The role of self‐regulation in modulating the heart‐brain connection

Abstract

Cardiovascular disease is characterized by autonomic imbalance. The sympathetic nervous system is activated in order to compensate for declining cardiac function, but the increased activation actually has deleterious effects over time. Mortality in end‐stage heart failure is predicted by elevated plasma norepinephrine levels and a decrease in overall heart rate variability. Beta adrenergic blocking drugs are increasingly used to prevent the cardiac remodeling which follows myocardial infarction or other stresses to the myocardium. Together with sympathetic overdrive, the parasympathetic branch of the autonomic nervous system is correspondingly down‐regulated, and it is now clear that decreased parasympathetic input to the cardiovascular system may be equally harmful, promoting a pro‐inflammatory state which further exacerbates disease. Biofeedback‐mediated stress management is a method for training individuals to control the balance of sympathetic and parasympathetic nervous system activation. Such training can be used to increase parasympathetic and decrease sympathetic activation, with corresponding effects on remodeling and disease progression. Work in our research program focuses on testing the hypothesis that patients with cardiovascular disease can be taught to improve autonomic balance, and that this improvement will result in decreased symptoms, improved quality of life, and possibly even disease reversal. Patient populations which are currently being studied and which will be discussed include those with end‐stage heart failure awaiting transplantation and those with documented coronary artery disease.