Neurogenic Heart: Understanding the Connection Between the Nervous System and the Heart

Introduction

The term “neurogenic heart” refers to heart function disturbances caused by problems in the nervous system rather than the heart itself. The nervous system, particularly the autonomic nervous system (ANS), plays a crucial role in regulating heart rate, blood pressure, and overall cardiovascular function.

How the Nervous System Controls the Heart

The autonomic nervous system (ANS) has two main components: 1. Sympathetic Nervous System (SNS) – Increases heart rate and blood pressure (fight-or-flight response). 2. Parasympathetic Nervous System (PNS) – Slows down heart rate and promotes relaxation (rest-and-digest response). A dysfunction in this balance can lead to several neurogenic heart disorders.

Common Neurogenic Heart Conditions

1. Neurocardiogenic Syncope (Vasovagal Syncope)

• A sudden drop in heart rate and blood pressure due to overstimulation of the vagus nerve.
• Can cause fainting, dizziness, and weakness.

2. Dysautonomia and Postural Orthostatic Tachycardia Syndrome (POTS)

• Dysautonomia refers to a dysfunction of the autonomic nervous system, leading to blood circulation problems.
• POTS is a condition where the heart rate increases abnormally upon standing, often accompanied by dizziness, fatigue, and palpitations.

3. Arrhythmias Caused by Neurological Disorders

• Epileptic seizures or stroke can trigger irregular heart rhythms due to abnormal brain-heart communication.
• Some patients with neurodegenerative diseases (e.g., Parkinson’s, multiple system atrophy) may also develop heart rhythm disturbances.

4. Stress-Induced Cardiomyopathy (Takotsubo Syndrome)

• Also known as “broken heart syndrome”, caused by excessive sympathetic activation during severe emotional or physical stress.
• Mimics a heart attack but is usually reversible.

Diagnosis and Treatment

• Electrocardiogram (ECG), Heart Rate Variability Tests, and Autonomic Function Testing help diagnose neurogenic heart issues.
• Treatment depends on the underlying cause but may include:
  • Lifestyle modifications (hydration, salt intake, stress management).
  • Medications (beta-blockers, fludrocortisone, midodrine, ivabradine for POTS).
  • Pacemakers or Neuromodulation Therapy in severe cases.

Conclusion

Neurogenic heart disorders are complex conditions where the nervous system and the heart interact abnormally. Proper diagnosis and management are essential for improving quality of life and preventing complications.

Source recommendations

1. 2023 American Heart Association/American College of Cardiology Clinical Practice Guidelines for the Evaluation and Management of Syncope

1. https://www.ahajournals.org/doi/10.1161/cir.0000000000000499
2. https://www.jacc.org/doi/10.1016/j.jacc.2017.03.003
3. https://www.ahajournals.org/doi/10.1161/cir.0000000000000498
4. https://www.jacc.org/doi/abs/10.1016/j.jacc.2017.03.002
5. https://pubmed.ncbi.nlm.nih.gov/30412710/

2. 2022 European Society of Cardiology Guidelines for the Diagnosis and Management of Syncope

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Syncope-Guidelines-on-Diagnosis-and-Management-of
2. https://pubmed.ncbi.nlm.nih.gov/19713422/
3. https://www.jacc.org/doi/10.1016/j.jacc.2019.09.012
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC3295536/
5. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001106

3. Heart Rhythm Society Expert Consensus Statement on Neurocardiogenic Causes of Arrhythmia

1. https://www.hrsonline.org/documents/2015-hrs-pots-ist-vvspdf/download
2. https://www.heartrhythmjournal.com/article/S1547-5271(23)02246-4/fulltext
3. https://www.hrsonline.org/documents/2013-hrsehraaphrs-expert-consensus-statement-diagnosis-and-management-patients-inherited/download
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC5267948/
5. https://www.sciencedirect.com/science/article/pii/S0167527322016643