Autonomic Neuropathy and the Heart in Diabetes

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Abstract
Cardiac tissue has a dual nerve supply: one from the sympathetic and one from the parasympathetic system. The ganglion cells of the parasympathetic system are usually found in close proximity to the heart, while those of the sympathetic system are usually situated at a distance from the innervated heart. The sympathetic and parasympathetic systems are integrated and are complementary; both of these take part in the intricate regulation of cardiac functions, ensuring a proper adjustment of the functioning of the heart. It is now widely accepted that acetylcholine is the neurotransmitter released from postganglionic parasympathetic nerves whereas norepinephrine (NE) is the neurotransmitter released from the postganglionic sympathetic nerves in the heart. The sympathetic and parasympathetic systems are continually active, and their basal activity is known as sympathetic tone and parasympathetic tone, respectively. In the normal person the most important nervous control of heart is parasympathetic which is mainly active during the calm, steady, and homeostatic state whereas the sympathetic system is concerned with mobilization of energy during emergency and stressful situations. Therefore, the sympathetic system is not vital for life under normal conditions but is critical for proper reaction to stress and strain.

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