Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisComplicationsTreatmentCoping
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Complications
Treatment
Coping
Cardiovascular autonomic neuropathy(CAN) is a type of dysfunction commonly found in people withdiabetes. It results from damage to the nerves that lead to theheartand blood vessels.Autonomic nerves travel from thebrainto signal the heart to beat more forcefully or at a different pace to keep up with the body’s needs. In CAN, the heart and blood vessels either do not receive or appropriately respond to these signals, resulting in various symptoms. People with CAN may have increased risk of heart complications, includingarrhythmiasandheart failure.This article discusses CAN symptoms, causes, diagnosis, and treatment options.kupicoo / E+ / Getty ImagesSymptoms of Cardiovascular Autonomic NeuropathyCAN symptoms affect a person’s quality of life. They commonly include the following:Light-headedness or dizziness, especially with standingPalpitationsRacing heartFaintingFatigueExercise intoleranceMany symptoms of CAN occur or worsen when changing position from lying or sitting to standing. Symptoms such as light-headedness and vision disturbance upon standing are known asorthostaticintolerance.When we stand, blood pools in the legs, causing a temporary decrease in blood pressure. Autonomic nerves signal to the heart to beat faster and harder, and signal the veins in the blood vessels to help keep blood pressure up, as well as to contract the veins to help push the blood back up. Orthostatic intolerance happens where there is a problem with this process.What Is the Autonomic Nervous System?Theautonomic nervous systemcontrols basic body functions that we rely on without even being aware of them. This includes heartbeat, blood pressure, breathing, and digestion.CausesCAN is defined as an autonomic disorder in people with diabetes. Poor blood sugar control over time damages nerves throughout the body, leading to neuropathy.Diabetes and NeuropathyIf you’ve been diagnosed with diabetes, you have probably been told to monitor changes in your feet. This is because the nerves in the feet may be less sensitive and you could be unaware of a cut or infection there. This is known asperipheral neuropathy.Other causes of autonomic neuropathy, also known asdysautonomia, include the following:Autoimmune disorders likemultiple sclerosisandlupusAmyloidosisChronic alcohol abuseNeurologic disorders such asParkinson’s diseaseandmultiple system atrophyInfections like human immunodeficiency virus (HIV) and syphilisSome experts have suggested that some of the ongoing symptoms of long COVID after a COVID-19 infection may be related to CAN, but this need further study.DiagnosisBecause the symptoms of CAN can be vague and overlap with symptoms of other disorders, diagnosis can be challenging. Results from several types of tests are combined to arrive at a CAN diagnosis.These include cardiovascular autonomic reflex testing and cardiovascular sympathetic tests, which measure heart rate variability, blood pressure response, orelectrocardiogramfindings to various maneuvers.Nuclear imaging tests, known as heart sympathetic imaging, may have a role in diagnosing CAN in the future.ComplicationsCAN has been associated with heart disease. People with CAN may have a higher risk of the following:Coronary artery diseaseStrokeCardiomyopathy(heart muscle weakness)Heart failureTreatmentThere is no specific medical treatment to reverse CAN. Treatment instead focuses on preventing further damage and managing symptoms.Some lifestyle measures, like diet and exercise, may be able to reverse CAN, including:Controlling blood sugar to prevent further nerve damageOptimizingcardiovascular risk factors, such as cholesterol and blood pressureManaging complications like heart failure and coronary artery diseaseLifestyle considerations are important to help manage symptoms. For example, those with orthostatic intolerance can benefit from standing up slowly, staying well-hydrated, exercising, and using compression stockings.Some medications, such asfludrocortisone,midodrine, ordroxidopa, may be used to help alleviate symptoms.CopingCAN symptoms can be frustrating to live with since they may have a profound effect on everyday life. Having the understanding and support of your treatment team, family, and friends is important.Joining asupport groupfor people with autonomic disorders, either in person or online, can help connect you with others who may have similar experiences.SummaryCAN is a nervous system condition affecting the nerves that bring signals to the heart and blood vessels. When these nerves become dysfunctional, the heart and blood vessels don’t properly keep up with the needs of the body during activities. It can be noticed when standing up or exercising. This condition can result in symptoms that affect daily life, such as fatigue, heart racing, orthostatic intolerance, and difficulty exercising.CAN is most often a complication of long-standing, uncontrolled diabetes. Treatment involves managing symptoms and controlling risk factors for cardiovascular disease, such as blood sugar, cholesterol, and blood pressure. CAN also increases the risk of heart complications like heart attack and arrhythmias, so prompt treatment is essential.A Word From VerywellBecause symptoms of CAN overlap with many other conditions, diagnosis can be challenging and take time. Oftentimes, multiple tests and specialist referrals are required. All of this can be overwhelming and frustrating. Specialized centers for autonomic disorders and support groups can be invaluable for people living with CAN.
