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Published on: November 5, 2019
Sickle cell related cardiomyopathy and cardiovascular autonomic dysfunction
Jack Hartnett1,2,3, Niall Connolly1,2, Sandra Quinn1,2
1Department of Cardiology, St James's Hospital, Dublin, Ireland.
Insights
Sickle cell disease (SCD) patients live longer, increasing focus on end-organ damage. This review covers sickle cell cardiomyopathy, autonomic dysfunction, and sudden death risks in SCD.
Area of Science:
- Cardiology
- Hematology
- Genetics
Background:
- Sickle cell disease (SCD) is a global genetic hemoglobinopathy.
- Increased patient longevity necessitates understanding long-term complications.
- Chronic micro-vascular sickling leads to end-organ damage.
Purpose of the Study:
- To review literature on sickle cell cardiomyopathy.
- To explore the link between autonomic dysfunction and SCD.
- To examine the association between SCD and sudden death.
Main Methods:
- Literature review of sickle cell cardiomyopathy.
- Analysis of studies on autonomic function in SCD.
- Examination of mortality data related to sudden death in SCD.
Main Results:
- Sickle cell cardiomyopathy presents with ventricular changes and diastolic dysfunction.
- Autonomic dysfunction in SCD involves sympathetic overactivity and parasympathetic withdrawal.
- Sudden death is a significant mortality cause in SCD, with mechanisms under investigation.
Conclusions:
- Sickle cell cardiomyopathy is an emerging clinical concern in SCD.
- Autonomic dysfunction may contribute to vaso-occlusive crises and adverse cardiac events.
- Further research is needed to elucidate the mechanisms of sudden death in SCD.
Abstract:
Sickle cell disease (SCD) is the most common genetic haemoglobinopathy worldwide. Due to advancements in care, SCD patients are living longer. Consequently, there is increased interest in long term sequalae of chronic micro-vascular sickling and resultant end organ damage. Sickle cell cardiomyopathy is an emerging clinical entity characterised by a unique combination of ventricular dilatation, ventricular hypertrophy, diastolic dysfunction and pulmonary hypertension. Additionally, SCD patients have impaired autonomic function which is thought to pre-dispose to vaso-occlusive crises through sympathetic activation and parasympathetic withdrawal during times of physiologic stress. Furthermore, sudden death is a major cause of mortality among patients with SCD, however the mechanism has not been elucidated. This review summarizes the sickle cell cardiomyopathy literature, its relationship with autonomic dysfunction and its association with sudden death.
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