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[Variability of heart rate after heart surgery under extracorporeal circulation: aortocoronary bypass or aortic valve replacement].

The study of heart rate variability allows analysis of modulations of heart rate by the sympathetic vagal system. The authors studied the course of sinus variability by 24-hour Holter monitoring preoperatively, and on the 6th and 42nd postoperative day, in 25 patients undergoing coronary bypass graft (group I) and 10 patients undergoing aortic valve replacement (group II). Surgery was performed under cardiopulmonary bypass with selective antegrade cold crystalloid cardioplegia. The preoperative ejection fraction of these patients was 62% with a mean age of 59.5 years in group I and 61.5 years in group II. All temporal or spectral parameters were significantly decreased in the two groups on the sixth day (p < 0.05). Parameters which remain altered on D42 compared to baseline values were temporal parameters: pNN50 and rMSSD for group I and ASDNN for group II, with a tendency to return to baseline values, but with a higher mean heart rate in group II on D6 and D42 (p < 0.05). In the spectral domain, TP (total power of the spectrum) and LF (Low frequencies) remained decreased in both groups. A reversible alteration of sinus variability parameters was therefore observed in the two groups of patients. Other studies are necessary to define the mechanisms of these alterations, which are most probably related to catecholaminergic flooding related to CPB or partial vagal denervation by ischaemic or surgical damage to nerve structures.

Aged↗

Factors affecting heart rate variability and heart rate responses to tilting in infants aged 1 and 3 months.

Heart rate variability (HRV) and heart rate (HR) responses following a 60 degree head-up tilt were measured in 60 infants at 1 and 3 mo of age to investigate the effects on these of age, sleep state, sleep position, and mother's smoking status. HRV was determined from Poincaré plots of 500 sequential RR intervals to measure overall variability derived from the SDRR of this plot, and instantaneous variability derived from the SDdeltaRR. HR responses to the tilt were measured as changes in RR interval length from rest to immediately following the tilt and again once a stable pattern was reached. SDRR and SDdeltaRR increased 20 and 40%, respectively, with age (p < 0.0001), SDRR was higher in active sleep (AS) than quiet sleep (QS, +72%, p < 0.0001) but both measures of variability (SDRR and SDdeltaRR) were lower in the prone position compared with supine (-18%, p < 0.0001). However, several findings were dependent on the basal RR interval, thus the age effect disappeared once RR interval was taken into account, sleep state remained an important factor and the lower variability when prone now became a difference of -3% (p = 0.034). The tilt generally provoked a reflex tachycardia followed by a bradycardia and settling to a stable HR level below, at, or above baseline within 30 s. The more unusual responses were no HR change, sustained tachycardia or sustained bradycardia (15% of total). These were more likely to occur in younger infants (p = 0.008) and in AS (p < 0.0001). No changes were seen in any of the cardiac indices related to maternal smoking status. The findings confirm several reports indicating that prone sleeping damps some physiologic responses. The data emphasize the need to consider basal heart rate, and sleep position as well as sleep state in autonomic function testing during infant sleep.

Female↗

Heart rate discrimination and heart rate control: a test of Brener's theory.

Three experiments were conducted to examine predictions from Brener's theory regarding the relationship between autonomic discrimination and autonomic control. Experiment 1 examined the possibility that training subjects to discriminate their heart rates would enhance their skill at controlling that response. Twenty subjects participated in two sessions during which one group of 10 subjects received training (knowledge of results) on the Ashton discrimination technique. The second group performed the discrimination task but received no training. All subjects then took part in a third session of heart rate (HR) control (both increase and decrease) where half of each of the aforementioned groups received feedback during the control task, while the other half performed the HR control task without feedback. Results indicated that for the control of both HR increases and decreases, there was no significant difference between those subjects trained to discriminate their HR, and those who had received no training to discriminate HR. The second experiment investigated the hypothesis that training subjects with feedback to control their HR would enhance their capacity to discriminate their heart activity. Ten subjects participated in two sessions of HR control during which half the subjects received feedback training to increase HR. During a third session, all subjects underwent a test of discrimination ability using the Ashton technique, and no knowledge of results regarding performance was provided. Results confirmed the hypothesis. The final experiment in the series investigated the discrimination/control relationship within a problem-solving framework and used 20 subjects. Results confirmed the hypothesis that subjects forewarned at the time of discrimination training that a heart rate control task was to follow would perform better than 10 subjects receiving no forewarning of the task objective. This effect took place independently of cardiac discrimination ability. A second finding from this experiment was that subjects trained to discriminate heart rate were better able to increase heart rate than untrained subjects. This result contradicts that of Experiment 1, and reasons for this anomaly are discussed in detail.

Adolescent↗

[Factors of variation of heart rate].

Heart rate (HR), which participates in the short-term control of blood pressure and blood flow, depends on an intrinsic system and an extrinsic system via which the central nervous system processus and regulates the afferent stimuli of baroceptors and chemoreceptors. The situations responsible for short-term variations of HR include effort, the "white coat" effect, circadian rhythm, age, gender. The long-term maintenance of the HR level is dependent on nervous mechanisms, and haemodynamic and energetic conditions.

