVisualMD

Testing for bowel cancer

Video by Cancer Research UK/YouTube

MRI Animation

Video by Blausen Medical Corporate/YouTube

Carcinogenesis head and neck short version only animation

Video by Amsterdam UMC/YouTube

Head and Neck Cancer

Video by Robert Miller/YouTube

What are the Risk Factors and Symptoms of Head and Neck Cancers? | Dana-Farber Cancer Institute

Video by Dana-Farber Cancer Institute/YouTube

Introduction to Head and Neck Cancer | Memorial Sloan Kettering

Video by Memorial Sloan Kettering/YouTube

Throat Cancer

Video by Michigan Medicine/YouTube

Rush Radiosurgery: Head and Neck Cancer Radiation

Video by Rush Radiosurgery/YouTube

Treating the head and neck - Radiotherapy and its physics (3/15)

Video by OpenLearn from The Open University/YouTube

Nutrition Video for Head & Neck Cancer

Video by Stanford Health Care/YouTube

Throat Cancer Largely Due to Smoking And Drinking, Studies Show

Video by VOA News/YouTube

What is nuclear medicine? An illustrated introduction

Video by navalorama/YouTube

3:13

What is it Like to Have a PET Scan? | Cancer Research UK

Cancer Research UK/YouTube

PET Scan in 3 views

TheVisualMD

PET/CT Scans of Colorectal Cancer 1) Pet/CT scan 2) CT Scan 3) Pet Scan

TheVisualMD

1:33

How Does a PET Scan Work?

NIBIB gov/YouTube

1:30

UCSF Radiology: How does a PET scan help with cancer imaging?

UCSF Imaging/YouTube

3:31

Your PET/CT scan at University College Hospital

University College London Hospitals NHS Foundation Trust/YouTube

4:42

How X-rays see through your skin - Ge Wang

TED-Ed/YouTube

1:37

PET Scans and CAT Scans

Lee Health/YouTube

5:17

Having a PET-CT scan

Design Science/YouTube

4:25

How does a PET scan work?

Imperial College London/YouTube

Myocardial perfusion scan

TheVisualMD

1:37

Testing for bowel cancer

Cancer Research UK/YouTube

0:36

MRI Animation

Blausen Medical Corporate/YouTube

4:03

Carcinogenesis head and neck short version only animation

Amsterdam UMC/YouTube

7:27

Head and Neck Cancer

Robert Miller/YouTube

2:35

What are the Risk Factors and Symptoms of Head and Neck Cancers? | Dana-Farber Cancer Institute

Dana-Farber Cancer Institute/YouTube

18:04

Introduction to Head and Neck Cancer | Memorial Sloan Kettering

Memorial Sloan Kettering/YouTube

6:01

Throat Cancer

Michigan Medicine/YouTube

1:13

Rush Radiosurgery: Head and Neck Cancer Radiation

Rush Radiosurgery/YouTube

1:57

Treating the head and neck - Radiotherapy and its physics (3/15)

OpenLearn from The Open University/YouTube

4:25

Nutrition Video for Head & Neck Cancer

Stanford Health Care/YouTube

2:39

Throat Cancer Largely Due to Smoking And Drinking, Studies Show

VOA News/YouTube

3:02

What is nuclear medicine? An illustrated introduction

navalorama/YouTube

Blood Pressure Test

Blood Pressure Test

Also called: Blood pressure reading, Blood pressure screening, Systolic (maximum) pressure over diastolic (minimum) pressure

A blood pressure measurement is a test most often used to check for high blood pressure, a common condition that increases the risk for heart disease and stroke. The test can diagnose high blood pressure early, so it can be treated before it causes serious complications.

Blood Pressure Test

Also called: Blood pressure reading, Blood pressure screening, Systolic (maximum) pressure over diastolic (minimum) pressure

A blood pressure measurement is a test most often used to check for high blood pressure, a common condition that increases the risk for heart disease and stroke. The test can diagnose high blood pressure early, so it can be treated before it causes serious complications.

