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Diagnosis and management of adult hereditary cardio-neuromuscular disorders: A model for the multidisciplinary care of complex genetic disorders

Trends Cardiovasc Med. 2017 Jan;27(1):51-58. doi: 10.1016/j.tcm.2016.06.005. Epub 2016 Jun 14.

Abstract

Genetic disorders that disrupt the structure and function of the cardiovascular system and the peripheral nervous system are common enough to be encountered in routine cardiovascular practice. Although often these patients are diagnosed in childhood and come to the cardiologist fully characterized, some patients with hereditary neuromuscular disease may not manifest until adulthood and will present initially to the adult cardiologist for an evaluation of an abnormal ECG, unexplained syncope, LV hypertrophy, and or a dilated cardiomyopathy of unknown cause. Cardiologists are often ill-equipped to manage these patients due to lack of training and exposure as well as the complete absence of practice guidelines to aid in the diagnosis and management of these disorders. Here, we review three key neuromuscular diseases that affect the cardiovascular system in adults (myotonic dystrophy type 1, Friedreich ataxia, and Emery-Dreifuss muscular dystrophy), with an emphasis on their clinical presentation, genetic and molecular pathogenesis, and recent important research on medical and interventional treatments. We also advocate the development of interdisciplinary cardio-neuromuscular clinics to optimize the care for these patients.

Keywords: Heart disease; Heart failure; Multidisciplinary care; Neuromuscular disease.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Cooperative Behavior
  • Delivery of Health Care, Integrated*
  • Friedreich Ataxia / diagnosis
  • Friedreich Ataxia / genetics
  • Friedreich Ataxia / therapy
  • Genetic Predisposition to Disease
  • Genetic Testing
  • Heart Diseases / diagnosis*
  • Heart Diseases / etiology
  • Heart Diseases / therapy*
  • Heart Function Tests
  • Humans
  • Infant
  • Interdisciplinary Communication
  • Muscular Dystrophy, Emery-Dreifuss / diagnosis
  • Muscular Dystrophy, Emery-Dreifuss / genetics
  • Muscular Dystrophy, Emery-Dreifuss / therapy
  • Myotonic Dystrophy / diagnosis
  • Myotonic Dystrophy / genetics
  • Myotonic Dystrophy / therapy
  • Neuromuscular Diseases / complications
  • Neuromuscular Diseases / diagnosis*
  • Neuromuscular Diseases / genetics
  • Neuromuscular Diseases / therapy*
  • Patient Care Team*
  • Phenotype
  • Predictive Value of Tests
  • Risk Factors
  • Treatment Outcome
  • Young Adult