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Heart rate changes in diabetes mellitus.

D J Ewing, I W Campbell, B F Clarke

    Lancet (London, England)
    |January 24, 1981
    PubMed
    Summary

    Diabetic autonomic neuropathy can increase resting heart rates due to damage to the parasympathetic nervous system, and sometimes combined with sympathetic nerve damage. This suggests the vagus nerve is affected before cardiac sympathetic nerves in diabetics.

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    Area of Science:

    • Cardiology
    • Neurology
    • Endocrinology

    Background:

    • Diabetic autonomic neuropathy (DAN) affects multiple organ systems, including the cardiovascular system.
    • Cardiovascular reflex abnormalities are common in individuals with diabetes mellitus.
    • Resting heart rate changes can indicate the extent of autonomic dysfunction in diabetes.

    Purpose of the Study:

    • To investigate the relationship between resting heart rate and cardiovascular reflex abnormalities in diabetic patients.
    • To determine the impact of parasympathetic and sympathetic nervous system involvement on heart rate in diabetes.
    • To explore the sequence of autonomic nerve damage in the progression of diabetic cardiovascular autonomic neuropathy.

    Main Methods:

    • Resting heart rates were measured in three positions (lying, sitting, standing) in 61 diabetic patients with varying degrees of cardiovascular reflex abnormalities.
    • Autonomic function tests were performed at least three times in 38 additional diabetic patients.
    • Heart rate patterns were analyzed in relation to parasympathetic and sympathetic nerve function.

    Main Results:

    • Patients with parasympathetic abnormalities alone exhibited the highest resting heart rates.
    • Individuals with both parasympathetic and sympathetic involvement had elevated heart rates, faster than those with normal reflexes.
    • Sequential heart rate changes in 13 patients indicated parasympathetic damage preceded sympathetic damage.

    Conclusions:

    • Increased resting heart rates in diabetics can result from isolated parasympathetic damage or combined parasympathetic and sympathetic damage.
    • The findings support the hypothesis that the vagus nerve is affected earlier than cardiac sympathetic nerves in diabetic neuropathy.
    • Monitoring resting heart rate provides insights into the progression and nature of cardiovascular autonomic dysfunction in diabetes.

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