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J Am Coll Cardiol. 2019 Mar 19;73(10):1189-1206. doi: 10.1016/j.jacc.2018.12.064.

Autonomic Nervous System Dysfunction: JACC Focus Seminar.

Author information

1
Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: j-goldberger@miami.edu.
2
Feinberg Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Northwestern University-Feinberg School of Medicine, Chicago, Illinois.
3
Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, University of California-Los Angeles Los Angeles, California.

Abstract

Autonomic nervous system control of the heart is a dynamic process in both health and disease. A multilevel neural network is responsible for control of chronotropy, lusitropy, dromotropy, and inotropy. Intrinsic autonomic dysfunction arises from diseases that directly affect the autonomic nerves, such as diabetes mellitus and the syndromes of primary autonomic failure. Extrinsic autonomic dysfunction reflects the changes in autonomic function that are secondarily induced by cardiac or other disease. An array of tests interrogate various aspects of cardiac autonomic control in either resting conditions or with physiological perturbations from resting conditions. The prognostic significance of these assessments have been well established. Clinical usefulness has not been established, and the precise mechanistic link to mortality is less well established. Further efforts are required to develop optimal approaches to delineate cardiac autonomic dysfunction and its adverse effects to develop tools that can be used to guide clinical decision-making.

KEYWORDS:

arrhythmia; autonomic; heart failure; myocardial infarction

PMID:
30871703
DOI:
10.1016/j.jacc.2018.12.064

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