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Can Parkinson’s Cause Heart Problems

Understanding The Neurologic Control Of The Cardiac System

What is Parkinson’s Disease?

Before we explore this issue, lets first learn a bit about the autonomic nervous system and about the cardiac systems place within it. The ANS is part of the peripheral nervous system, a network of nerves throughout the body. The ANS exerts control over functions that are not under conscious direction such as respiration, heart function, blood pressure, digestion, urination, sexual function, pupillary response, and much more. The ANS is further subdivided into the parasympathetic nervous system and the sympathetic nervous system. Both the parasympathetic and sympathetic nervous systems regulate most major organs. Often, they have opposite effects, with the sympathetic nervous system activating a system and the parasympathetic system calming it down.

One of the systems controlled by the ANS is cardiac regulation. Blood pressure sensors, known as baroreceptors, reside in the heart as well as in the carotid artery, the major artery in the neck. If the baroreceptors sense a change in the blood pressure, a signal is sent to particular areas in the brain. From there, the autonomic nervous system sends signals to the heart to control heart rate and cardiac output. Signals are also sent to the blood vessels to change the size of their diameter, thereby regulating blood pressure.

Heart Damage Could Be Early Indicator Of Parkinsons

Parkinsons disease is most widely known for causing muscle tremors and motor-control symptoms, but most Parkinsons sufferers also exhibit damage to their hearts connection to the sympathetic nervous system. In fact, that damage is one of the first signs of Parkinsons, but the connection is often not made until the more visible symptoms develop.

Researchers at theWisconsin National Primate Research Center and the University of Wisconsin have found a new way to examine stress and inflammation in the heart that could serve as an early indicator of Parkinsons well before the more common symptoms begin.

The heart damage is significant because it contributes to a tendency for Parkinsons patients to suffer physical injury as a result of blood pressure fluctuations.

This neural degeneration in the heart means patients bodies are less prepared to respond to stress and to simple changes like standing up, said, a University of WisconsinMadison professor of medical physics and Parkinsons researcher at the WiNPRC. They have increased risk for fatigue, fainting and falling that can cause injury and complicate other symptoms of the disease.

The sympathetic nervous system signals the heart to accelerate its pumping to match quick changes in activity and blood pressure. Researchers at WiNPRC developed a method for tracking the mechanisms that cause the damage to heart nerve cells, then tested the method in the nervous system and heart of monkeys.

Parkinson’s Drugs: Heart Damage Link

Researchers Raise Concerns About Damage to Heart Valves From 2 Parkinson’s Drugs

Jan. 3, 2007 — Two drugs used in the treatment of Parkinson’s disease appear to increase the risk of heart valve disease, according to new research that also raises safety questions about similar-acting drugs.

The drugs pergolide, marketed as Permax, and cabergoline, sold as Dostinex, were associated with heart valve damage in two European studies published in the Jan. 4 issue of the New England Journal of Medicine.

Both drugs are in a class known as ergot-derived dopamine receptor agonists, and both have been linked to heart valve issues in earlier case reports.

“We showed that treatment with either pergolide or cabergoline for more than six months was strongly associated with an increase in valve-related heart disease,” Edeltraut Garbe, MD, PhD, tells WebMD. “No increase in risk was seen in patients treated with other dopamine agonists.”

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What Medications Are Used To Treat Parkinsons Disease

Medications are the main treatment method for patients with Parkinsons disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.

Medications combat Parkinsons disease by:

  • Helping nerve cells in the brain make dopamine.
  • Mimicking the effects of dopamine in the brain.
  • Blocking an enzyme that breaks down dopamine in the brain.
  • Reducing some specific symptoms of Parkinsons disease.

Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinsons disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinsons disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .

What Are The Different Stages Of Parkinsons Disease

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Each person with Parkinsons disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinsons disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.

In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:

Early stage

Early symptoms of Parkinsons disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.

Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.

Mid stage

Mid-late stage

Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.

Advanced stage

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What Is The Treatment For Parkinson’s Disease

    There is currently no treatment to cure Parkinson’s disease. Several therapies are available to delay the onset of motor symptoms and to ameliorate motor symptoms. All of these therapies are designed to increase the amount of dopamine in the brain either by replacing dopamine, mimicking dopamine, or prolonging the effect of dopamine by inhibiting its breakdown. Studies have shown that early therapy in the non-motor stage can delay the onset of motor symptoms, thereby extending quality of life.

    The most effective therapy for Parkinson’s disease is levodopa , which is converted to dopamine in the brain. However, because long-term treatment with levodopa can lead to unpleasant side effects , its use is often delayed until motor impairment is more severe. Levodopa is frequently prescribed together with carbidopa , which prevents levodopa from being broken down before it reaches the brain. Co-treatment with carbidopa allows for a lower levodopa dose, thereby reducing side effects.

