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Cardiovascular involvement in Parkinson’s disease

Published on September 28, 2023   57 min

A selection of talks on Clinical Practice

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0:00
Hello everyone. I'm Dave Goldstein. I'm the Chief of the Autonomic Medicine Section in the Division of Intramural Research at the National Institute of Neurological Disorders and Stroke at the National Institutes of Health in Bethesda, Maryland, in the USA. Today, I'm going to be lecturing on cardiovascular involvement in Parkinson's disease.
0:28
There are three general topics for today's lecture. One is on neurogenic orthostatic hypotension, a characteristic feature of Parkinson's with autonomic failure. Then, I'm going to go into the sympathetic innervation of the heart, which plays a major role in the cardiovascular abnormalities that are found in Parkinson's. Then, I'll finish with future trends as I see them in this area.
1:01
Two general areas under neurogenic orthostatic hypotension that I'll be covering. One is on the clinical and prognostic significance and the second is on how you identify orthostatic hypotension as neurogenic. Concerning orthostatic hypotension.
1:18
The frequency of orthostatic hypotension and Parkinson's varies remarkably among studies. This is because of different referral patterns to different types of centers. For instance, a neurology center will see the movement disorder and may underestimate the frequency of orthostatic hypotension because of dependence on complaints. Many patients with Parkinson's orthostatic hypotension don't have any symptoms of orthostatic hypotension. Orthostatic hypotension in Parkinson's can be an early finding in this situation and can be misdiagnosed as multiple system atrophy or pure autonomic failure. We'll be going over some of the clinical correlates that are related to the treatment considerations for Parkinson's with orthostatic hypotension. I'll provide evidence that orthostatic hypotension in Parkinson's Disease occurs independently of Levodopa treatment. However, dopaminergic drugs such as Levodopa decrease blood pressure when the person is standing. Orthostatic hypotension in Parkinson's is often associated with supine hypertension and this poses a treatment dilemma. Some of the special treatment considerations that we'll be reviewing are that orthostatic hypotension in Parkinson's usually is worse in the morning. It's associated with heat intolerance, post-exercise, drop in blood pressure, and post-prandial hypotension after eating a large meal. Acute water ingestion can raise the blood pressure, and this provides a useful tact as we'll get into it. Finally, I'll discuss the importance of determining whether the patient has denervation super sensitivity because this would drive the choice of drug used to treat orthostatic hypotension.

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Cardiovascular involvement in Parkinson’s disease

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