Cardiovascular Reflexes and Autonomic Neuropathy

1978 ◽  
Vol 55 (4) ◽  
pp. 321-327 ◽  
Author(s):  
D. J. Ewing
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Autonomic Neuropathy ◽  
Autonomic Dysfunction ◽  
Postural Hypotension ◽  
Systemic Disease ◽  
Cardiovascular Reflexes ◽  
Diabetic Patients ◽  
Pharmacological Agents ◽  
Autonomic Nervous

Clinical features of autonomic neuropathy include postural hypotension, sweating abnormalities, disturbance of body temperature regulation, gastric fullness and nausea, intermittent nocturnal diarrhoea, constipation, bladder problems and impotence. In diabetic patients, gustatory sweating and hypoglycaemic unawareness also sometimes occur (Johnson & Spalding, 1974). The onset of symptoms is usually insidious and permanent, but may occasionally be acute and reversible (Young, Asbury, Corbett & Adams, 1975). Autonomic dysfunction can arise from three main causes: first, those where the damage to the autonomic nervous system is isolated, as in primary postural hypotension (Bannister, Sever & Gross, 1977) and familial dysautonomia (Brunt & McKusick, 1970); secondly, those caused by toxic or pharmacological agents which interfere with autonomic reflexes; thirdly, those associated with systemic disease, of which diabetes mellitus is the most common. Other diseases which may cause autonomic dysfunction include amyloidosis, porphyria, tetanus, polyneuritis, tabes dorsalis, parkinsonism, chronic renal failure and alcoholism, and occasionally autonomic neuropathy has been associated with carcinoma of the bronchus or the pancreas (Johnson & Spalding, 1974). Although it is possible to localize lesions within the autonomic nervous system to afferent or efferent sympathetic or parasympathetic pathways (Johnson & Spalding, 1974; Moskowitz, 1977), many of the available tests are complex and invasive and often lack adequate control measurements (Young et al., 1975). Because of the patchy nature of autonomic neuropathy, current interest has centred around the search for bedside tests that are ‘global’, reproducible and non-invasive. This review summarizes the present state of knowledge of simple tests of cardiovascular reflex function in the clinical evaluation of autonomic neuropathy, particularly in diabetic subjects.

scholarly journals Autonomic nervous system evaluation in Type 2 diabetic patients and effect of its duration

2013 ◽  
Vol 1 (2) ◽  
pp. 77-83
Author(s):  
DB Karki ◽  
S Acharya ◽  
P Shrestha ◽  
S Pant ◽  
A Pokhrel ◽  
...  
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Autonomic Dysfunction ◽  
Preventive Measures ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Autonomic Nervous ◽  
Medical College ◽  
Type 2 Diabetic

Introduction: Dysfunction of the autonomic nervous system is common in diabetic patients. Presence of autonomic dysfunction should alert the physicians of its serious consequences that require timely preventive measures. Objectives: This study was done to fi nd out the autonomic nervous system involvement in Type 2 diabetic patients and to see its relation with the duration of diabetes. Methods: This was a hospital based cross-sectional study. All consecutive diabetic patients of both genders attending Kathmandu Medical College and a private clinic, Temple of Healing were included. A battery of six well validated and accepted autonomic nervous system evaluation tests were done to evaluate the autonomic function in 245 Type 2 diabetic patients. Results: Prevalence of autonomic dysfunction was found to be 71.02% with 58.78% patients having mild autonomic dysfunction and 12.24% having moderate dysfunction. Severe autonomic dysfunction was detected in none of the patients. Parasympathetic dysfunction was much more common than sympathetic dysfunction (68.16% vs. 17.96%). No association was found between autonomic dysfunction and duration of diabetes. Conclusions: Autonomic dysfunction is very common in diabetics and can be detected by simple tests. Timely detection of autonomic dysfunction in diabetic patients is advised so that its preventive measures can be effective. DOI: http://dx.doi.org/10.3126/jkmc.v1i2.8142 Journal of Kathmandu Medical College, Vol. 1, No. 2, Oct.-Dec., 2012: 77-83

Diabetic Autonomic Neuropathy

1999 ◽  
Vol 12 (2) ◽  
pp. 142-154
Author(s):  
Roy C. Parish
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Drug Therapy ◽  
Autonomic Neuropathy ◽  
Cardiac Arrhythmias ◽  
Diabetic Autonomic Neuropathy ◽  
Diabetic Patients ◽  
Specific Information ◽  
Autonomic Nervous ◽  
Increased Risk

