What is multiple sclerosis (MS) ?
Multiple sclerosis is a systemic and chronic disease that affects the nervous system (spinal nerves and brain cells). It damages the myelin sheath that protects the nerve cells. This makes the nerve impulses to pass slower and numbness and other symptoms like sweating,urinary dysfunction, orthostatic imbalance, gastrointestinal symptoms and sexual dysfunction may be present due to myelin uncovered nerves
Women are 2-3 times more affected than men and symptoms start at 15-60 years of age. Multiple slerosis is considered an autoimmune disease. The area of demyelination provides the type of symptoms. Multiple sclerosis affects the cardiovascular system as well and multiple sclerosis heart palpitations are quite common in these patients. They manifest the cardiac problems that follow sclerosis.
There are four types of multiple sclerosis:
– Relapsing-remitting multiple sclerosis (RRMS) is the most common form and responds good to treatment.
– Secondary progressive multiple sclerosis (SPMS) is when a remission of RRMS is not fully resolved.
– Primary progressive multiple sclerosis (PPMS) progresses over time without episodes of improvements of remissions.
– Progressive-relapsing multiple sclerosis (PRMS) is the case of escalating symptoms over time and intermittent remission events.
How is multiple sclerosis related to heart palpitations? Mechanism.
Multiple sclerosis may lead to abnormalities in blood pressure, heart rate and rhythm (arrhythmia), left ventricular systolic dysfunction (conduction system defects), cardiomyopathy (hypertrophy), pericardial effusions, heart failure, pulmonary edema as well (due to pulmonary hypertension) and valvular impairment (rare case). All of these situations can manifest palpitations as a symptom.
Primary myocardial disease (not associated with systemic or pulmonary hypertension or any other pulmonary or renal severe disease) is thought to be due to microvascular ischaemia. Undetected cardiac lesions can progress silently to myocardial fibrosis and can lead to arrhythmia and heart failure.
The vascular lesions and fibrosis impair microcirculation and myocardial function and develop multiple sclerosis heart palpitations. Also thinning of the left ventricular myocardium can be present in 29% of cases and pericardial effusions, systolic and diastolic ventricular dysfunctions are also present.
Vasospasm of the blood vessels is an important cardiac manifestation. Fixed structural abnormalities of the coronary vessels reduce the coronary flow reserve and make the heart suffer.
Myocardial fibrosis can remain subclinical (with light or no symptoms at all) for a very long period of time. It occurs later and can lead to severe manifestations. Myocardial fibrosis may affect both ventricles, leading to increased ventricular mass thus decreases the movement of the ventricular walls and impaires relaxation during diastole. This means your heart can not pump normally.
Treatment/management of multiple sclerosis heart palpitations.
Treatment of early abnormalities with calcium channel blockers and ACE- inhibitors may improve myocardial perfusion and function. Patients may benefit from the administration of the calcium channel blockers (nifedipine), the ACE-inhibitor captopril, as well as intravenous dipyridamole (as a pharmacodynamic test inducing maximal coronary artery vasodilatation). Treatment with these agents improves myocardial perfusion but some abnormalities may be irreversible.
There is no specific information on effective treatments for heart in multiple sclerosis. Controling systemic hypertension and early treatment of pulmonary hypertension are important to prevent secondary cardiac damage. When left ventricular function is impaired the situation needs aggressive treatment. If there is severe diastolic heart failure, diuretics must be used.
You must know that there is no treatment to change the natural history of the primary cardiac involvement in multiple sclerosis. The ACE inhibitor captopril and the calcium channel blockers nifedipine and nicardipine have been shown to improve cardiac microcirculation for some patients. Nifedipine and bosentan can increase myocardial perfusion and function when given together.
All these drugs by improving the cardiac health contribute in relieving the multiple sclerosis heart palpitations especially in arrhythmias.
Also multiple sclerosis must be treated as much as possible to prevent the fast progression of the disease. Interferon therapies, natalizumab, nitotaxone etc. are used to help the immune system and control sclerosis but they have side effects that must be taken into consideration.
The treatment depends on the time the symptoms appeared, with accompanied diseases, age and the severity of symptoms. Each time must be a doctor who will prescribe medication.