Cardiovascular autonomic neuropathy(CAN) is a type of dysfunction commonly found in people withdiabetes. It results from damage to the nerves that lead to theheartand blood vessels.
Autonomic nerves travel from thebrainto signal the heart to beat more forcefully or at a different pace to keep up with the body’s needs. In CAN, the heart and blood vessels either do not receive or appropriately respond to these signals, resulting in various symptoms. People with CAN may have increased risk of heart complications, includingarrhythmiasandheart failure.
This article discusses CAN symptoms, causes, diagnosis, and treatment options.
kupicoo / E+ / Getty Images
Symptoms of Cardiovascular Autonomic Neuropathy
CAN symptoms affect a person’s quality of life. They commonly include the following:
Many symptoms of CAN occur or worsen when changing position from lying or sitting to standing. Symptoms such as light-headedness and vision disturbance upon standing are known asorthostaticintolerance.
When we stand, blood pools in the legs, causing a temporary decrease in blood pressure. Autonomic nerves signal to the heart to beat faster and harder, and signal the veins in the blood vessels to help keep blood pressure up, as well as to contract the veins to help push the blood back up. Orthostatic intolerance happens where there is a problem with this process.
What Is the Autonomic Nervous System?Theautonomic nervous systemcontrols basic body functions that we rely on without even being aware of them. This includes heartbeat, blood pressure, breathing, and digestion.
What Is the Autonomic Nervous System?
Theautonomic nervous systemcontrols basic body functions that we rely on without even being aware of them. This includes heartbeat, blood pressure, breathing, and digestion.
CAN is defined as an autonomic disorder in people with diabetes. Poor blood sugar control over time damages nerves throughout the body, leading to neuropathy.
Diabetes and NeuropathyIf you’ve been diagnosed with diabetes, you have probably been told to monitor changes in your feet. This is because the nerves in the feet may be less sensitive and you could be unaware of a cut or infection there. This is known asperipheral neuropathy.
Diabetes and Neuropathy
If you’ve been diagnosed with diabetes, you have probably been told to monitor changes in your feet. This is because the nerves in the feet may be less sensitive and you could be unaware of a cut or infection there. This is known asperipheral neuropathy.
Other causes of autonomic neuropathy, also known asdysautonomia, include the following:
Some experts have suggested that some of the ongoing symptoms of long COVID after a COVID-19 infection may be related to CAN, but this need further study.
Because the symptoms of CAN can be vague and overlap with symptoms of other disorders, diagnosis can be challenging. Results from several types of tests are combined to arrive at a CAN diagnosis.
These include cardiovascular autonomic reflex testing and cardiovascular sympathetic tests, which measure heart rate variability, blood pressure response, orelectrocardiogramfindings to various maneuvers.
Nuclear imaging tests, known as heart sympathetic imaging, may have a role in diagnosing CAN in the future.
CAN has been associated with heart disease. People with CAN may have a higher risk of the following:
There is no specific medical treatment to reverse CAN. Treatment instead focuses on preventing further damage and managing symptoms.
Some lifestyle measures, like diet and exercise, may be able to reverse CAN, including:
Lifestyle considerations are important to help manage symptoms. For example, those with orthostatic intolerance can benefit from standing up slowly, staying well-hydrated, exercising, and using compression stockings.
Some medications, such asfludrocortisone,midodrine, ordroxidopa, may be used to help alleviate symptoms.
CAN symptoms can be frustrating to live with since they may have a profound effect on everyday life. Having the understanding and support of your treatment team, family, and friends is important.
