Stress-related dysautonomias and neurocardiology-based treatment approaches

Abstract

Cardiovascular and psychiatric disorders are among the most commonly treated conditions worldwide. Research in neurocardiology, psychiatry, and epidemiology have defined bidirectional relationships between psychiatric disorders and heart disease, affirming the role of impaired autonomic nervous system, or dysautonomia in the prognosis and development in these disorders. These studies have fueled rapid clinical translation of experimental findings, with potential to complement existing pharmacological therapies. In this review, we comprehensively discuss the state-of-the-art investigations and novel treatment approaches for stress-related dysautonomias, emphasizing the effects of stress on the cardiac neuronal hierarchy. Increasing evidence suggests that autonomic modulation stands as an attractive therapeutic strategy in the treatment of dysautonomias that could complement existing therapies and possibly reduce the burden of drug-related side effects and treatment-resistant conditions. Further investigations regarding treatment optimization, selectivity, usability, and ethical concerns are required.

Keywords: Bioelectronic medicine; Dorsal root ganglia; Dysautonomia; Myocardial ischemia; Neurocardiology; Posttraumatic stress disorder; Renal denervation; Spinal cord; Stress; Transcranial magnetic stimulation; Vagus nerve stimulation; tragus nerve stimulation.