    In earlier stages of Parkinson’s disease, substances that mimic the action of dopamine , and substances that reduce the breakdown of dopamine inhibitors) can be very efficacious in relieving motor symptoms. Unpleasant side effects of these preparations are quite common, including swelling caused by fluid accumulation in body tissues, drowsiness, constipation, dizziness, hallucinations, and nausea.

    How Do I Prevent Falls From Common Hazards

    • Floors: Remove all loose wires, cords, and throw rugs. Minimize clutter. Make sure rugs are anchored and smooth. Keep furniture in its usual place.
    • Bathroom: Install grab bars and non-skid tape in the tub or shower. Use non-skid bath mats on the floor or install wall-to-wall carpeting.
    • Lighting: Make sure halls, stairways, and entrances are well-lit. Install a night light in your bathroom or hallway and staircase. Turn lights on if you get up in the middle of the night. Make sure lamps or light switches are within reach of the bed if you have to get up during the night.
    • Kitchen: Install non-skid rubber mats near the sink and stove. Clean spills immediately.
    • Stairs: Make sure treads, rails, and rugs are secure. Install a rail on both sides of the stairs. If stairs are a threat, it might be helpful to arrange most of your activities on the lower level to reduce the number of times you must climb the stairs.
    • Entrances and doorways: Install metal handles on the walls adjacent to the doorknobs of all doors to make it more secure as you travel through the doorway.

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    How Does The Cholesterol Myth Relate To Heart Disease

    MIT Scientist Raymond Francis answers this question in his paper titled The Cholesterol Myth, arguing that the answer is a story involving the triumph of money and power over science.

    Francis goes on to explain:

    Atherosclerosisthe main cause of heart attacks and strokesis the accumulation of fatty plaque inside the walls of major arteries. As the disease progresses, arteries become increasingly narrow, making it easier for a blood clot or piece of dislodged plaque to completely block blood flow, resulting in either a heart attack or a stroke. When cholesterol was found to be a major component of arterial plaque, the cholesterol theory of heart disease was born, thinking that high cholesterol levels cause atherosclerosis. The truth, however, is not so simple. Cholesterol is an anti¬oxidant, a repair and healing molecule. The body produces more of it in response to stress and tissue damage, when repair and healing are needed. Remove the causes of the bodys distress, like inflammation and oxidation, and you lower cholesterol. It turned out that blaming cholesterol for heart disease makes as much sense as blaming the Red Cross for the disasters it responds to.

    The authors of this particular study concluded:

    Not only are Statins unnecessary for many of the people who take them, but they pose numerous health risks as well. A new study conducted by Penn State College found a correlation between use of Statins and increased risk of Parkinsons disease.

    Characteristics Of The Population

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    This was an observational, cross-sectional, comparative pilot study carried-out in an ambulatory setting. Non-demented PD patients were consecutively recruited from our department. Patients with suspected atypical or secondary parkinsonism were excluded, as well as those with comorbidities known to influence HRV , or those patients taking drugs that are known to reduce HRV . Similar exclusion criteria were used for healthy controls , who were matched 1:1 for sex and age to PD patients. All the participants gave their informed consent to participate in the study. The study was approved by the local ethics committee and conducted according to the principles of the Declaration of Helsinki.

    During the study period, 127 patients were evaluated. Overall, 104 patients were excluded because they did not meet the inclusion criteria . Five of the final 23 patients invited, refused to participate in the study.

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    What Is Parkinsons Disease

    Parkinsons disease is a progressive brain disorder that affects mobility and mental ability. If you or a loved one has been diagnosed with Parkinsons, you may be wondering about life expectancy.

    According to some research, on average, people with Parkinsons can expect to live almost as long as those who dont have the condition.

    Tips For Coping With Breathing Difficulties

    • Work with your doctor to identify and treat any non-PD causes of shortness of breath, such as lung disease, heart disease or lack of physical conditioning and endurance.
    • Exercise as much as possible. Shortness of breath may lead a person to move less. Less physical activity reduces the ability to take deep breaths. Staying active improves pulmonary function.
    • Take steps to cope with anxiety. Talk with your doctor to figure out what sets off anxiety and find treatments and techniques that work for you.
    • Speak to your doctor about getting an evaluation performed by a speech-language pathologist who can help you address issues related to swallowing.
    • Give up smoking.

    Page reviewed by Dr. Chauncey Spears, Movement Disorders Fellow at the University of Florida, a Parkinsons Foundation Center of Excellence.

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    Dichotomisation Was Used In The Assessment Of The Level Of Physical Activity And Smoking Habits

    Stopping Parkinson

    Four levels of physical activity resulted in three levels tested in relation to inactive habits. The first level was somewhat active, the second level was more active and the third level was high activity, including sports and rational training.

