On Neurocardiology Updates: an Interdisciplinary Field at the Intersection of Neurology and Cardiology

This review examines the evolving field of neurocardiology, tracing its development from early homeostatic theories to modern understandings of the bidirectional neural networks that link the heart and brain. We propose an integrative framework to explain neuro-cardiac interactions in health and disease, with a focus on clinical applications and emerging therapies.

The neuro-cardiac axis comprises hierarchical neural networks, from the intrinsic cardiac nervous system to subcortical and cortical brain regions. This structure underlies a range of clinical syndromes. Acute brain injuries can induce cardiac dysfunction via autonomic dysregulation, as seen in neurogenic stunned myocardium (NSM), while cardiac disease contributes to cerebral small vessel disease (CSVD) and cognitive decline. Cardioception-the brain's processing of cardiac signals-is increasingly recognized as a key mediator of autonomic control and emotional experience. Clinical trials highlight the value of targeted interventions, including extended cardiac monitoring to detect occult atrial fibrillation, improved risk stratification for managing patent foramen ovale, and intensive vascular risk control for cerebrovascular protection. Growing awareness of neuro-cardiac pathways is reshaping clinical care. Understanding how brain insults provoke cardiac dysfunction via disrupted autonomic outflow is critical, particularly in NSM. Meanwhile, cardioception is gaining relevance as a therapeutic target in the regulation of emotions and the autonomic nervous system. Conversely, cardiac pathology promotes stroke, CSVD, and cognitive impairment not only through embolism but also through altered perfusion and autonomic imbalance. Comprehensive management of modifiable vascular risks confers dual protection for the heart and brain. Interdisciplinary collaboration is increasingly vital for managing disorders along the heart-brain continuum. Translating insights from neurocardiac mechanisms into precision therapies marks a new frontier. Advances in neuroimaging, artificial intelligence, and neuromodulation offer opportunities for personalized care. The ongoing development of cross-specialty training and integrated research platforms will be essential for translating scientific progress into improved outcomes in neurocardiac disorders.