Diabetic autonomic neuropathy (DAN) occurs in approximately half of Caucasian patients with diabetes and perhaps three-fourths of black diabetic patients. This may be asymptomatic for several years, but the majority of patients with DAN eventually exhibit symptoms of diarrhea, cardiac arrhythmias, sexual dysfunction, and abnormal sweating. Prolonged hyperglycemia results in damage to the autonomic nervous system (ANS), particularly the vagus nerve and other parts of the parasympathetic division. DAN is associated with increased risk of sudden death, high-risk cardiac arrhythmias, myocardial infarction, and death from other causes. Objective testing of autonomic nervous system function yields specific information that affects treatment decisions. Drug therapy can effect improvements in ANS function and reduce these risks. Complications of diabetes that result from ANS dysfunction can be partly reversed or their progress can be slowed by appropriate drug therapy. Features, implications, and therapy of the most common complications resulting from DAN are reviewed, and suggestions for pharmacist involvement in the care of these difficult patients are offered.

scholarly journals A35 ASSOCIATIONS BETWEEN AUTONOMIC DYSFUNCTION, COLONIC DYSMOTILITY AND ABSENT DEFECATION REFLEXES IN PATIENTS WITH CHRONIC REFRACTORY CONSTIPATION

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 276-278
Author(s):  
L Liu ◽  
N Milkova ◽  
M Ali ◽  
K Sharma ◽  
J D Huizinga ◽  
...  
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
High Resolution ◽  
Autonomic Dysfunction ◽  
Sympathetic Tone ◽  
Stress Index ◽  
Autonomic Reactivity ◽  
Autonomic Tone ◽  
Autonomic Nervous ◽  
Colonic Manometry

Abstract Background A defecation reflex involves sensory information from the colon sent to the central nervous system which results in propulsive motor patterns in the colon through programmed neural activity from the autonomic nervous system. Neurological causes of constipation are recognized but specific neurological pathways that contribute to pathophysiology of the disease is underexplored. Diagnosis and treatment usually do not involve the autonomic nervous system. Aims Our objective was to assess autonomic dysfunction and abnormal defecation reflexes as a possible cause of chronic constipation. Methods Defecation reflexes were assessed by high-resolution colonic manometry through balloon distention, meal intake, and rectal bisacodyl. Specific heart rate variability (HRV) parameters were used to assess general orthostatic autonomic reactivity, and autonomic functioning during high resolution colonic manometry, in 14 patients with chronic refractory constipation considered for surgery. Results All patients had a unique combination of motility, reflex ability and HRV profiles. Patients overall did not generate HAPWs or had lower HAPW amplitude and lower propulsive activity compared to healthy individuals. Half of the 14 patients were tested to have high sympathetic tone based on Baevsky’s stress index prior to HRCM, and 11 of the patients had sympathetic hyper-reactivity and/or low parasympathetic reactivity to at least one type of colonic stimulation during HRCM. Abnormal autonomic tone or autonomic reactivity to colonic stimulation was present in all four patients with absence of the vagosacral defecation reflex. Five of the seven patients with absence of the sacral defecation reflex showed high sympathetic tone or high sympathetic reactivity to stimulation. Only two patients had abnormality in coloanal coordination and this was associated with low parasympathetic reactivity to stimulation in both patients. Conclusions The assumption that colonic resection was needed to remove an inert colon was wrong in most patients, but most patients had some form of reflex abnormality. Sympathetic dominance far outweighed parasympathetic dysfunction. Incorporation of assessments of defecation reflexes and autonomic nervous system activity into diagnosis of chronic refractory constipation provides a comprehensive pathophysiological understanding of specific defective neurological pathways contributing to dysmotility. This forms the basis for our individualized treatment efforts through sacral neuromodulation. Funding Agencies CIHR

DIAGNOSTIC POTENTIAL OF SELECTED SALIVARY PROTEOMICS FOR AUTONOMIC NERVOUS SYSTEM ACTIVITY ASSESSMENT

2020 ◽  
Vol 18 (2) ◽  
pp. 285-303
Author(s):  
Lukasz Dobrek
Keyword(s):  
Heart Rate ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Hydrolytic Enzyme ◽  
Cardiovascular Reflexes ◽  
Laboratory Diagnostics ◽  
Laboratory Assessment ◽  
Autonomic Nervous ◽  
Laboratory Markers ◽  
Diagnostic Potential

The clinical assessment of autonomic nervous system (ANS) functioning, enabling the diagnosis of autonomic neuropathy present in the course of many diseases, is currently based on performing simple cardiovascular reflexes (Ewing tests), analyzing heart rate variability (HRV) or heart rate turbulence (HRT), examining skin sweating or recording neurophysiological tests (e.g. microneurography). Laboratory assessment of ANS function is very scarce and practically only includes the plasma assessment of noradrenaline as a surrogate for the biochemical indicator of sympathetic activity. Recently, the possibility of evaluation of selected compounds present in saliva as laboratory markers of not only oral diseases but also systemic diseases has been raised. This work focuses on a brief description of the anatomy and physiology of the salivary glands and describes the formation of saliva, its composition and the use of this bodily fluid in laboratory diagnostics. In addition, the paper specifically discusses the possibility of determining selected compounds that are considered to reflect autonomic activity. A review of the literature indicates primarily four proteomics: two neuropeptides (vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY) that are co-transmitters in autonomic fibers, chromogranin A, a synaptic vesicle protein and α-amylase, a hydrolytic enzyme pre-digesting carbohydrates in the oral cavity. These are currently the most widely investigated agents for their usefulness as laboratory markers of ANS activity.

