Cardiovascular dysfunction in multiple sclerosis

Cardiovascular dysfunction (CD) in multiple sclerosis (MS) is related to in volvement of reflex pathways in the brainstem. The battery of CD tests was applied to a group of 40 healthy subjects and 40 patients with MS, divided in 2 subgroups according to the expanded disability status scale (EDSS). Th e tests included: 1) postural blood pressure changes, 2) postural heart rat e changes, 3) heart rate changes on inspiration/forced expiration and 4) EC G R-R interval measurement on the Valsalva maneuver. Both groups were subje cted to the functional independence scale (FIM). Imaging studies were revie wed and autonomic dysfunction at other levels was explored. The results sho wed a statistically significant difference (P < 0.05) in all tests when com paring patients to controls. Tests 1 and 4 had the highest significance, wi th findings of more severe involvement in patients with a higher EDSS and l ower FIM. A correlation was also found between CD and brainstem lesions on MRI (P < 0.01). A significant number of MS patients had evidence of CD. Tes t 1 may be considered a simple marker, in daily clinical practice, to detec t subclinical CD. Subclinical CD is a cause of disability in this group of patients.