{"label":"BP systolic reference range","scale":"lin","step":1,"hideunits":false,"items":[{"flag":"abnormal","label":{"short":"L","long":"Low","orientation":"horizontal"},"values":{"min":50,"max":90},"text":"Some people can naturally have low blood pressure levels. However, in most cases, a BP lower than 90\/60 can cause signs and symptoms of hypotension, such as dizziness, lightheadedness, blurry vision, and nausea. ","conditions":["Hypotension","Dehydration","Blood loss","Pregnancy","Some medications"]},{"flag":"normal","label":{"short":"N","long":"Normal","orientation":"horizontal"},"values":{"min":90,"max":121},"text":"Systolic blood pressure is the pressure inside the body's arteries as the heart beats while pumping blood. It is the upper (higher) number of the two measuring blood pressure.","conditions":[]},{"flag":"borderline","label":{"short":"E","long":"Elevated","orientation":"horizontal"},"values":{"min":121,"max":130},"text":"Blood pressure in this range is called prehypertension. At this stage, doctors are likely to prescribe lifestyle changes to prevent the development of hypertension. <br \/>\n","conditions":["Prehypertension"]},{"flag":"abnormal","label":{"short":"H","long":"High","orientation":"horizontal"},"values":{"min":130,"max":140},"text":"At this stage of high blood pressure, doctors are likely to prescribe lifestyle changes and may consider adding blood pressure medication based on your risk of cardiovascular disease, such as heart attack or stroke. ","conditions":["Hypertension Stage 1","Cardiovascular disease","Heart attack","Stroke","Chronic kidney disease"]},{"flag":"abnormal","label":{"short":"VH","long":"Very high","orientation":"horizontal"},"values":{"min":140,"max":200},"text":"At this stage of high blood pressure, doctors are likely to prescribe a combination of blood pressure medications along with lifestyle changes.","conditions":["Hypertension Stage 2","Cardiovascular disease","Heart attack","Stroke","Chronic kidney disease"]}],"units":[{"printSymbol":"mm\u00a0Hg","code":"mm[Hg]","name":"millimeter of mercury"}],"value":105}[{"abnormal":0},{"normal":0},{"borderline":0},{"abnormal":0},{"abnormal":1}]
Use the slider below to see how your results affect your health.
mm Hg
90
121
130
140
Your result is Normal.
Systolic blood pressure is the pressure inside the body's arteries as the heart beats while pumping blood. It is the upper (higher) number of the two measuring blood pressure.
Related conditions
{"label":"BP diastolic reference range","scale":"lin","step":1,"hideunits":false,"items":[{"flag":"abnormal","label":{"short":"L","long":"Low","orientation":"horizontal"},"values":{"min":40,"max":60},"text":"Some people can naturally have low blood pressure levels. However, in most cases, a BP lower than 90\/60 can cause signs and symptoms of hypotension, such as dizziness, lightheadedness, blurry vision, and nausea. ","conditions":["Hypotension","Dehydration","Blood loss","Pregnancy","Some medications"]},{"flag":"normal","label":{"short":"N","long":"Normal","orientation":"horizontal"},"values":{"min":60,"max":81},"text":"Diastolic blood pressure is the pressure in the arteries when the heart is at rest between beats. It is the lower number of the two measuring blood pressure.","conditions":[]},{"flag":"abnormal","label":{"short":"H","long":"High","orientation":"horizontal"},"values":{"min":81,"max":90},"text":"At this stage of high blood pressure, doctors are likely to prescribe lifestyle changes and may consider adding blood pressure medication based on your risk of cardiovascular disease, such as heart attack or stroke. ","conditions":["Hypertension Stage 1","Cardiovascular disease","Heart attack","Stroke","Chronic kidney disease"]},{"flag":"abnormal","label":{"short":"VH","long":"Very high","orientation":"horizontal"},"values":{"min":90,"max":120},"text":"At this stage of high blood pressure, doctors are likely to prescribe a combination of blood pressure medications along with lifestyle changes.","conditions":["Hypertension Stage 2","Cardiovascular disease","Heart attack","Stroke","Chronic kidney disease"]}],"units":[{"printSymbol":"mm\u00a0Hg","code":"mm[Hg]","name":"millimeter of mercury"}],"value":70}[{"abnormal":0},{"normal":0},{"abnormal":0},{"abnormal":1}]
Use the slider below to see how your results affect your health.
mm Hg
60
81
90
Your result is Normal.
Diastolic blood pressure is the pressure in the arteries when the heart is at rest between beats. It is the lower number of the two measuring blood pressure.
Related conditions
Each time your heart beats, it pumps blood into your arteries. A blood pressure measurement is a test that measures the force (pressure) in your arteries as your heart pumps. Blood pressure is measured as two numbers:
- Systolic blood pressure (the first and higher number) measures pressure inside your arteries when the heart beats.
- Diastolic blood pressure (the second and lower number) measures the pressure inside the artery when the heart rests between beats.
High blood pressure, also known as hypertension, affects tens of millions of adults in the United States. It increases the risk of life-threatening conditions including heart attack and stroke. But high blood pressure rarely causes symptoms. A blood pressure measurement helps diagnose high blood pressure early, so it may be treated before it leads to serious complications.
A blood pressure measurement is most often used to diagnose high blood pressure.
Blood pressure that's too low, known as hypotension, is much less common. But you may get tested for low blood pressure if you have certain symptoms. Unlike high blood pressure, low blood pressure usually causes symptoms. These include:
- Dizziness or lightheadedness
- Nausea
- Cold, sweaty skin
- Pale skin
- Fainting
- Weakness
A blood pressure measurement is often included as part of a regular checkup. Adults 18 years and older should have their blood pressure measured at least once every two to five years. You should get tested every year if you have certain risk factors. You may be at higher risk if you:
- Are 40 years old or older
- Are overweight or have obesity
- Have a family history of heart disease or diabetes
- Take birth control pills
- Are Black/African American. Black/African Americans have a higher rate of high blood pressure than other racial and ethnic groups
You may need this test if you have symptoms of low blood pressure.
A blood pressure test includes the following steps:
- You will sit in a chair with your feet flat on the floor.
- You will rest your arm on a table or other surface, so your arm is level with your heart. You may be asked to roll up your sleeve.
- Your provider will wrap a blood pressure cuff around your arm. A blood pressure cuff is a strap-like device. It should fit snugly around your upper arm, with the bottom edge placed just above your elbow.
- Your provider will inflate the blood pressure cuff using a small hand pump or by pressing a button on an automated device.
- Your provider will measure the pressure manually (by hand) or with an automated device.
  If manually, he or she will place a stethoscope over the major artery in your upper arm to listen to the blood flow and pulse as the cuff inflates and deflates.
  If using an automated device, the blood pressure cuff automatically inflates, deflates, and measures pressure.
- As the blood pressure cuff inflates, you'll feel it tighten around your arm.
- Your provider will then open a valve on the cuff to slowly release air from it. As the cuff deflates, blood pressure will fall.
- As the pressure falls, a measurement is taken when the sound of blood pulsing is first heard. This is the systolic pressure.
- As the air continues to be let out, the blood pulsing sound will start to go away. When it completely stops, another measurement is taken. This is the diastolic pressure.
This test only takes about one minute to complete.

