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Neurocardiology: Structure-Based Function
DOI:10.1002/cphy.c150046.png)
摘要
En 中文
Cardiac control is mediated via a series of reflex control networks involving somata in the (i) intrinsic cardiac ganglia (heart), (ii) intrathoracic extracardiac ganglia (stellate, middle cervical), (iii) superior cervical ganglia, (iv) spinal cord, (v) brainstem, and (vi) higher centers. Each of these processing centers contains afferent, efferent, and local circuit neurons, which interact locally and in an interdependent fashion with the other levels to coordinate regional cardiac electrical and mechanical indices on a beat-to-beat basis. This control system is optimized to respond to normal physiological stressors (standing, exercise, and temperature); however, it can be catastrophically disrupted by pathological events such as myocardial ischemia. In fact, it is now recognized that autonomic dysregulation is central to the evolution of heart failure and arrhythmias. Autonomic regulation therapy is an emerging modality in the management of acute and chronic cardiac pathologies. Neuromodulation-based approaches that target select nexus points of this hierarchy for cardiac control offer unique opportunities to positively affect therapeutic outcomes via improved efficacy of cardiovascular reflex control. As such, understanding the anatomical and physiological basis for such control is necessary to implement effectively novel neuromodulation therapies. (C) 2016 American Physiological Society.
Keyword:
INTRINSIC CARDIAC NEURONS
SPINAL-CORD STIMULATION
VAGUS NERVE-STIMULATION
CHRONIC HEART-FAILURE
REFRACTORY VENTRICULAR-ARRHYTHMIAS
NONMEDULLATED VAGAL AFFERENTS
CHRONIC MYOCARDIAL-INFARCTION
SA-NODAL PARASYMPATHECTOMY
ATRIAL GANGLIONATED PLEXUS
BRAIN-STEM PROJECTIONS
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954
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