Cardiology: The Autonomic Benefit

Most cardiology patients have P&S dysfunction.  Most cardiology diagnoses involve Sympathetic Excess, notable exceptions include low Blood Pressure and Orthostatic Hypotension (OH); although the latter may involve high BP as a compensatory mechanism to the drop in BP caused by OH.  As a result, most medications prescribed by Cardiologists reduce Sympathetic activity, directly or indirectly, with some sort of Sympathetic blockade, including anti-hypertensives, beta-blockers, alpha-blockers, diuretics, anti-arrhythmic medications, etc. 

We know that too much Sympathetic blockade can cause exercise intolerance, lightheadedness, and more.  P&S Monitoring help to prevent this and tailor therapy to the specific needs of the patient, rather than simply prescribing more and more and more until the patient has no energy for a decent quality of life. 

Each cardiac patient, depending on the diagnosis or severity of disease, and the therapy, may be approached selectively with P&S tests, at the discretion of the clinician.  Ultimately, heart failure or a heart attack are end-points doctors and patients alike wish to avoid.  The risk of these endpoints is foreshadowed by P&S monitoring which can detect when the nervous system is no longer communicating with the heart appropriately (known as autonomic neuropathy), placing the patient at risk for adverse endpoints.  P&S Monitoring is an example of the non-invasive techniques that provide more information.  More P&S information is reproducible and appears to be the most appropriate for many patients for risk stratification and follow-up of pharmacological and non-pharmacologic therapy.  Simultaneous assessment of both autonomic branches plays a key role.  More P&S information and serial non-invasive P&S monitoring also enables earlier diagnoses, treatment, and possible prevention of autonomic dysfunctions as a means of maintaining quality of life.

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* ‘RFa’ is known to be a measure of Parasympathetic activity and ‘LFa’ is known to be a measure of Sympathetic activity, based on reference: Colombo J, Arora RR, DePace NL, Vinik AI, Clinical Autonomic Dysfunction: Measurement, Indications, Therapies, and Outcomes. Springer Science + Business Media, New York, NY; 2014.