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In neurogenic shock, the body loses its ability to activate the SNS so that only parasympathetic tone remains. The resulting loss of sympathetic tone, which plays a major role in other forms of shock, is responsible for the unique and atypical features mentioned above. [7] [9]
In this context, tone specifically refers to the continual nature of baseline parasympathetic action that the vagus nerve exerts. While baseline vagal input is constant, the degree of stimulation it exerts is regulated by a balance of inputs from sympathetic and parasympathetic divisions of the autonomic nervous system, with parasympathetic ...
The sympathetic nervous system is described as being antagonistic to the parasympathetic nervous system. The latter stimulates the body to "feed and breed" and to (then) "rest-and-digest". The SNS has a major role in various physiological processes such as blood glucose levels, body temperature, cardiac output, and immune system function.
Parasympathetic action helps in digestion and absorption of food by increasing the activity of the intestinal musculature, increasing gastric secretion, and relaxing the pyloric sphincter. It is called the “rest and digest” division of the ANS. [24] The parasympathetic nervous system decreases respiration and heart rate and increases digestion.
Parasympathetic innervation of the heart is partially controlled by the vagus nerve and is shared by the thoracic ganglia. Vagal and spinal ganglionic nerves mediate the lowering of the heart rate. The right vagus branch innervates the sinoatrial node. In healthy people, parasympathetic tone from these sources is well-matched to sympathetic tone.
Airway smooth muscle is primarily innervated by cholinergic parasympathetic nerves, while its adrenergic sympathetic innervation is sparse to non-existent. Specifically, cholinergic parasympathetic signalling increases the airway tone, meaning the airway tone is proportional to the vagal tone. [8] [10]
Regardless of the trigger, the mechanism of syncope is similar in the various vasovagal syncope syndromes. The nucleus tractus solitarii of the brainstem is activated directly or indirectly by the triggering stimulus, resulting in simultaneous enhancement of parasympathetic nervous system tone and withdrawal of sympathetic nervous system tone.
Autonomic nervous system, showing splanchnic nerves in middle, and the vagus nerve as "X" in blue. The heart and organs below in list to right are regarded as viscera. The autonomic nervous system has been classically divided into the sympathetic nervous system and parasympathetic nervous system only (i.e., exclusively motor).