Your results, also known as a blood pressure reading, will contain two numbers. The top or first number is the systolic pressure. The bottom or second number is the diastolic pressure. High blood pressure readings are also labeled by categories, ranging from normal to crisis. Your reading may show your blood pressure is:

Blood Pressure Category	Systolic Blood Pressure		Diastolic Blood Pressure
Normal	Less than 120	and	Less than 80
High Blood Pressure (no other heart risk factors)	140 or higher	or	90 or higher
High Blood Pressure (with other heart risk factors, according to some providers)	130 or higher	or	80 or higher
Dangerously high blood pressure - seek medical care right away	180 or higher	and	120 or higher

If you've been diagnosed with high blood pressure, your provider may recommend lifestyle changes and/or medicines to control your blood pressure. Your provider may also recommend that you regularly check your blood pressure at home with an automated blood pressure monitor. An at-home blood pressure monitor usually includes a blood pressure cuff and a digital device to record and display blood pressure readings.

Home monitoring is not a replacement for regular visits to your provider. But it can provide important information, such as whether treatment is working or your condition may have worsened. Also, home monitoring may make the test less stressful. Many people get nervous about getting their blood pressure taken at a provider's office. This is called "white coat syndrome." It can cause a temporary rise in blood pressure, making the results less accurate. For more information about home monitoring of blood pressure, talk to your provider.

If you were tested for low blood pressure, a blood pressure reading of 90 systolic, 60 diastolic (90/60) or lower is considered abnormal. Treatments for low blood pressure may include medicines and making certain changes to your diet.

If you were diagnosed with high blood pressure, your provider may recommend one or more of the following lifestyle changes.
- Exercise regularly. Staying active can help lower your blood pressure and also help manage your weight. Most adults should aim for 150 minutes of physical activity per week. Check with your provider before beginning an exercise program.
- Keep a healthy weight. If you are overweight, losing as little as 5 pounds can lower your blood pressure.
- Eat a healthy diet that includes fruits, vegetable, and whole grains. Limit foods high in saturated fat and total fat.
- Reduce salt in your diet. Most adults should have less than 1500 mg of salt per day.
- Limit alcohol use. If you choose to drink, limit yourself to one drink a day if you are a woman; two drinks a day if you're a man.
- Don't smoke.
1. https://www.cdc.gov/bloodpressure/measure.htm [accessed on Mar 24, 2019]
2. https://www.nhlbi.nih.gov/health-topics/high-blood-pressure [accessed on Mar 24, 2019]
3. https://www.nhlbi.nih.gov/node/80139 [accessed on Mar 24, 2019]
4. https://www.nia.nih.gov/health/high-blood-pressure [accessed on Mar 24, 2019]
5. https://newsinhealth.nih.gov/2018/01/experts-lower-high-blood-pressure-numbers [accessed on Mar 24, 2019]
6. https://newsinhealth.nih.gov/2016/01/blood-pressure-matters [accessed on Mar 24, 2019]
7. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/11/09/11/41/2017-guideline-for-high-blood-pressure-in-adults [accessed on Mar 27, 2019]
8. https://www.acc.org/latest-in-cardiology/articles/2017/11/14/14/42/the-2017-high-blood-pressure-guideline-risk-reduction-through-better-management [accessed on Mar 27, 2019]

Additional Materials (50)

This browser does not support the video element.

