Multiple sclerosis (MS) can affect cardiovascular function in a variety of ways leading to abnormalities in blood pressure response, heart rate, heart rhythm, left ventricular systolic function, and may cause pulmonary edema or cardiomyopathy. Cardiovascular dysfunction in MS is incompletely understood and likely underrecognized.
The clinical presentation and pathophysiology of cardiovascular dysfunction in MS are reviewed, as are the cardiovascular toxicities of MS therapies, fingolimod and mitoxantrone. Cardiovascular dysfunction in MS can be caused by brainstem lesions affecting autonomic pathways in the medulla, overall plaque burden, and clinical severity of the disease.
Cardiovascular abnormalities may be clinical or subclinical, and can lead to sudden death in some cases. Neurologists should be aware of the clinical presentation and pathophysiology of cardiovascular dysfunction in MS so as to ameliorate cardiovascular symptoms, prevent cardiovascular complications, and choose therapeutic agents that do not worsen underlying cardiovascular disease.
*Department of Neurology, Brigham and Women’s Hospital
†Department of Neurology, Massachusetts General Hospital, Harvard Medical School
‡Department of Neurology, Brigham and Women’s Hospital, Miriam Sydney Joseph Professor of Neurology, Harvard Medical School, Boston, MA
Dr. Berkowitz receives royalties from Clinical Pathophysiology Made Ridiculously Simple (MedMaster, Inc.) and The Improvising Mind (Oxford Press). The other author have no conflict of interest to declare.
Reprints: Tamara B. Kaplan, MD, Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115 (e-mail: firstname.lastname@example.org).