    Six levels of smoking information resulted in two groups to compare with non-smokers. The first group was current smokers and ex-smokers and the second group was former smokers with former ex-smokers.

    At the time of the health-care visit, serum triglycerides , serum cholesterol, waist/height, BMI, BP and blood glucose from oral glucose tolerance test were assessed and examined by univariate comparisons between cases and controls, and if significant, they were included in the conditional logistic regression.

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    Checking For Heart Valve Disease

    In a separate study from Italy, researchers performed echocardiograms on Parkinson’s patients being treated with either ergot-derived or nonergot-derived dopamine-targeting drugs. An echocardiogram is an ultrasound of the heart which can provide information on the heart’s chambers and valves and how well blood is pumping through the heart.

    Compared with an age-matched group without Parkinson’s disease, patients taking pergolide or cabergoline had significantly more evidence of heart valve disease.

    Clinically important evidence of valve damage was seen in roughly 5% of the comparison group, compared with 23% of patients taking pergolide and 28% of patients taking cabergoline.

    Garbe says it is clear from the two studies that patients taking either pergolide or cabergoline should be monitored closely for heart valve damage.

    “We aren’t saying that these drugs should not be used,” she says. “I think if patients are appropriately followed they can be prescribed. But neurologists and other treating physicians have to be made aware of the risks.”

    A spokesman for pergolide manufacturer Valeant Pharmaceuticals International tells WebMD that the company would have no direct comment on the two new studies. But a company statement reaffirmed the safety of the drug.

    What Are The Surgical Treatments For Parkinsons Disease

    Most patients with Parkinsons disease can maintain a good quality of life with medications. However, as the disease worsens, medications may no longer be effective in some patients. In these patients, the effectiveness of medications becomes unpredictable reducing symptoms during on periods and no longer controlling symptoms during off periods, which usually occur when the medication is wearing off and just before the next dose is to be taken. Sometimes these variations can be managed with changes in medications. However, sometimes they cant. Based on the type and severity of your symptoms, the failure of adjustments in your medications, the decline in your quality of life and your overall health, your doctor may discuss some of the available surgical options.

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    I’m Concerned About My Cardiovascular Health What Should I Do

    The first thing to do is make an appointment with your GP or practice nurse.

    They can carry out an assessment using special computer software that can calculate your risk based on factors including things like age, blood pressure and family history of vascular disease.

    If you are at medium or high vascular risk they will be able to discuss the best ways to reduce your risk. These include lifestyle changes to diet and exercise, and possibly medications like statins.

    What Looks Like Parkinsons But Isnt

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    Dr. Fernandez describes two main Parkinsons mimics:

    Essential tremor. Also known as benign essential tremor or familial tremor, this movement disorder causes brief, uncontrollable shaking.

    It most often affects your hands, but can also affect your head and neck, larynx and other areas. In rare cases, it affects your lower body as well.

    But one clue can help distinguish essential tremor from Parkinsons.

    This is not an absolute rule, but if shaking occurs at rest, it often is Parkinsons. And if shaking occurs in action, such as when youre writing or eating, it is essential tremor, Dr. Fernandez says.

    About half of those with essential tremor have a family history of the condition.

    Unlike Parkinsons, essential tremor is generally not perceived as a progressive disorder, and, if mild, may not require treatment.

    Doctors can prescribe medications to reduce shaking, but they are not the same drugs used to treat Parkinsons, he says.

    Drug-induced Parkinsons. Along with shaking, this condition may cause many symptoms similar to Parkinsons disease, including stiffness, slow movement, a decrease in facial expression and a change in speech.

    As the name suggests, taking certain drugs, most commonly antipsychotics and mood stabilizers, can trigger this condition. How long it takes to develop can vary greatly, depending on which drug youre taking, how long you take it and the dosage.

    Your doctor likely will treat drug-induced Parkinsons by adjusting your medication.

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    What Causes Parkinsons Disease

    Parkinsons disease occurs when nerve cells in an area of the brain called the substantia nigra become impaired or die. These cells normally produce dopamine, a chemical that helps the cells of the brain communicate . When these nerve cells become impaired or die, they produce less dopamine. Dopamine is especially important for the operation of another area of the brain called the basal ganglia. This area of the brain is responsible for organizing the brains commands for body movement. The loss of dopamine causes the movement symptoms seen in people with Parkinsons disease.

    People with Parkinsons disease also lose another neurotransmitter called norepinephrine. This chemical is needed for proper functioning of the sympathetic nervous system. This system controls some of the bodys autonomic functions such as digestion, heart rate, blood pressure and breathing. Loss of norepinephrine causes some of the non-movement-related symptoms of Parkinsons disease.

    Scientists arent sure what causes the neurons that produce these neurotransmitter chemicals to die.

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