What is Blood Pressure?

Blood pressure is stated as two numbers that represent the highest and lowest pressure your heart attains during a single beat. The first or top number represents the pressure when your heart contracts: the systolic pressure. The second or bottom number represents the pressure when your heart rests between beats: the diastolic pressure.

Video by TheVisualMD

This browser does not support the video element.

What is Hypertension?

Go deep inside the human body to understand how your blood pressure works, as you travel into the vessels to see the damage that high blood pressure leaves in its wake. Listen to some of the world's top doctors, including renowned cardiologist Mehmet Oz, talk about why hypertension is "the silent killer" and how you can defend yourself against it.

Video by TheVisualMD

How blood pressure works - Wilfred Manzano

Video by TED-Ed/YouTube

What is blood pressure? | Circulatory system physiology | NCLEX-RN | Khan Academy

Video by khanacademymedicine/YouTube

The Heart, Part 1 - Under Pressure: Crash Course A&P #25

Video by CrashCourse/YouTube

The Heart, Part 2 - Heart Throbs: Crash Course A&P #26

Video by CrashCourse/YouTube

Systole vs. Diastole | Match Health

Video by Match Health/YouTube

Lub Dub | Circulatory system physiology | NCLEX-RN | Khan Academy

Video by khanacademymedicine/YouTube

Understanding Blood Pressure | Human Anatomy and Physiology video 3D animation | elearnin

Video by Elearnin/YouTube

Regulation of blood pressure with baroreceptors | NCLEX-RN | Khan Academy

Video by khanacademymedicine/YouTube

Systolic murmurs, diastolic murmurs, and extra heart sounds - Part 1 | NCLEX-RN | Khan Academy

Video by khanacademymedicine/YouTube

Systolic murmurs, diastolic murmurs, and extra heart sounds - Part 2 | NCLEX-RN | Khan Academy

Video by khanacademymedicine/YouTube

High Blood Pressure - Causes, Symptoms and Treatment Options

Video by Rehealthify/YouTube

Blood Pressure Medicines - What You Need To Know

Video by Rehealthify/YouTube

High blood pressure - What is it?

Video by Healthchanneltv / cherishyourhealthtv/YouTube

Treating High Blood Pressure

Video by Centers for Disease Control and Prevention (CDC)/YouTube

Medicating for High Blood Pressure (HBP #3)

Video by Healthguru/YouTube

High Blood Pressure and Your Kidneys - A to Z Guide

Video by National Kidney Foundation/YouTube

Renin Angiotensin Aldosterone System

Video by Mechanisms in Medicine/YouTube

5 Major Effects of High Blood Pressure - 3D Medical Animation

Video by kreativevistas/YouTube

High Blood Pressure Basics

Video by Centers for Disease Control and Prevention (CDC)/YouTube

Hypertension effects on the heart | Health & Medicine | Khan Academy

Video by khanacademymedicine/YouTube

Hypertension

Video by GABAY MEDICAL library/YouTube

Hypertension and Stroke (Health Tip)

Video by Healthguru/YouTube

Medical Shock - The Correct Treatment

Video by justdoitguides/YouTube

Cardiogenic shock | Circulatory System and Disease | NCLEX-RN | Khan Academy

Video by khanacademymedicine/YouTube

Consequences of High Blood Pressure (HBP #2)

Video by Healthguru/YouTube

Shock Explained in 120 Seconds | Treatment, Symptoms, Causes | Video

Video by Lifestyle by IK/YouTube

What is shock? | Circulatory System and Disease | NCLEX-RN | Khan Academy

Video by khanacademymedicine/YouTube

Shock - hemodynamics | Circulatory System and Disease | NCLEX-RN | Khan Academy

Video by khanacademymedicine/YouTube

Hypovolemic shock | Circulatory System and Disease | NCLEX-RN | Khan Academy

Video by khanacademymedicine/YouTube

Syncope Diagnosed

Video by smallcogbigmachine/YouTube

Syncope Causes

Video by smallcogbigmachine/YouTube

How the heart actually pumps blood - Edmond Hui

Video by TED-Ed/YouTube

Hypertension - High Blood Pressure, Animation

Video by Alila Medical Media/YouTube

British Heart Foundation - Your guide to 24 hour blood pressure and Holter monitoring tests

