RSD Puzzle #066

H. Hooshmand, M. D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

BOARD CERTIFIED IN ELECTROENCEPHOLOGRAPHY

BOARD CERTIFIED IN ELECTROMYOGRAPHY

BOARD CERTIFIED IN AMERICAN BOARD OF ELECTODIAGNOSTIC MEDICINE

INTRACTABLE NEUROLOGY

EPILEPSY, PAIN, MS

An International Referral Center dedicated to Treatment, Education and Research

RSD PUZZLE #66
The Relationship Of RSD With Heart Disease

You have inquired regarding the relationship of RSD with heart disease. Apparently you have had a pre-existing heart disease that is becoming aggravated by RSD.

RSD causes three independent negative influences on cardiac function.

1. The sympathetic system is responsible for three main functions, i.e., temperature regulation, vital signs, and regulation of the immune system. The vital signs in the form of heart beat, blood pressure and respiration are up regulated and accelerated by stimulation of the sympathetic system. The RSD is not a simple hyperactivity only stimulation of the sympathetic system. It is the result of dysfunction of the sympathetic system. This dysfunction shows an instability of the sympathetic system at times causing fluctuation of blood pressure and at other times causing attacks of fast heart beat.

2. The second reason RSD affects cardiac function is due to the anatomical innervation of the heart muscles. Of all the visceral organs, the heart has the richest innervation of the sympathetic system. This is in the form of cardiac plexus which is a rich plexus of nerves surrounding the heart. In any stressful condition, the natural response is rapid heart beat and rise of the blood pressure. The RSD being a distressful type of dysfunction of the sympathetic system, results in repetitive pathological and exaggerated response of the sympathetic system to stress, chest pain, palpation, and bouts of high blood pressure.

3. One of the main principles of development of RSD is inflammation. RSD is a condition with four major features. First, the allodynia and hyperpathia typical with pains seen with sympathetic dysfunction. Second, motor response to such pain in the form of vasoconstriction, muscle spasm and tremor. Thirdly, inflammation in the form of skin rash, swelling of soft tissues of the extremities, and increased circulation in the visceral structures resulting in osteoporosis, pelvic inflammation, and attacks of vascular headaches. The same inflammation and increased visceral circulation causes distress on the heart. Obviously if the patient has already had pre-existing cardiac disease, the distressful disease of RSD is going to cause further stress on the heart on the basis of the above mentioned three principles.

H. Hooshmand, M.D.

cc: Eric Phillips

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