Cardiovascular dysfunction inmultiple sclerosis

Abstract

Cardiovascular dysfunction (CD) in multiple sclerosis (MS) is related to involvement of reflex pathways in the brainstem. The battery of CD tests was applied to a group of 40 healthy subjects and 40 patients with MS, divided in 2 subgroups according to the expanded disability status scale (EDSS). The tests included: 1) postural blood pressure changes, 2) postural heart rate changes, 3) heart rate changes on inspiration/forced expiration and 4) ECG R-R interval measurement on the Valsalva maneuver. Both groups were subjected to the functional independence scale (FIM). Imaging studies were reviewed and autonomic dysfunction at other levels was explored. The results showed a statistically significant difference (P < 0.05) in all tests when comparing patients to controls. Tests 1 and 4 had the highest significance, with findings of more severe involvement in patients with a higher EDSS and lower FIM. A correlation was also found between CD and brainstem lesions on MRI (P < 0.01). A significant number of MS patients had evidence of CD. Test 1 may be considered a simple marker, in daily clinical practice, to detect subclinical CD. Subclinical CD is a cause of disability in this group of patients.

Autonomic dysfunction in multiple sclerosis

“…Cardiovascular autonomic dysfunction is reported to be present in up to two-thirds of MS patients and is known to show deterioration during the course of the disease [8,9].…”

New Markers of Early Cardiovascular Risk in Multiple Sclerosis Patients: Oxidized-LDL Correlates with Clinical Staging

“…The precise etiology of the disease is still unknown, although epidemiological data indicate that genetic and environmental factors are important [2]. Despite data are still scarce, studies point to an increased cardiovascular risk (CVR) in patients with MS, at least when compared with individuals of similar age [3][4][5]. MS patients exhibit autonomic dysfunc-tion [6], increased blood pressure and tachycardia [7], ventricular disturbances [8] and impairment of the balance between vasoconstrictors and vasodilators, such as prostaglandins and nitric oxide (NO) [9,10].…”

Sudden Death in Demyelinating Disorders

“…Cardiovascular dysfunction related to autonomic neuropathy has been associated with death in MS [1][2][3]. Our patients had sudden onset of shortness of breath which could be related to either respiratory or cardiovascular system [4][5]. Topographic lesions in sudden death in Multiple sclerosis and Neuromyelitis Optica [6], have revealed predominant brain stem lesions in one study, and death could also occur in a patient with underlying chronic lesions [7].…”