scholarly journals An Autonomic Nervous System Model Applied to the Analysis of Orthostatic Tests

2008 ◽  
Vol 2008 ◽  
pp. 1-15 ◽  
Author(s):  
Virginie Le Rolle ◽  
Alfredo I. Hernández ◽  
Pierre-Yves Richard ◽  
Guy Carrault
Keyword(s):  
Heart Rate ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Cardiovascular Response ◽  
Patient Specific ◽  
Diabetic Patients ◽  
Model Parameters ◽  
Autonomic Nervous ◽  
Ventricular Mechanics ◽  
Model Based

One of the clinical examinations performed to evaluate the autonomic nervous system (ANS) activity is the tilt test, which consists in studying the cardiovascular response to the change of a patient's position from a supine to a head-up position. The analysis of heart rate variability signals during tilt tests has been shown to be useful for risk stratification and diagnosis on different pathologies. However, the interpretation of such signals is a difficult task. The application of physiological models to assist the interpretation of these data has already been proposed in the literature, but this requires, as a previous step, the identification of patient-specific model parameters. In this paper, a model-based approach is proposed to reproduce individual heart rate signals acquired during tilt tests. A new physiological model adapted to this problem and coupling the ANS, the cardiovascular system (CVS), and global ventricular mechanics is presented. Evolutionary algorithms are used for the identification of patient-specific parameters in order to reproduce heart rate signals obtained during tilt tests performed on eight healthy subjects and eight diabetic patients. The proposed approach is able to reproduce the main components of the observed heart rate signals and represents a first step toward a model-based interpretation of these signals.

scholarly journals A Study of autonomic nervous system dysfunction among patient with diabetes mellitus: a cross sectional study

2017 ◽  
Vol 4 (2) ◽  
pp. 406 ◽  
Author(s):  
Sidheshwar Virbhadraappa Birajdar ◽  
Sheshrao Sakharam Chavan ◽  
Sanjay A. Munde ◽  
Yuvraj P. Bende
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Peripheral Neuropathy ◽  
Autonomic Neuropathy ◽  
Blood Pressure Response ◽  
Pressure Response ◽  
Diabetic Autonomic Neuropathy ◽  
Autonomic Nervous

Background: Neuropathy is a common complication of diabetes mellitus and it may affect both the peripheral nerves and autonomic nervous system. It’s prevalence ranges from 1% to 90%. The present study is therefore designed to investigate autonomic nervous system involvement in diabetes mellitus by using simple bedside tests and to study its association with other diabetic angiopathies.Methods: 100 patients of diabetes mellitus were selected in the study. In Autonomic function tests for evaluating parasympathetic damage E: I ratio, 30:75 ratio and Valsalva ratio test was performed. Sympathetic damage was diagnosed by Blood pressure response to standing test and Blood pressure response to sustained handgrip test.Results: Abnormal E:I ratio was noticed in only 24 patients. The 30:15 ratio was found to be abnormal in 38 patients while the Valsalva Ratio was abnormal in 34 patients. Postural hypotension was observed in only 8% patients. The sustained hand grip test was abnormal in 10 patients. The prevalence of cardiac autonomic neuropathy was 58%. The association between the presence of autonomic neuropathy and peripheral neuropathy was statistically significant. However, the association between autonomic neuropathy and retinopathy and nephropathy was not statistically significant.Conclusions: The overall prevalence of autonomic neuropathy in diabetes mellitus was 58%. There was parasympathetic preponderance over sympathetic nervous system in the involvement of diabetic autonomic neuropathy. There was statistically significant association of diabetic autonomic neuropathy with peripheral neuropathy as compared to retinopathy and nephropathy.

scholarly journals DYSFUNCTION OF THE AUTONOMIC NERVOUS SYSTEM IN EPILEPSY

2019 ◽  
Vol 72 (1) ◽  
pp. 120-123
Author(s):  
Beata Łabuz-Roszak ◽  
Iwona Mańka-Gaca
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Ion Channels ◽  
Antiepileptic Drugs ◽  
Autonomic Dysfunction ◽  
Circulatory System ◽  
Epileptic Seizures ◽  
Autonomic Nervous ◽  
The Central Nervous System

Generalized or partial epileptic seizures may be accompanied by autonomic dysfunction. They may also take the form of self-inflicted seizures or be present during interictal period. Arrhythmias, resulting in haemodynamic disturbances in the circulatory system and prolonged hypoxia of the central nervous system, may itself provoke secondary episodes of seizure morphology. The doctor when diagnosing patients with epileptic seizures should always be aware of the potential for cardiogenic disorders. Consideration should be given to the effect of epilepsy on the structure of the autonomic nervous system, the effect of antiepileptic drugs, and the potential for mutations within the ion channels.

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