Video by British Heart Foundation/YouTube

What are Palpitations

Video by smallcogbigmachine/YouTube

The Cardiac Cycle, Animation

Video by Alila Medical Media/YouTube

Aldosterone raises blood pressure and lowers potassium | NCLEX-RN | Khan Academy

Video by khanacademymedicine/YouTube

Understanding Blood Pressure

Video by British Heart Foundation/YouTube

SPRINT Participant Has Blood Pressure Measured

In this image: Mr. Curtis Minor, 58 year old AA Male who is taking part in the SPRINT study at Downtown Health Plaza with Miriam Baird, RN. A major NIH-funded clinical trial has discovered nuanced evidence linking brain and vascular health.

Image by National Institutes of Health (NIH)

Man getting Blood Pressure Reading

Some risk factors for prostate cancer are controllable, some aren't. Knowing what the risk factors are can help you to lower your chances of getting prostate cancer and to make decisions about beginning screening.

Image by TheVisualMD

Doctor Taking Woman's Blood Pressure

This image shows a female patient having blood pressure read by a male doctor and by using a blood pressure cuff in a clinical setting. Hypertension is often referred to as the \"silent killer,\" because it can cause no symptoms and go undetected for years. And as hypertension goes undiagnosed, the delicate linings of your blood vessels are being damaged, particularly those of the heart, the kidneys, and the eyes. Hypertension is another word for high blood pressure; it has nothing to do with whether a person is considered tense or high-strung. Blood pressure is the measurement of the force the blood exerts as it pushes against the walls of your arteries. Your blood pressure is measured by a blood pressure cuff that is wrapped around your upper arm. Originally the readings referred to the height of a displaced column of mercury, but as in thermometers, the mercury yardstick is giving way to digital technologies. The \"top\" or first number-systolic pressure-represents the blood's pressure as the heart is contracted. The \"bottom\" or second number-diastolic pressure-represents the blood's pressure in the vessels when the heart is relaxed. Normal blood pressure is in the range of 120 (systolic) over 70 (diastolic).

Image by TheVisualMD

Blood Pressure

Taking a person's blood pressure

Image by BruceBlaus

Blood Pressure

Blood pressure is stated as two numbers that represent the highest and lowest pressure your heart attains during a single beat. The first or top number represents the pressure when your heart contracts: the systolic pressure. The second or bottom number represents the pressure when your heart rests between beats: the diastolic pressure.

Image by TheVisualMD

Blood Pressure Ranges

High blood pressure, or hypertension, is an important risk factor for strokes and heart attacks. A physician uses a sphygomomanometer to measure a patient's blood pressure by inflating a rubber cuff around his or her arm. The reading is shown on the scale represented in this image. Systolic pressure refers to the pressure in an artery when the heart beats, or contracts. This number is higher than the diastolic pressure, which is occuring when the heart is at rest, between beats. Average blood pressure for adults is 120/80, with the systolic pressure denoted over the diastolic pressure.

Image by TheVisualMD

Man with Visible Brain and Heart

The most obvious way in which your body manages blood flow and pressure is to change the heart rate. When the pulse rate goes up, in general, the pressure in the system goes up, which in turns drives the blood around the body more quickly. The blood vessels themselves also play an important role in pressure-management. Blood vessels are \"living pipes\". They're elastic and flexible and have special sensors called baroreceptors that monitor the ebb and flow of blood. Baroreceptors are actually nerve bundles that provide immediate feedback to the brain. With this information and depending on the needs of the moment, the arteries dilate and contract to help propel blood through the system. Blood can be diverted to muscles during exercise, for example, or away from the skin during cold weather to avoid heat loss. The arteries can contract to prevent blood loss due to injury or dilate to flood the face for that telling blush.

Image by TheVisualMD

Arm with Blood Pressure Cuff

This diagram represents the number of individuals affected with hypertension. The American Heart Association estimates that nearly one-third of Americans have hypertension.

Image by TheVisualMD

Keeping Blood Pressure Healthy

Image by TheVisualMD

Medicating High Blood Pressure

If lifestyle changes don’t reduce blood pressure to an acceptable level, doctors will generally prescribe antihypertensive medications. There are a number of different types of antihypertensives available. The most commonly prescribed include: Thiazide diuretics. Often the first drug prescribed, diuretics dilate blood vessels and also decrease fluid volume in the body by helping the kidneys to eliminate salt and water. Angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors reduce hypertension by dilating arterioles (the smallest divisions of the arteries, linking the arteries and the capillaries). They do this by blocking the production of ACE, a naturally occurring substance that constricts blood vessels. Angiotensin II receptor blockers (ARBs). Like ACE inhibitors, ARBs dilate arterioles, but they accomplish this by preventing ACE from having any effect on the heart and blood vessels. ARBs are often prescribed for people who experience adverse side effects from ACE inhibitors.

