Goh Fang Qin, Tan Benjamin Y Q, Yeo Leonard L L, Sia Ching-Hui
Department of Medicine, National University Hospital, Singapore 119074.
Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074.
Cardiol Discov. 2025 Jun;5(2):162-177. doi: 10.1097/CD9.0000000000000156. Epub 2025 Apr 17.
The heart-brain axis involves complex interactions between the cardiovascular and nervous systems via a network of cortical and subcortical structures working with the autonomic nervous system and intracardiac nervous system. Heart-brain interactions may be divided into 2 broad categories: cardiac effects of neurological disease and neurological effects of cardiac disease. The pathogenesis of neurogenic cardiac effects is thought to involve a neurogenic cascade where sudden shifts in autonomic balance lead to an exaggerated catecholamine release. This can occur in acute neurological conditions such as ischemic stroke, intracranial hemorrhage, and epilepsy. Cardiovascular complications include the stroke-heart syndrome, neurogenic pulmonary edema and cardiomyopathy, Takotsubo syndrome, arrhythmias, and even sudden cardiac death. Certain areas of the brain, such as the insular cortex, play key roles in cardiac autonomic regulation, and disorders affecting these areas have greater effects on the heart. On the other hand, cardiac conditions can also adversely impact the neurological system. Atrial fibrillation and left ventricular thrombus can cause cardioembolic strokes, whereas heart failure and severe aortic stenosis have been linked to the development of cognitive impairment. This review aims to provide a broad overview of key topics in neurocardiology as well as delve into the evidence and pathophysiology behind these conditions.
心脑轴涉及心血管系统和神经系统之间通过皮质和皮质下结构网络与自主神经系统和心内神经系统协同作用的复杂相互作用。心脑相互作用可分为两大类：神经系统疾病的心脏效应和心脏疾病的神经学效应。神经源性心脏效应的发病机制被认为涉及一种神经源性级联反应，即自主神经平衡的突然改变导致儿茶酚胺过度释放。这可发生在急性神经系统疾病，如缺血性中风、颅内出血和癫痫中。心血管并发症包括中风-心脏综合征、神经源性肺水肿和心肌病、应激性心肌病、心律失常，甚至心源性猝死。大脑的某些区域，如岛叶皮质，在心脏自主调节中起关键作用，影响这些区域的疾病对心脏的影响更大。另一方面，心脏疾病也会对神经系统产生不利影响房颤和左心室血栓可导致心源性栓塞性中风，而心力衰竭和严重主动脉瓣狭窄与认知障碍的发生有关。本综述旨在对神经心脏病学的关键主题进行广泛概述，并深入探讨这些疾病背后的证据和病理生理学。
