Total Cardiac Denervation in Diabetic Autonomic Neuropathy

Lloyd‐Mostyn, R H; Watkins, P J

doi:10.2337/diab.25.9.748

Cited by 35 publications

(6 citation statements)

References 4 publications

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“…Respiratory influences on the donor heart rate are absent, and there is a reduced or absent heart rate response to various pharmacological and physiological manoeuvres (15,16). Similar findings have also been reported in a patient with total cardiac denervation due to diabetic autonomic neuropathy (17).…”

Section: Discussionsupporting

confidence: 72%

Chronic Paroxysmal Hemicrania: Heart Rate Changes and ECG Rhythm Disturbances. A Computerized Analysis of 24 h Ambulatory ECG Recordings

Russell

Storstein

1984

Cephalalgia

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Ambulatory ECG recordings have been carried out in five patients suffering from CPH. During the study a total of 105 attacks occurred. Contrary to findings in cluster headache, no typical pattern of heart rate change was found in association with attacks of CPH. A striking finding in all patients, however, was that there were often large and rapid variations in heart rate which could be observed "before", "during" or "after" the attacks. One patient developed bradycardia and sino-atrial block and another bundle branch block together with episodes of atrial fibrillation in association with attacks.

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Section: Discussionsupporting

confidence: 72%

Chronic Paroxysmal Hemicrania: Heart Rate Changes and ECG Rhythm Disturbances. A Computerized Analysis of 24 h Ambulatory ECG Recordings

Russell

Storstein

1984

Cephalalgia

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“…The orthostatic blood pressure disturbance was not severe in most of our IDDM patients and this could be due to their abilities to increase the heart rates. Diabetic patients incapacitated by severe orthostatic blood pressure falls often have a fixed heart rate due to cardiac autonomic neuropathy [20]. As suggested from recent findings in diabetic children [21], our prospective study favors the concept of an inherent defective postural vasoconstriction in diabetic patients.…”

Section: Discussionsupporting

confidence: 68%

A prospective study of orthostatic blood pressure in diabetic patients

Kanter

Lilja

Elmståhl

et al. 1998

Clinical Autonomic Research

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To clarify whether orthostatic blood pressure is affected by the type of diabetes, cardiac autonomic neuropathy, and the duration of diabetes, orthostatic blood pressure (passive 90 degrees tilt) was evaluated in 102 patients with insulin dependent diabetes mellitus (IDDM), 51 patients with non-insulin dependent diabetes mellitus (NIDDM), and in 238 control subjects in a first study followed up after 8 to 17 years. The heart rate reaction during deep breathing (E/I ratio) and to tilt (acceleration and brake indices) assessed cardiac autonomic function. In the first study, the lowest systolic blood pressure (LSBP) and the lowest diastolic blood pressure (LDBP) after tilt were significantly lower in IDDM patients compared with NIDDM patients (p < 0.001 for LSBP and p < 0.05 for LDBP) and controls (p < 0.001). LDBP was, however, also significantly lower (p < 0.05) in NIDDM patients than in controls. Hence, although most severe in IDDM, LDBP was disturbed in both types of diabetes. In IDDM, a low E/I ratio was associated with disturbed orthostatic blood pressure. At follow-up examinations, orthostatic blood pressure deteriorated in NIDDM but not in IDDM patients. In conclusion, LSBP and LDBP were impaired in IDDM patients compared with NIDDM and control subjects; however, LDBP was also impaired in NIDDM patients compared with controls. When the duration of diabetes increased, orthostatic blood pressure deteriorated in NIDDM but not in IDDM patients.

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“…In some cases they return to normal with treatment. Depressed RCVRs are generally viewed as a sign of autonomic neuropathy 13); an absent RCVR in diabetics has been equated with total cardiac denervation [13].…”

Section: Discussionmentioning

confidence: 99%

Quantitation of the sweating deficiency in diabetes mellitus

Kennedy

Sakuta

Sutherland

et al. 1984

Annals of Neurology

120

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This report introduces quantitative tests for the evaluation of sweating and the results obtained in 81 diabetic and 30 control subjects. The tests rely on the ability of pilocarpine, introduced into the skin by iontophoresis, to stimulate sweating from fully or partially innervated sweat glands but not from denervated glands. Many diabetic patients had a reduced number of excitable sweat glands and a low volume of sweat per square centimeter of skin. The results of the sweat tests correlated best with the clinically determined perception of pain from pinprick. The similar degree of involvement of sudomotor axons and pain-conveying axons may be related to the known similarity in size and reinnervation patterns. There was poor correlation of the sweating deficiency with alpha motor conduction velocity and with denervation of foot muscles as determined by the evoked muscle action potential. The number of excitable sweat glands was usually normal if the muscle action potential was above 0.5 mv, and often normal even when a muscle action potential was unobtainable. Every diabetic patient with abnormal sweating and several with normal sweating had reduced heart rate fluctuation during a standard Valsalva maneuver or during slow respiration.

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Total Cardiac Denervation in Diabetic Autonomic Neuropathy

Cited by 35 publications

References 4 publications

Chronic Paroxysmal Hemicrania: Heart Rate Changes and ECG Rhythm Disturbances. A Computerized Analysis of 24 h Ambulatory ECG Recordings

Chronic Paroxysmal Hemicrania: Heart Rate Changes and ECG Rhythm Disturbances. A Computerized Analysis of 24 h Ambulatory ECG Recordings

A prospective study of orthostatic blood pressure in diabetic patients

Quantitation of the sweating deficiency in diabetes mellitus

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