Image by TheVisualMD

2:46

What is Blood Pressure?

TheVisualMD

3:36

What is Hypertension?

TheVisualMD

4:32

How blood pressure works - Wilfred Manzano

TED-Ed/YouTube

6:21

What is blood pressure? | Circulatory system physiology | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

10:08

The Heart, Part 1 - Under Pressure: Crash Course A&P #25

CrashCourse/YouTube

9:34

The Heart, Part 2 - Heart Throbs: Crash Course A&P #26

CrashCourse/YouTube

1:35

Systole vs. Diastole | Match Health

Match Health/YouTube

9:50

Lub Dub | Circulatory system physiology | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

2:49

Understanding Blood Pressure | Human Anatomy and Physiology video 3D animation | elearnin

Elearnin/YouTube

12:09

Regulation of blood pressure with baroreceptors | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

12:07

Systolic murmurs, diastolic murmurs, and extra heart sounds - Part 1 | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

14:39

Systolic murmurs, diastolic murmurs, and extra heart sounds - Part 2 | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

1:46

High Blood Pressure - Causes, Symptoms and Treatment Options

Rehealthify/YouTube

1:11

Blood Pressure Medicines - What You Need To Know

Rehealthify/YouTube

3:10

High blood pressure - What is it?

Healthchanneltv / cherishyourhealthtv/YouTube

3:00

Treating High Blood Pressure

Centers for Disease Control and Prevention (CDC)/YouTube

3:20

Medicating for High Blood Pressure (HBP #3)

Healthguru/YouTube

1:07

High Blood Pressure and Your Kidneys - A to Z Guide

National Kidney Foundation/YouTube

3:43

Renin Angiotensin Aldosterone System

Mechanisms in Medicine/YouTube

3:01

5 Major Effects of High Blood Pressure - 3D Medical Animation

kreativevistas/YouTube

1:32

High Blood Pressure Basics

Centers for Disease Control and Prevention (CDC)/YouTube

7:19

Hypertension effects on the heart | Health & Medicine | Khan Academy

khanacademymedicine/YouTube

2:29

Hypertension

GABAY MEDICAL library/YouTube

1:04

Hypertension and Stroke (Health Tip)

Healthguru/YouTube

2:11

Medical Shock - The Correct Treatment

justdoitguides/YouTube

10:50

Cardiogenic shock | Circulatory System and Disease | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

3:03

Consequences of High Blood Pressure (HBP #2)

Healthguru/YouTube

2:02

Shock Explained in 120 Seconds | Treatment, Symptoms, Causes | Video

Lifestyle by IK/YouTube

7:15

What is shock? | Circulatory System and Disease | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

7:40

Shock - hemodynamics | Circulatory System and Disease | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

9:38

Hypovolemic shock | Circulatory System and Disease | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

1:09

Syncope Diagnosed

smallcogbigmachine/YouTube

1:45

Syncope Causes

smallcogbigmachine/YouTube

4:28

How the heart actually pumps blood - Edmond Hui

TED-Ed/YouTube

3:49

Hypertension - High Blood Pressure, Animation

Alila Medical Media/YouTube

4:47

British Heart Foundation - Your guide to 24 hour blood pressure and Holter monitoring tests

British Heart Foundation/YouTube

3:15

What are Palpitations

smallcogbigmachine/YouTube

4:11

The Cardiac Cycle, Animation

Alila Medical Media/YouTube

13:18

Aldosterone raises blood pressure and lowers potassium | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

1:55

Understanding Blood Pressure

British Heart Foundation/YouTube

SPRINT Participant Has Blood Pressure Measured

National Institutes of Health (NIH)

Man getting Blood Pressure Reading

TheVisualMD

Doctor Taking Woman's Blood Pressure

TheVisualMD

Blood Pressure

BruceBlaus

Blood Pressure

TheVisualMD

Blood Pressure Ranges

TheVisualMD

Man with Visible Brain and Heart

TheVisualMD

Arm with Blood Pressure Cuff

TheVisualMD

Keeping Blood Pressure Healthy

TheVisualMD

Medicating High Blood Pressure

TheVisualMD

Heart Rate Test

Heart Rate Test

Also called: Pulse, Pulse Rate, Resting Heart Rate

The heart rate is the number of times the heart beats in one minute, and it’s comparable to the pulse rate. The easiest way to determine a person’s heart rate is by checking their pulse; which can be done by placing the fingers directly above the arteries closest to the surface of the skin in certain parts of the body.