Joining asupport groupfor people with autonomic disorders, either in person or online, can help connect you with others who may have similar experiences.
Summary
CAN is a nervous system condition affecting the nerves that bring signals to the heart and blood vessels. When these nerves become dysfunctional, the heart and blood vessels don’t properly keep up with the needs of the body during activities. It can be noticed when standing up or exercising. This condition can result in symptoms that affect daily life, such as fatigue, heart racing, orthostatic intolerance, and difficulty exercising.
CAN is most often a complication of long-standing, uncontrolled diabetes. Treatment involves managing symptoms and controlling risk factors for cardiovascular disease, such as blood sugar, cholesterol, and blood pressure. CAN also increases the risk of heart complications like heart attack and arrhythmias, so prompt treatment is essential.
A Word From Verywell
Because symptoms of CAN overlap with many other conditions, diagnosis can be challenging and take time. Oftentimes, multiple tests and specialist referrals are required. All of this can be overwhelming and frustrating. Specialized centers for autonomic disorders and support groups can be invaluable for people living with CAN.
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Chowdhury M, Nevitt S, Eleftheriadou A, et al.Cardiac autonomic neuropathy and risk of cardiovascular disease and mortality in type 1 and type 2 diabetes: a meta-analysis.BMJ Open Diabetes Research and Care.2021;9:e002480. doi:10.1136/bmjdrc-2021-002480Serhiyenko VA, Serhiyenko AA.Cardiac autonomic neuropathy: Risk factors, diagnosis and treatment.World J Diabetes. 2018;9(1):1-24. doi:10.4239/wjd.v9.i1.1MedlinePlus.Autonomic nervous system disorders.Zelt JGE, deKemp RA, Rotstein BH, et al.Nuclear imaging of the cardiac sympathetic nervous system: A disease-specific interpretation in heart failure.JACC Cardiovasc Imaging. 2020;13(4):1036-1054. doi:10.1016/j.jcmg.2019.01.042Centers for Disease Control and Prevention.Diabetes: Nerve damage.MedlinePlus.Autonomic neuropathy.Dani M, Dirksen A, Taraborrelli P, et al.Autonomic dysfunction in ‘long COVID’: rationale, physiology and management strategies.Clin Med. 2021;21(1):e63-e67. doi:10.7861/clinmed.2020-0896Dhumad MM, Hamdan FB, Khudhair MS, Al-Matubsi HY.Correlation of staging and risk factors with cardiovascular autonomic neuropathy in patients with type II diabetes mellitus.Sci Rep. 2021;11(1):3576. doi:10.1038/s41598-021-80962-wNational Organization for Rare Disorders.Orthostatic hypotension.Olshansky B, Muldowney J.Cardiovascular safety considerations in the treatment of neurogenic orthostatic hypotension.American Journal of Cardiology. 2020;125(10):1582-1593. doi:10.1016/j.amjcard.2020.01.037
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Chowdhury M, Nevitt S, Eleftheriadou A, et al.Cardiac autonomic neuropathy and risk of cardiovascular disease and mortality in type 1 and type 2 diabetes: a meta-analysis.BMJ Open Diabetes Research and Care.2021;9:e002480. doi:10.1136/bmjdrc-2021-002480Serhiyenko VA, Serhiyenko AA.Cardiac autonomic neuropathy: Risk factors, diagnosis and treatment.World J Diabetes. 2018;9(1):1-24. doi:10.4239/wjd.v9.i1.1MedlinePlus.Autonomic nervous system disorders.Zelt JGE, deKemp RA, Rotstein BH, et al.Nuclear imaging of the cardiac sympathetic nervous system: A disease-specific interpretation in heart failure.JACC Cardiovasc Imaging. 