Neural control of the heart

Areas distributed throughout the neuraxis, including the anterior insula, anterior cingulate cortex (ACC), amygdala, hypothalamus, periaqueductal gray matter, parabrachial nucleus, and several regions of the medulla, exert a beat-to-beat control on cardiac function. These areas are critically involved in emotional behavior, stress responses, and homeostatic reflexes and exert their influence on heart rate (HR) and cardiac contractility via the sympathetic and parasympathetic nervous systems. Over the past several years, advances in neuroanatomical, neurophysiologic, and functional imaging studies have provided insight into the central and peripheral mechanisms of neural control of cardiac function in humans. Whereas some issues, such as lateralization of this central control, remain unresolved, the adverse cardiac consequences of a wide variety of neurologic disorders emphasize the need to better understand the functional anatomy and neurochemical mechanisms of the neural control of the heart. Important examples are severe arrhythmias and myocardial injury in the setting of neurologic catastrophes and sudden unexplained death in epilepsy. This review will focus on some of the current experimental and clinical information related to these relevant issues for the neurologist.