Heart Rate Test

Also called: Pulse, Pulse Rate, Resting Heart Rate

The heart rate is the number of times the heart beats in one minute, and it’s comparable to the pulse rate. The easiest way to determine a person’s heart rate is by checking their pulse; which can be done by placing the fingers directly above the arteries closest to the surface of the skin in certain parts of the body.

{"label":"Heart rate reference range","scale":"lin","step":1,"hideunits":false,"items":[{"flag":"abnormal","label":{"short":"Low","long":"Low","orientation":"horizontal"},"values":{"min":30,"max":60},"text":"A heart rate slower than 60 bpm is referred to as bradycardia. However, having bradycardia doesn\u2019t\u00a0necessarily means that you have a health problem. Furthermore, bradycardia as low as 40 bpm is normal in athletes and in people who exercise regularly.","conditions":["Heart disease","Injury to the heart","Hypothyroidism","Obstructive sleep apnea","Electrolyte imbalance","Inflammatory diseases","Intake of certain drugs"]},{"flag":"normal","label":{"short":"Normal","long":"Normal","orientation":"horizontal"},"values":{"min":60,"max":100},"text":"The normal heart rate varies from person to person, and it also depends on multiple factors such as age, air temperature, emotions, fitness level, and medication use.","conditions":[]},{"flag":"abnormal","label":{"short":"High","long":"High","orientation":"horizontal"},"values":{"min":100,"max":200},"text":"A heart rate faster than 100 bpm is referred to as tachycardia. A wide variety of conditions can cause the heart to beat faster than normal.","conditions":["Stress","Anxiety\u00a0","Fatigue","Excessive intake of caffeine","Excessive intake of alcohol","Strenuous exercise or physical activity","Smoking","Use of illegal drugs","Intake of certain medications","Fever\u00a0","Electrolyte imbalance","Anemia","Heart disease","Hyperthyroidism","Injury to the heart"]}],"units":[{"printSymbol":"bpm","code":"{beats}\/min","name":"heart beats per minute"}],"value":80}[{"abnormal":0},{"normal":0},{"abnormal":0}]
Use the slider below to see how your results affect your health.
bpm
60
100
Your result is Normal.
The normal heart rate varies from person to person, and it also depends on multiple factors such as age, air temperature, emotions, fitness level, and medication use.
Related conditions
The normal heart rate varies from person to person, and it also depends on multiple factors such as age, air temperature, emotions, fitness level, and medication use.
In adults, a normal resting heart rate (when not exercising) is between 60 bpm (beats per minute) to 100 bpm.
Low heart rate
A heart rate slower than 60 bpm is referred to as bradycardia. However, having bradycardia doesn’t necessarily means that you have a health problem.
Bradycardia as low to 40 bpm is normal in athletes and in people who exercise regularly because their heart is in better shape and doesn’t need to pump as much to maintain a steady beat.
Bradycardia can be caused by several conditions, including:
- Heart disease
- Injury to the heart, for instance from a heart attack
- Hypothyroidism (underactive thyroid gland)
- Obstructive sleep apnea
- Electrolyte imbalance
- Inflammatory diseases, like lupus
- Intake of certain drugs, such as a beta blockers
High heart rate
A heart rate faster than 100 bpm is referred to as tachycardia. A wide variety of conditions can cause tachycardia, including:
- Stress
- Anxiety
- Fatigue
- Excessive intake of caffeine
- Excessive intake of alcohol
- Strenuous exercise or physical activity
- Smoking
- Use of illegal drugs
- Intake of certain medications, such as cough syrups
- Fever
- Electrolyte imbalance
- Anemia (low red blood cell count)
- Heart disease
- Hyperthyroidism (hyperactive thyroid gland)
- Injury to the heart, for instance from a heart attack
1. https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure/all-about-heart-rate-pulse [accessed on Mar 21, 2019]
2. https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=85&ContentID=P00866 [accessed on Mar 21, 2019]
3. https://www.healthline.com/health/dangerous-heart-rate#diagnosis [accessed on Mar 21, 2019]
4. https://www.medicalnewstoday.com/articles/235710.php [accessed on Mar 21, 2019]
5. https://www.webmd.com/heart-disease/heart-failure/watching-rate-monitor#1 [accessed on Mar 21, 2019]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (12)

Pulse

Pulse evaluation

Image by Pia von Lutzau

Heart Rate

Regulation of Heart Rate : The rate at which the heart beats is modulated by the autonomic nervous system. Baroreceptors, nerve endings in the aortic arch and the carotid arteries, are sensitive to arterial blood pressure. If it's too low or too high, they send signals to the brain, which in turn causes your heart rate to increase or decrease and the arteries to constrict or dilate as necessary to control blood pressure.

