Assessment of Cardiovascular Effects in Diabetic Autonomic Neuropathy and Prognostic Implications

TLDR

Cardiovascular effects of diabetic autonomic neuropathy include postural hypotension, resting tachycardia, painless myocardial infarction, and may contribute to sudden deaths via abnormal autonomic reflexes. Cardiovascular reflex involvement in diabetes is evaluated with noninvasive tests such as the Valsalva maneuver, beat‑to‑beat heart‑rate variation, standing heart‑rate response, postural blood‑pressure fall, and sustained handgrip. Parasympathetic dysfunction is detected earlier and more frequently than sympathetic damage, which appears later and is linked to clinical symptoms; when tests are abnormal alongside autonomic‑neuropathy symptoms, the prognosis is grave.

Abstract

Cardiovascular effects of diabetic autonomic neuropathy include postural hypotension, resting tachycardia, and, possibly, painless myocardial infarction. Involvement of cardiovascular reflexes in diabetes can be assessed using simple noninvasive tests: the Valsalva maneuver, beat-to-beat heart rate variation, the heart rate response to standing, postural fall in blood pressure, and the sustained handgrip test. Tests of parasympathetic function appear to be abnormal more frequently and earlier in cardiac autonomic involvement, whereas sympathetic damage usually occurs later and is associated with clinical symptoms. When test results are abnormal, in association with symptoms suggestive of autonomic neuropathy, the prognosis is grave. Some sudden deaths that occur may be due to abnormal autonomic reflexes.