Cardiac autonomic testing and treating heart disease. “A clinical perspective”
Abstract
Overview
Background. Coronary heart disease (CHD) is a major health concern, affecting nearly half the middle-age population
and responsible for nearly one-third of all deaths. Clinicians have several major responsibilities beyond
diagnosing CHD, such as risk stratification of patients for major adverse cardiac events (MACE) and treating risks,
as well as the patient. This second of a two-part review series discusses treating risk factors, including autonomic
dysfunction, and expected outcomes.
Methods. Therapies for treating cardiac mortality risks including cardiovascular autonomic neuropathy (CAN),
are discussed.
Results. While risk factors effectively target high-risk patients, a large number of individuals who will develop
complications from heart disease are not identified by current scoring systems. Many patients with heart
conditions, who appear to be well-managed by traditional therapies, experience MACE. Parasympathetic and
Sympathetic (P&S) function testing provides more information and has the potential to further aid doctors in
individualizing and titrating therapy to minimize risk. Advanced autonomic dysfunction (AAD) and its more severe
form cardiovascular autonomic neuropathy have been strongly associated with an elevated risk of cardiac
mortality and are diagnosable through autonomic testing. This additional information includes patient-specific
physiologic measures, such as sympathovagal balance (SB). Studies have shown that establishing and maintaining
proper SB minimizes morbidity and mortality risk.
Conclusions. P&S testing promotes primary prevention, treating subclinical disease states, as well as secondary
prevention, thereby improving patient outcomes through (1) maintaining wellness, (2) preventing symptoms
and disorder and (3) treating subclinical manifestations (autonomic dysfunction), as well as (4) disease and
symptoms (autonomic neuropathy).
Keywords
Cardiac autonomic neuropathy, Cardiovascular risk factors, Heart disease, Mortality
Article Information
Disclosure
Financial support: None.
Correspondence
Nicholas L. DePace, Sr. M.D 438 Ganttown Rd Ste. 8 & 9 Sewell, NJ 08080, USA dovetech@erols.com
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