Cardiac innervations in diabetes mellitus-Anatomical evidence of neuropathy

The extensive innervations of the heart include a complex network of sympathetic, parasympathetic, and sensory nerves connected in loops that serve to regulate cardiac output. Metabolic dysfunction in diabetes affects many different organ systems, including the cardiovascular system; it causes cardiac arrhythmias, silent myocardial ischemia, and sudden cardiac death, among others. These conditions are associated with damage to the nerves that innervate the heart, cardiac autonomic neuropathy (CAN), which is caused by various pathophysiological mechanisms. In this review, the main facts about the anatomy of cardiac innervations and the current knowledge of CAN, its pathophysiological mechanisms, and its diagnostic approach are discussed. In addition, anatomical evidence for CAN from human and animal studies has been summarized.

Automated summary

The heart is extensively innervated by a complex network of sympathetic, parasympathetic, and sensory nerves that regulate cardiac output. Metabolic dysfunction in diabetes affects multiple organ systems, including the cardiovascular system, leading to conditions such as cardiac arrhythmias, silent myocardial ischemia, and sudden cardiac death. These conditions are associated with damage to the nerves that innervate the heart, known as cardiac autonomic neuropathy, which is caused by various pathophysiological mechanisms.