Cardiac Autonomic Neuropathy: Why Should Cardiologists Care about That?

Abstract

Background Cardiac autonomic neuropathy (CAN) is a frequent but underdiagnosed complication of diabetes mellitus. It has a strong influence on various cardiac disorders including myocardial ischemia and infarction, hypertension, orthostatic hypotonia, heart failure, and arrhythmias. CAN can lead to severe morbidity and mortality and increase the risk of sudden cardiac death. Methods This review article summarizes the latest evidence regarding the epidemiology, pathogenesis, influence on the cardiovascular system, and diagnostic methods for CAN. The methodology of this review involved analyzing available data from recent papers relevant to the topic of diabetic autonomic neuropathy and cardiac disorders. Conclusions The early diagnosis of CAN can improve the prognosis and reduce adverse cardiac events. Methods based on heart rate variability enable the diagnosis of CAN even at a preclinical stage. These methods are simple and widely available for use in everyday clinical practice. According to the recently published Toronto Consensus Panel on Diabetic Neuropathy, all diabetic patients should be screened for CAN. Because diabetes mellitus often coexists with heart diseases and the most common methods used for diagnosis of CAN are based on ECG, not only diabetologists but also cardiologists should be responsible for diagnosis of CAN.

Novel Invasive and Noninvasive Cardiac-Specific Biomarkers in Obesity and Cardiovascular Diseases

“…The two halves of the ANS, the parasympathetic nervous system (PNS) and the SNS, cooperate to control heart rate, cardiac output, myocardial contractility, and constriction and dilatation of blood vessels. 275,276 Dysfunction of the ANS contributes to the development or stabilization of obesity and is associated with cardiovascular mortality. 277 The study of ANS function in obesity is of considerable clinical interest.…”

The Magic of Spells

“…If there is a pause of greater than 7 seconds in older persons, this is diagnostic. It should be avoided in persons with a carotid brunt, recent stroke or myocardial infarction or a history of ventricular tachycardia (11). The work up for cardiac syncope is outlined in Figure 1.…”

“…The work up for cardiac syncope is outlined in Figure 1. Persons with autonomic neuropathy are at high risk of having lethal arrythmias ("death in the bed syndrome") (11). If no obvious cardiac causes, orthostasis or postprandial hypotension are present, an elderly person with syncope should be considered for a subcutaneous implantable loop recorder (12).…”

Heart Rate Variability as Biomarker for Prognostic of Metabolic Disease

“…In order to realize clinical diagnosis of CAN, the performing cardiac autonomic reflex test or neuropathy Ewing's battery is recommended. It consists of the assessment of the HRV in rest condition, while standing, during paced deep breathing, during sustained muscle contraction with the use of a handgrip dynamometer (handgrip exercise), and during and after a provoked increase in intrathoracic/ abdominal pressure (maneuver of Valsalva) (see Figure 5) [29,30].…”