Image by TheVisualMD

Vital Signs

Navy Cmdr. Jesus Mallari, a Philippine native, listens to a child's heartbeat while getting her vital signs aboard the U.S. Military Sealift Command (MSC) Hospital Ship USNS Mercy (T-AH 19).

Image by U.S. Navy photo by Photographer's Mate 2nd Class Erika N. Jones

Pulse

The pulse is most readily measured at the radial artery, but can be measured at any of the pulse points shown.

Image by OpenStax College

Normal Vs Accelerated Heart Rate

Video by Seth Meshko/YouTube

Fetal Heart Rate Tone Monitoring Decelerations | Early, Late, Variable NCLEX OB Maternity Nursing

Video by RegisteredNurseRN/YouTube

What Is Tachycardia (Irregular Heart Rate)

Video by healthery/YouTube

Your Heart Rate

Video by Cleveland Clinic/YouTube

What is my target heart rate?

Video by British Heart Foundation/YouTube

How To: Check Your Pulse

Video by Baylor College of Medicine/YouTube

Fast heart rate when standing up? Postural tachycardia syndrome (POTS) explained

Video by Top Doctors UK/YouTube

Vital Signs Nursing: Respiratory Rate, Pulse, Blood Pressure, Temperature, Pain, Oxygen

Video by RegisteredNurseRN/YouTube

Pulse

Pia von Lutzau

Heart Rate

TheVisualMD

Vital Signs

U.S. Navy photo by Photographer's Mate 2nd Class Erika N. Jones

Pulse

OpenStax College

1:53

Normal Vs Accelerated Heart Rate

Seth Meshko/YouTube

10:44

Fetal Heart Rate Tone Monitoring Decelerations | Early, Late, Variable NCLEX OB Maternity Nursing

RegisteredNurseRN/YouTube

2:31

What Is Tachycardia (Irregular Heart Rate)

healthery/YouTube

1:28

Your Heart Rate

Cleveland Clinic/YouTube

1:00

What is my target heart rate?

British Heart Foundation/YouTube

2:48

How To: Check Your Pulse

Baylor College of Medicine/YouTube

9:03

Fast heart rate when standing up? Postural tachycardia syndrome (POTS) explained

Top Doctors UK/YouTube

13:29

Vital Signs Nursing: Respiratory Rate, Pulse, Blood Pressure, Temperature, Pain, Oxygen

RegisteredNurseRN/YouTube

Treatment

Space-filling model of the levodopa molecule, also known as L-DOPA, a non-standard amino acid.

Image by Jynto (talk) / https://commons.wikimedia.org/wiki/File:Levodopa_zwitterion_3D_spacefill.png

How Is MSA Treated?

Currently, there are no treatments to delay the progressive neurodegeneration of MSA, and there is no cure. There are treatments to help people cope with the symptoms of MSA.

In some individuals, levodopa may improve motor function; however, the benefit may not continue as the disease progresses.

The fainting and lightheadedness from orthostatic hypotension may be treated with simple interventions such as wearing compression stockings, adding extra salt and/or water to the diet, and avoiding heavy meals. The drugs fludrocortisone and midodrine sometimes are prescribed. In 2014, the U.S. Food and Drug Administration approved the medication droxidopa for the treatment of orthostatic hypotension seen in MSA. Dihydroxyphenylserine helps to replace chemical signals called neurotransmitters which are decreased in the autonomic nervous system in MSA. Some medications used to treat orthostatic hypotension can be associated with high blood pressure when lying down, so affected individuals may be advised to sleep with the head of the bed tilted up.

Bladder control problems are treated according to the nature of the problem. Anticholinergic drugs, such as oxybutynin or tolteridine, may help reduce the sudden urge to urinate. Fixed abnormal muscle postures (dystonia) may be controlled with injections of botulinum toxin. Sleep problems such as REM sleep behavior disorder can be treated with medicines including clonazepam, melatonin, or some antidepressants. Some individuals with MSA may have significant difficulties with swallowing and may need a feeding tube or nutritional support. Speech therapy may be helpful in identifying strategies to address swallowing difficulties.

Physical therapy helps maintain mobility, reduce contractures (chronic shortening of muscles or tendons around joints, which prevents the joints from moving freely), and decrease muscle spasms and abnormal posture. Individuals may eventually need assistive devices such as walkers and wheelchairs. Occupational therapists help with home safety and learning new ways to address activities of daily living such as dressing and eating.

Source: National Institute of Neurological Disorders and Stroke (NINDS)

Additional Materials (2)

1:09:14

Treatment of and Research on Multiple System Atrophy

CurePSP/YouTube

Tyrosine

Share and discuss

Share your story, discuss an issue or get
advice from the community

Create conversation

Sign up here for full access to StoryMD

Get free access to in-depth articles and track your personal health.

Create Free Account Sign In