Heart Matters: Cardiac Dysfunction and Other Autonomic Changes in Parkinson’s Disease

Abstract

It has been more than 200 years since James Parkinson made the first descriptions of the disease that bears his name. Since then, knowledge about Parkinson’s disease has been improved, and its pathophysiology, diagnosis, and treatments are well described in the scientific and medical literature. However, there is no way to prevent the disease from its progressive nature yet and only its symptoms can be minimized. It is known that the process of neurodegeneration begins before the onset of motor signs and symptoms of the disease, when diagnosis is usually made. Therefore, recognizing manifested non-motor symptoms can make an early diagnosis possible and lead to a better understanding of the disease. Autonomic dysfunctions are important non-motor manifestations of Parkinson’s disease and affect the majority of patients. Importantly, heart failure is the third leading cause of death in people suffering from Parkinson’s disease. Several evidences have shown the correlation between Parkinson’s disease and the preexistence of cardiovascular diseases. Therefore, cardiovascular monitoring and identification of its dysfunctions can have a prodromal role for Parkinson’s disease. This review presents studies of the literature that can lead to a better understanding of Parkinson’s disease with special attention to its relation to heart and cardiovascular parameters.

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

“…Additionally, the evaluation of myocardial function has revealed that, in general, it worsens in PD subjects and specially as the disease progresses [82]. Altogether, these results may be related to the increased prevalence of heart failure in PD [29,79,83] (Figure 2). An open debate exists regarding the origin of abnormalities in the electrocardiographs of PD subjects: some studies point out that they might be caused as a consequence of some parkinsonian treatments, while others have found no relationship [79,80,83].…”

“…The sympathetic system controls increases in heart rate, while the parasympathetic one is in charge of its decrease [29]. Different evidence points out that in the early phases of PD, there might be a decrease in parasympathetic activity and an increment in sympathetic activity, resulting in the dysregulation of the autonomous system [30].…”

“…An increase in NA plasma levels is needed to change from a supine to a standing position. OH is defined by the inability to compensate for a sudden systemic blood pressure decrease due to the loss of NA innervation [14,29].…”

“…Cardiovascular alterations can affect approximately 80% of PD patients and can worsen the progression of the disease, increasing the risk of death [17,29,65]. The most frequent clinical manifestation of cardiac autonomic failure in PD is OH [66].…”

“…For example, postprandial hypotension, supine hypertension, increased blood pressure variability and decreased heart rate variability, as well as chronotropic incompetence [63,[70][71][72][73]. In fact, some authors support the idea that they could be used as early diagnostic tools, since some of them appear in the prodromal stages of the disease [29,70]. In particular, postprandial hypotension can appear in early stages of the disease and it is related to a worse outcome of the motor condition.…”