From the Guidelines
Parkinson's disease can significantly impact the heart, primarily through autonomic dysfunction, which can lead to orthostatic hypotension, irregular heart rhythms, and reduced heart rate variability, as a result of the neurodegenerative processes affecting both movement control and nerve cells regulating heart function. The disease's effect on the heart is multifaceted, involving not just the direct neurodegenerative impact but also the side effects of medications used to treat Parkinson's, such as levodopa, which can exacerbate orthostatic hypotension or introduce other cardiovascular issues 1. Furthermore, Parkinson's disease may lead to cardiac sympathetic denervation, where the nerve connections to the heart are compromised, altering the heart's response to stress and exercise. This can result in an increased risk of heart failure and reduced exercise capacity for patients with Parkinson's due to these autonomic changes.
Key aspects of how Parkinson's disease affects the heart include:
- Autonomic dysfunction leading to orthostatic hypotension and irregular heart rhythms
- Potential cardiovascular side effects from Parkinson's medications
- Cardiac sympathetic denervation affecting the heart's response to stress and exercise
- Increased risk of heart failure and reduced exercise capacity
Management of these cardiovascular complications typically involves careful adjustment of medications, lifestyle modifications such as gradual position changes, increased salt and fluid intake, and sometimes specific medications like midodrine or fludrocortisone to address blood pressure issues. It's crucial to consider the potential for certain medications, like pergolide, a dopamine-receptor agonist used in Parkinson's treatment, to cause valvular heart disease, as noted in reports of a carcinoid-like valvulopathy in patients treated with such drugs 1.
Given the complexity of Parkinson's disease and its treatment, managing its impact on the heart requires a comprehensive approach, considering both the disease's direct effects on the autonomic nervous system and the potential side effects of its treatment. The most recent and highest quality evidence should guide clinical decisions to optimize outcomes in terms of morbidity, mortality, and quality of life for patients with Parkinson's disease.
From the Research
Cardiovascular Effects of Parkinson's Disease
Parkinson's disease can have significant effects on the heart, including:
- Orthostatic hypotension, which is a common symptom in patients with Parkinson's disease, affecting up to 20% of patients 2, 3
- Cardiac dysautonomia due to autonomic nervous system malfunction, which is the most prevalent type of cardiovascular manifestation in patients with Parkinson's disease 4
- Supine hypertension, which is often associated with orthostatic hypotension 5
- Increased risk of developing ischemic heart disease, heart failure, and arrhythmias 4
Autonomic Dysfunction
Autonomic dysfunction is a key feature of Parkinson's disease, and can be triggered by the disease itself or as a side-effect of drug treatment 5. Diagnostic tests such as 24-h ambulatory blood pressure measurements can identify significant autonomic failure, which needs treatment 5.
Treatment and Management
Treatment of orthostatic hypotension in patients with Parkinson's disease should always start with patient education and nonpharmacological treatment 2, 3. Drug therapy should be reserved for symptomatic patients who do not benefit from nonpharmacological management, and may include alpha1-adrenergic agonists such as midodrine or plasma volume expanders such as fludrocortisone 2, 3.
Cardiovascular Monitoring
Cardiovascular monitoring and identification of dysfunctions can have a prodromal role for Parkinson's disease, and may lead to a better understanding of the disease 6. Heart failure is the third leading cause of death in people suffering from Parkinson's disease, highlighting the importance of cardiovascular monitoring and management 6.