Franklin Cardiovascular Associates was founded in Philadelphia in 1983. Now located in Sicklerville, the 9,000-square-foot major medical center draws patients from around the globe.
Conditions expertly treated at Franklin Cardiovascular Associates run the full gamut of what would be expected at a cardiology practice. Dr. Nicholas DePace and his colleagues treat high blood pressure, high cholesterol disorders, heart failure, heart valve problems, cardiovascular disease and arrhythmias. However, unlike most other cardiologists, the practice’s clinicians also specialize in autonomic dysfunction.
With five board certifications, over 100 published articles and six books authored on autonomic dysfunction, Dr. DePace’s expertise on the subject is extensive. But it was a personal connection that prompted the doctor to start studying the condition many years ago.
“When I was working full time at Jefferson in Philadelphia as a young cardiologist, I got a virus and went into an autonomic dysfunction state. I had almost a year of symptoms that required treatment,” he recalls. “That’s why we’re so prolific in treating it and studying it and have such a big patient base.”
What is autonomic dysfunction?
The autonomic nervous system is responsible for the body’s involuntary, unconscious tasks, such as the heart beating and lungs breathing. When that system becomes imbalanced, it can cause a wide range of symptoms, including fainting or near-fainting episodes, chronic fatigue, light headedness, brain fog, sleep disturbances and sweating abnormalities. These patients may also experience various gastrointestinal problems such as gastroparesis and irritable bowel syndrome, as well as urinary tract abnormalities such as interstitial cystitis.
“In conjunction with that, they may also have mast cell activation syndrome where they produce too much histamine in their body. That will aggravate all those other conditions,” DePace explains.
Autonomic dysfunction is often triggered by a virus, concussion, major operation, major life stressor or even childbirth. Some people are also predisposed to the condition, such as those with Ehlers-Danlos syndrome or long COVID.
While the issue may resolve with treatment in six to 18 months, for others, autonomic dysfunction can be a lifelong battle. And even for the former patients with resolved symptoms, it is important to continue physician care.
“Even when you’re in remission, you still need to be watched,” DePace cautions.
Diagnosis and treatment
Autonomic dysfunction can be diagnosed in patients as young as 7 years old. The first step in diagnosing an imbalance of the autonomic nervous system is identifying whether the imbalance is between the sympathetic nervous system, which is the accelerator of the body, or the parasympathetic nervous system, which is the brakes of the body. An example of the latter would be postural orthostatic tachycardia syndrome (POTS), which is a common autonomic dysfunction that causes racing of the heart with palpitations when standing still. Symptoms that would be indicative of an imbalance in the parasympathetic nervous system include fatigue, headache and fainting.
“There are all different combinations of symptoms,” DePace says, adding that diagnosis is approached from several angles.
“We diagnose it with clinical history and objective autonomic laboratory tests that are noninvasive that we do right in the office,” he says. “So it’s a general clinical evaluation and autonomic testing, and oftentimes we use blood urine analysis.”
Treatment is a combination of integrative, holistic and pharmacological approaches. This includes special exercise programs and physical therapy; various fluid electrolyte replacement programs; leg, arm and abdomen compression garments; powerful antioxidant natural combinations specific for the nervous system; and nitric oxide compounds for the fatigue factor.
While many of the disorders related to autonomic dysfunction are not life threatening, they are life impairing and need treatment. According to DePace, 85% of those with autonomic dysfunction will improve, and many go into remission. Those who do not improve are often referred for neural feedback.
Finding validation
Many individuals suffering from autonomic dysfunction are misdiagnosed again and again, going from hospital emergency room to hospital emergency room, doctor to doctor. They are misdiagnosed with fibromyalgia, sleep disturbances, chronic fatigue, chronic infection and even anxiety and panic attacks.
“There are an estimated 20 million people in the United States with chronic fatigue syndrome. Most show autonomic dysfunction,” DePace says. “And there are 10 million people with long COVID—and most of those show autonomic dysfunction, too.”
When patients visit Franklin Cardiovascular Associates and receive a diagnosis of autonomic dysfunction, DePace says they are relieved.
“They say, ‘I’ve been told I have anxiety,’ or, ‘I’ve been told I have fibromyalgia.’ Some are told it’s in their head,” DePace says. “Then we diagnose them. They feel validated.”
Franklin Cardiovascular Associates
Sicklerville
(856) 589-6034
FranklinCardiovascular.com
