The Brain-Heart interaction is becoming increasingly important as the underlying pathophysiological mechanisms become better understood. “Neurocardiology” is a new field which explores the pathophysiological interplay of the brain and cardiovascular systems. Brain-heart cross-talk presents as a result of direct stimulation of some areas of the brain, leading to a sympathetic or parasympathetic response or it may present as a result of a neuroendocrine response attributing to a clinical picture of a sympathetic storm. It manifests as cardiac rhythm disturbances, hemodynamic perturbations and in the worst scenarios as cardiac failure and death. Brain-Heart interaction (BHI) is most commonly encountered in traumatic brain injury and subarachnoid hemorrhage presenting as dramatic electrocardiographic changes, neurogenic stunned myocardium or even as ventricular fibrillation. A well-known example of BHI is the panic disorders and emotional stress resulting in Tako-tsubo syndrome giving rise to supraventricular and ventricular tachycardias and transient left ventricular dysfunction.
In this review article, we will discuss cardiovascular changes caused due to the disorders of specific brain regions such as the insular cortex, brainstem, prefrontal cortex, hippocampus and the hypothalamus; neuro-cardiac reflexes namely the Cushing\'s reflex, the Trigemino-cardiac reflex and the Vagal reflex; and other pathological states such as neurogenic stunned myocardium /Takotsubo cardiomyopathy. There is a growing interest among intensivists and anesthesiologists in brain heart interactions as there are an increasing number of cases being reported and there is a need to address unanswered questions, such as the incidence of these interactions, the multifactorial pathogenesis, individual susceptibility, the role of medications, and optimal management.
Key Messages: BHI contribute in a significant way to the morbidity and mortality of neurological conditions such as traumatic brain injury, subarachnoid hemorrhage, cerebral infarction and status epilepticus. Constant vigilance and a high index of suspicion have to be exercised by clinicians to avoid misdiagnosis or delayed recognition. The entire clinical team involved in patient care should be aware of brain heart interaction to recognize these potentially life-threatening scenarios.
Natelson BH. Neurocardiology: an Interdisciplinary Area for the 80s. Archives Neurol 1985;42(2):178–184.
Van der wall EE. The brain-heart connection; a round trip. Neth Heart J 2011;19:269–270.
Chatterjee S. ECG changes in subarachnoid haemorrhage: a synopsis. Neth Heart J 2011;19:31–34.
Kukla P, Jastrzebski M, Praefort W. J-wave-associated ventricular fibrillation in a patient with a subarachnoid haemorrhage. Europace 2012;14:1063–1064.
Van der Wall EE. A broken heart: repair needed? Neth Heart J 2012;20:1–2.
Riera M, Llompart-Pou JA, Carrillo A, Blanco C. Head injury and inverted Takotsubo cardiomyopathy. J Trauma 2010; 68: E13–E15.
Goldstein DS. Sympathetic neuroimaging. In Handbook of Clinical Neurology, vol. 117, 365–370, Elsevier, 2013.
Lizarraga KJ, Gorgulho A, Chen W, Salles AA. Molecular imaging of movement disorders. World Journal Radiol 2016; 8(3): 226–239.
Colivicchi F, Bassi A, Santini M, Caltagirone C. Cardiac autonomic derangement and arrhythmias in right-sided stroke with insular involvement. Stroke 2004;35(9) 2094–2098.
Orlandi G, Fanucchi S, Strata G, Pataleo L, Landucci, Pellegrini et al. Transient autonomic nervous system dysfunction during hyperacute stroke. Acta Neurologica Scandinavica 2000;102 (2): 317–321.
Makovac E, Meeten F, Watson DR, Herman A, Garfinkel SN, D Critchley H, et al. Alterations in amygdala-prefrontal functional connectivity account for excessive worry and autonomic dysregulation in generalized anxiety disorder. Biol Psychiatry 2016; 80 (10): 786–795.
Cummings KJ, Commons KG, Fan KC, Li A, Nattie EE. Severe spontaneous bradycardia associated with respiratory disruptions in rat pups with fewer brain stem 5- HT neurons. Am J Physiol Regul Integr Comp Physiol. 2009;296(6):R1783–R1796.
Goldstein DS. Sympathetic neuroimaging. Handbook of Clinical Neurology, vol. 117, pp. 365–370, Elsevier, 2013.
Oppenheimer S, Cechetto D. The insular cortex and the regulation of cardiac function. Compr Physiol 2016; 6 (2) 1081–1133.
Nagai M, Hoshide S, Kario K. The insular cortex an cardiovascular system: a new insight into the brain-heart axis. J Am Soc of Hypertens 2010 ; 4 (4):174–182.
Ravindran K, Powell KL, Todaro M, O'Brien TJ. The pathophysiology of cardiac dysfunction in epilepsy. Epilepsy Res 2016; 127: 19–29.
Rauramaa T, Pikkarainen M, Englund E, Ince PG, Jellinger K, Paetau A, et al. Cardiovascular diseases and hippocampal infarcts. Hippocampus 2011;21(3): 281–287.
Wandschneider B, Koepp M, Scott C, Micallef C, Balestrini S, Sisodiya SM et al. Structural imaging biomarkers of sudden unexpected death in epilepsy. Brain 2015;138 (10): 2907–2919.
Zhang R, Niu H, Kang X, Ban T, Hong H, Ai J. Longterm administration of neuropeptide y in the subcutaneous infusion results in cardiac dysfunction and hypertrophy in rats. Cell Physiol Biochem. 2015 ;37(1):94–104.
Adams JP. Non-neurological complications of brain injury. In: Adams JP, Bell MDD, McKinlay J, eds. Neurocritical Care: A Guide to Practical Management. London: Springer, 2010; 77–88.
Lee VH, Connolly HM, Fulgham JR, Manno EM, Brown RD Jr, Wijdicks EF. Tako-tsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage: an underappreciated ventricular dysfunction. J Neurosurg 2006; 105: 246–270.
Heymans C. The control of heart rate consequent to changes in the cephalic blood pressure and in the intracranial pressure. Am J Physiol 1928; 85: 498–505.
Schaller B. Trigeminocardiac reflex: A clinical phenomenon or a new physiological entity? J Neurol 2004;251:658–665.