No abstract

Introduction: The central nervous system is the generator of the dynamic balance between cholinergic and noradrenergic activity. Different behavioral tendencies are observed in subjects with prevalent parasympatic tone (defense strategy, energy sparing, dissociation) compared to those with sympathic one (relational interaction, high energy expenditure). These responses may influence susceptibility and vulnerability to diseases. The aim of our study was to examine cardiovascular function from the heart to the periphery by 24 hours detection of both heart and pulse rate in cerebrovascular conditions. Materials and Methods: We recruited 113 Acute Ischaemic Syndromes (AIS, age 73,43 sd 12,34), 32 Chronic Cerebro-Vascular Diseases (CCVD, age 75,95 sd 8,06), 30 Other Neurological Diseases (OND, age 50,09 sd 15,05). Cardiovascular reactivity (CR) was defined by beat indices, ratio (R) or difference (D) between higher maximal or minimal heart rate (HR) on higher maximal or minimal pulse rate (PR). A value < 1 or > 1 were considered as negative (NCR) or positive CR (PCR), respectively. Results: Max PR was significantly higher in CCVD and AIS compared to OND. Max CR was lower in CCVD and AIS compared to OND. Increased levels of glycosylated hemoglobin, cardiac biomarkers, abnormal findings at Holter ECG and Echocardiography were particularly observed in case of NCR. Conclusions: NCR may interfere with normal activity of daily living. Higher Hachinski ischaemic scores in these patients point out a higher ischaemic load. Moreover, NCR identified a category of acute patients with worst outcomes, requiring prompt intensive care because of higher risk of complications and mortality. Our observations may be useful for better choosing among therapeutical options, planning rehabilitation and health enhancing physical activity in aging. Moreover, they may reduce the risk of injuries for training overload in athletes.

Prevalence and incidence of Atrial Fibrillation (AF) is high in western countries. It is apparently lower in developing countries, because of unrecognition, undertreatment and related complications and mortality. Studies in subjects wearing cardiac implantable electronic devices showed a wide burden of AF, ranging from subclinical episodes to permanent AF. The aim of our study was to identify haematological and haemodynamic differences between Paroxysmal Atrial Tachyarrhythmias (PAT) compared to Non-Paroxysmal AF (NPAF), detected by 24 hours Holter ECG, and predictive negative factors associated with increased risk of evolution from paroxysmal to persistent or permanent AF. Our data highlight the dynamic nature of PAT and NPAF. PAT in young subjects is a red flag, requiring at least changes in lifestyle and further diagnostic examinations to avoid progression to irreversible pathological myocardial electrical and structural remodeling. Comorbidities, scarce compliance, or inappropriate treatments account for high incidence of acute cerebrovascular events with disabling outcomes in elderly patients. Further studies are needed on genetic susceptibility and vulnerability. Educational campaign is the most effective, long- term strategy. Personalized approach and therapeutical scheme are recommended based on patient compliance and actual risk. A holistic approach to patient is the pillar for any clinical decision and practice.