Cardiac autonomic neuropathy and physical therapy: A case report

Cardiac autonomic neuropathy (CAN) is a complication of diabetes mellitus, which imposes significant functional limitations and at times, sudden death. In an evolving healthcare landscape, physical therapists are assuming greater clinical responsibility and thus must be aware of this potential complication and tailor the plan of care appropriately. The purpose of this case report is to highlight the need for increased awareness of CAN among physical therapists in order to improve screening, diagnosis, and treatment. A 41-year-old Spanish-speaking male with uncontrolled type 2 diabetes arrived to the emergency department (ED) with dizziness and syncope leading to an inability to walk, work, or complete community service hours. After evaluation by the ED physical therapist, the patient was admitted for further work-up and diagnosed with CAN. After a short hospital course, the patient returned home symptomatic, fell, and was re-admitted the same day. Throughout the second hospital stay, the patient's symptoms improved with robust medical management allowing physical therapy treatment and functional independence for safe discharge home. Additionally, patient-specific goals were met with the help of social work and the medical team. Clinical knowledge of CAN for the non-cardiopulmonary specialist physical therapist is lacking. As physical therapists prepare to be advanced practice providers in a rapidly evolving healthcare landscape, increasing awareness has the potential to lead to improved screening, diagnosis, and treatment of persons with CAN, a severe complication of diabetes.