It is well-known that the communication between the heart and brain is a dynamic, two-way process. According to the sympathetic and parasympathetic branches of the autonomic nervous system, the brain can control the heart directly. Sympathetic postganglionic fibers can significantly innervate the cardiac conduction system, and the cardiac cycle (HP) is almost linearly shortened with the frequency of sympathetic postganglionic discharge. The decrease in HP will increase the ventricular contractility and diastolic rate and increase the atrioventricular conduction time.
Recent studies showed that the heart has a complex neural network composed of complex ganglia, neurotransmitters, proteins, and support cells. Like the brain in the head, the heart-brain's neural circuitry allows independent learning, memory, decision-making, and even feeling and perception. Under normal physiological conditions, the heart-brain neural circuitry plays an important role in the routine control of cardiac functions.
Fig.1 The possible brain-heart connection in the pathogenesis of TTS. (Bustamante-Sánchez, 2020)
Communication Methods Between Heart and Brain
Nervous system - transmission of nerve impulses
Biochemically - according to hormones and neurotransmitters
Biophysically - through pressure waves
Energetically - interactions in electromagnetic fields
Clinical Implications of Heart-brain's Neural Circuitry
In general, temporary sympathetic hyperactivity is the body's coping mechanism against physical or psychological stress. However, sympathetic overactivity has been served as a common phenomenon relates to cardiac pathologies. There are many reasons for the occurrence of paroxysmal sympathetic hyperactivity, such as insular stroke, sepsis, seizures, and brainstem lesions. What's more, neurodegenerative diseases often lead to autonomic nerve failure, while autonomic overactivity is associated with inflammation, traumatic disease, and adverse drug reactions.
In recent years, the analysis of heart rate variability (HRV) presents great potentials for the detection of autonomic impairments and the prediction of prognosis of some neurological disorders. Due to the relationship between heart-brain neural circuitry and multiple neurological diseases, the discovery of sympathetic cardiovascular markers is necessary for early clinical detection. Based on the development in magnetic resonance neuroimaging, as well as a series of advanced signals processing techniques, our understanding of brain-heart interaction will be greatly improved.
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Bustamante-Sánchez, A.; et al. Effect of stress on autonomic and cardiovascular systems in military population: A systematic review. Cardiology Research and Practice. 2020, 2020.