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Cardiovascular autonomic dysfunction: diagnosis and prognosis.

V L Broadstone1, T Roy, M Self

  • 1Department of Medicine, University of Louisville, Kentucky.

Diabetic Medicine : a Journal of the British Diabetic Association
|January 1, 1991
PubMed
Summary

Cardiovascular autonomic dysfunction in diabetes can be subtle. Tests like RR-variation and the Valsalva maneuver help identify issues like abnormal heart rate response and postural hypotension, crucial for managing diabetic complications.

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Area of Science:

  • Cardiology
  • Neurology
  • Endocrinology

Background:

  • Cardiovascular autonomic dysfunction (CAD) symptoms in diabetes can be subtle and manifest late.
  • Key symptoms include abnormal exercise response, postural hypotension, and cardiac denervation.
  • Autonomic nervous system (ANS) testing evaluates complex reflex pathways.

Purpose of the Study:

  • To review common and validated cardiovascular autonomic tests for diabetic patients.
  • To highlight the significance of RR-variation, Valsalva maneuver, and postural testing.
  • To provide an assessment algorithm for diabetic patients with postural symptoms.

Main Methods:

  • Evaluation of RR-variation (sinus arrhythmia during breathing).
  • Assessment of the Valsalva maneuver (forced expiration).

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  • Postural testing to detect hypotension.

    • Main Results:

    • Diabetic patients with autonomic neuropathy show decreased RR-variation.
    • Abnormal exercise response correlates with impaired RR-variation in diabetics.
    • Diabetic patients with autonomic neuropathy often lack the normal reflex bradycardia after the Valsalva maneuver.
    • An algorithm aids in assessing diabetic patients with postural symptoms.

    Conclusions:

    • RR-variation is a sensitive indicator of cardiac autonomic innervation impairment.
    • Early identification of patients at risk for painless ischemia is possible.
    • Management of postural hypotension involves addressing secondary causes, mechanical measures, plasma volume expansion, and vasoconstriction.
    • Cardiovascular stress testing is recommended before exercise programs in at-risk individuals.