Cardiac Changes in Parkinson’s Disease: Lessons from Clinical and Experimental Evidence

Abstract

Dysautonomia is a common non-motor symptom in Parkinson’s disease (PD). Most dysautonomic symptoms appear due to alterations in the peripheral nerves of the autonomic nervous system, including both the sympathetic and parasympathetic nervous systems. The degeneration of sympathetic nerve fibers and neurons leads to cardiovascular dysfunction, which is highly prevalent in PD patients. Cardiac alterations such as orthostatic hypotension, heart rate variability, modifications in cardiogram parameters and baroreflex dysfunction can appear in both the early and late stages of PD, worsening as the disease progresses. In PD patients it is generally found that parasympathetic activity is decreased, while sympathetic activity is increased. This situation gives rise to an imbalance of both tonicities which might, in turn, promote a higher risk of cardiac damage through tachycardia and vasoconstriction. Cardiovascular abnormalities can also appear as a side effect of PD treatment: L-DOPA can decrease blood pressure and aggravate orthostatic hypotension as a result of a negative inotropic effect on the heart. This unwanted side effect limits the therapeutic use of L-DOPA in geriatric patients with PD and can contribute to the number of hospital admissions. Therefore, it is essential to define the cardiac features related to PD for the monitorization of the heart condition in parkinsonian individuals. This information can allow the application of intervention strategies to improve the course of the disease and the proposition of new alternatives for its treatment to eliminate or reverse the motor and non-motor symptoms, especially in geriatric patients.

Propolis induces cardiac metabolism changes in 6-hydroxydopamine animal model: A dietary intervention as a potential cardioprotective approach in Parkinson’s disease

“…The understanding of PD needs to be comprehensive, not just derived from the degeneration of the nigrostriatal system, as the non-motor manifestations are intrinsic to the disease encompassing and encompass several organ systems, with autonomic nervous system dysfunction of particular interest ( Goldstein, 2014 ; Cuenca-Bermejo et al, 2021 ). Cardiovascular changes are a non-motor symptom derived from autonomic dysfunction and commonly seen in PD patients.…”

“…It is expected that about 80%-90% of PD patients will have changes in the autonomic system, and a higher risk of dying due to major cardiac complications than the general population (Palma and Kaufmann, 2018;Scorza et al, 2018;Zhang and Chen, 2020;Gonçalves et al, 2021). Likewise, there is twice the prevalence of heart failure in patients with PD compared to the general population (Cuenca-Bermejo et al, 2021), and these patients are more susceptible to heart failure, coronary artery disease, sudden cardiac death, orthostatic hypotension, hypertension, bradycardia and reduced heart rate variability, pointing to direct changes in the sympathetic and parasympathetic nervous systems (Gonçalves et al, 2020;Finsterer et al, 2018). Therefore, the existence of heart disease needs to be recognized and monitored more intensively in PD, in order to improve the patient's prognosis and quality of life.…”

“…Although known as a typical movement disorder defined by the presence of bradykinesia, combined with resting tremor, and/or muscle rigidity caused by the loss of approximately 50% of dopaminergic neurons in the substantia nigra pars compacta, PD has several non-motor manifestations that usually occur in the prodromal phase of the disease, years before the diagnosis of PD ( Durcan et al, 2019 ; Bloem et al, 2021 ; Longinetti et al, 2021 ). Autonomic disorders and cardiovascular abnormalities are among the most common non-motor symptoms of PD ( Scorza et al, 2018 ; Park et al, 2020 ; Cuenca-Bermejo et al, 2021 ). It is expected that about 80%–90% of PD patients will have changes in the autonomic system, and a higher risk of dying due to major cardiac complications than the general population ( Palma and Kaufmann, 2018 ; Scorza et al, 2018 ; Zhang and Chen, 2020 ; Gonçalves et al, 2021 ).…”

Nitric Oxide Involvement in Cardiovascular Dysfunctions of Parkinson Disease

“…Cardiovascular abnormalities can also appear as a side effect of PD treatment by L-DOPA leading to a decrease in blood pressure aggravating the orthostatic hypotension. This side effect limits the therapeutic use of L-DOPA in geriatric patients with PD and can contribute to the number of hospital admissions ( Cuenca–Bermejo et al, 2021 ). It is estimated that 80% of PD patients have heart rate and blood pressure abnormalities ( Gibbons et al, 2017 ).…”

The implication of cardio-oncology on Parkinson's disease: answers begin to emerge

“… 6 Several studies have found autonomic dysfunction to be a valuable predictor of cardiovascular morbidity and mortality in PD patients. 8 , 9 Despite the tremendous clinical and epidemiological relevance of these studies, Sudden Death in PD (SUDPAR), a rare but fatal event, contributes to the increased mortality in PD patients. 2 , 10 …”