2020;13(4):1036-1054. doi:10.1016/j.jcmg.2019.01.042Centers for Disease Control and Prevention.Diabetes: Nerve damage.MedlinePlus.Autonomic neuropathy.Dani M, Dirksen A, Taraborrelli P, et al.Autonomic dysfunction in ‘long COVID’: rationale, physiology and management strategies.Clin Med. 2021;21(1):e63-e67. doi:10.7861/clinmed.2020-0896Dhumad MM, Hamdan FB, Khudhair MS, Al-Matubsi HY.Correlation of staging and risk factors with cardiovascular autonomic neuropathy in patients with type II diabetes mellitus.Sci Rep. 2021;11(1):3576. doi:10.1038/s41598-021-80962-wNational Organization for Rare Disorders.Orthostatic hypotension.Olshansky B, Muldowney J.Cardiovascular safety considerations in the treatment of neurogenic orthostatic hypotension.American Journal of Cardiology. 2020;125(10):1582-1593. doi:10.1016/j.amjcard.2020.01.037
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Chowdhury M, Nevitt S, Eleftheriadou A, et al.Cardiac autonomic neuropathy and risk of cardiovascular disease and mortality in type 1 and type 2 diabetes: a meta-analysis.BMJ Open Diabetes Research and Care.2021;9:e002480. doi:10.1136/bmjdrc-2021-002480Serhiyenko VA, Serhiyenko AA.Cardiac autonomic neuropathy: Risk factors, diagnosis and treatment.World J Diabetes. 2018;9(1):1-24. doi:10.4239/wjd.v9.i1.1MedlinePlus.Autonomic nervous system disorders.Zelt JGE, deKemp RA, Rotstein BH, et al.Nuclear imaging of the cardiac sympathetic nervous system: A disease-specific interpretation in heart failure.JACC Cardiovasc Imaging. 2020;13(4):1036-1054. doi:10.1016/j.jcmg.2019.01.042Centers for Disease Control and Prevention.Diabetes: Nerve damage.MedlinePlus.Autonomic neuropathy.Dani M, Dirksen A, Taraborrelli P, et al.Autonomic dysfunction in ‘long COVID’: rationale, physiology and management strategies.Clin Med. 2021;21(1):e63-e67. doi:10.7861/clinmed.2020-0896Dhumad MM, Hamdan FB, Khudhair MS, Al-Matubsi HY.Correlation of staging and risk factors with cardiovascular autonomic neuropathy in patients with type II diabetes mellitus.Sci Rep. 2021;11(1):3576. doi:10.1038/s41598-021-80962-wNational Organization for Rare Disorders.Orthostatic hypotension.Olshansky B, Muldowney J.Cardiovascular safety considerations in the treatment of neurogenic orthostatic hypotension.American Journal of Cardiology. 2020;125(10):1582-1593. doi:10.1016/j.amjcard.2020.01.037
Chowdhury M, Nevitt S, Eleftheriadou A, et al.Cardiac autonomic neuropathy and risk of cardiovascular disease and mortality in type 1 and type 2 diabetes: a meta-analysis.BMJ Open Diabetes Research and Care.2021;9:e002480. doi:10.1136/bmjdrc-2021-002480
Serhiyenko VA, Serhiyenko AA.Cardiac autonomic neuropathy: Risk factors, diagnosis and treatment.World J Diabetes. 2018;9(1):1-24. doi:10.4239/wjd.v9.i1.1
MedlinePlus.Autonomic nervous system disorders.
Zelt JGE, deKemp RA, Rotstein BH, et al.Nuclear imaging of the cardiac sympathetic nervous system: A disease-specific interpretation in heart failure.JACC Cardiovasc Imaging. 2020;13(4):1036-1054. doi:10.1016/j.jcmg.2019.01.042
Centers for Disease Control and Prevention.Diabetes: Nerve damage.
MedlinePlus.Autonomic neuropathy.
Dani M, Dirksen A, Taraborrelli P, et al.Autonomic dysfunction in ‘long COVID’: rationale, physiology and management strategies.Clin Med. 2021;21(1):e63-e67. doi:10.7861/clinmed.2020-0896
Dhumad MM, Hamdan FB, Khudhair MS, Al-Matubsi HY.Correlation of staging and risk factors with cardiovascular autonomic neuropathy in patients with type II diabetes mellitus.Sci Rep. 2021;11(1):3576. doi:10.1038/s41598-021-80962-w
National Organization for Rare Disorders.Orthostatic hypotension.
Olshansky B, Muldowney J.Cardiovascular safety considerations in the treatment of neurogenic orthostatic hypotension.American Journal of Cardiology. 2020;125(10):1582-1593. doi:10.1016/j.amjcard.2020.01.037
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