Autonomic Nervous System↗

Age related reference ranges of respiratory rate and heart rate for children in South Africa.

BACKGROUND: The authors have recently presented reference ranges for heart rate and respiratory rate in healthy resting schoolchildren, aged 4-16 years, in the United Kingdom. There are no similar ranges for children in the developing world. AIMS: To undertake a study in Cape Town, South Africa, to establish whether the UK ranges may be applied to socioeconomically disadvantaged groups. METHODS: Data on 346 children in a township school were recorded; their height, weight, heart rate, and respiratory rate were compared to the UK ranges. RESULTS: The two groups plotted closely together by height and weight on the UK 90 growth reference charts. There was no difference in heart rate between the two groups, and a difference of 0.46 breathes per minutes in respiratory rate, which is not felt to be of clinical significance. CONCLUSION: The reference rages of heart and respiratory rate derived in the UK may be applied to children in developing world situations.

Adolescent↗

Controlled 5-mo aerobic training improves heart rate but not heart rate variability or baroreflex sensitivity.

Endurance-trained athletes have increased heart rate variability (HRV), but it is not known whether exercise training improves the HRV and baroreflex sensitivity (BRS) in sedentary persons. We compared the effects of low- and high-intensity endurance training on resting heart rate, HRV, and BRS. The maximal oxygen uptake and endurance time increased significantly in the high-intensity group compared with the control group. Heart rate did not change significantly in the low-intensity group but decreased significantly in the high-intensity group (-6 beats/min, 95% confidence interval; -10 to -1 beats/min, exercise vs. control). No significant changes occurred in either the time or frequency domain measures of HRV or BRS in either of the exercise groups. Exercise training was not able to modify the cardiac vagal outflow in sedentary, middle-aged persons.

Adult↗

Effect of chronic cocaine administration and cocaine withdrawal on coronary flow rate and heart rate responses to epinephrine and cocaine in isolated perfused rat hearts.

The acute dose-dependent effects of epinephrine and cocaine on heart rate and coronary flow rate (CFR) were examined in isolated, perfused (Langendorff) rat hearts from animals: i) pretreated with daily cocaine injections (20 mg/kg/day) for 8 weeks; ii) after 2-day withdrawal from 8-week cocaine pretreatment; iii) vehicle-treated controls. Chronic cocaine (CC) hearts were significantly less sensitive to the chronotropic effects of epinephrine than control (C) or withdrawal (CW) hearts. CW hearts exhibited significantly higher heart rates in response to epinephrine than C and CC hearts. Epinephrine alone (2.5 x 10(-7) M) decreased CFR 11% (C), 9%(CC), 14%(CW) from respective baseline levels. Cocaine alone had no significant effect on CFR in C hearts but produced slight dose-dependent decrements in CFR in CC and particularly CW hearts at higher doses. Cocaine plus epinephrine markedly decreased CFR in all groups, particularly in CW hearts. The results indicate that chronic daily cocaine administration produces a functional tolerance of the heart to the chronotropic actions of epinephrine but a 2-day withdrawal from chronic cocaine results in a rebound supersensitivity to adrenergic stimulation and cocaine's sympathomimetic effects. In addition, cocaine produces only minor decrements in coronary flow in the rat heart, while cocaine acts synergisticallly with epinephrine to produce a marked decrease in CFR.

Animals↗

Heart rate turbulence and heart rate variability in patients with mitral valve prolapse.

AIMS: Heart rate turbulence (HRT) and heart rate variability (HRV) have been shown to be independent and powerful predictors of mortality in a specific group of cardiac patients. However, the predictive values of HRV alone is modest and information on HRV in patients with mitral valve prolapse (MVP) has so far been conflicting. In addition, no studies have previously evaluated HRT in patients with MVP. To define better the effects of MVP on cardiac autonomic function, we assessed HRT and time-domain parameters of HRV in patients with MVP. METHODS AND RESULTS: Fifty patients with MVP and 70 controls without MVP were investigated. The diagnosis of MVP was confirmed by cross-sectional echocardiography in the parasternal long-axis view and apical 4-chamber view. The HRV and turbulence analysis were assessed from a 24-hour Holter recording. When HRT parameters were compared, the values of the HRT onset and slope were significantly lower in MVP patients than in the controls group (-0.109+/-0.207 vs. -0.289+/-0.170%, P=0.001 and 8.6+/-7.2 vs. 11.5+/-7.4 ms/RRI, P=0.043, respectively) and the number of patients who had abnormal HRT onset was significantly higher in the MVP group than in controls (15 vs. 8, P=0.011). In addition, HRV parameters were not statistically different between the two groups. CONCLUSION: Although we found that the decrease in HRV parameters was not significantly different between MVP patients and controls, HRT variables (especially HRT onset) were significantly lower in MVP patients. Therefore, in our opinion, HRT is an attractive, easily applicable, and better way of non-invasive risk prediction compared with another non-invasive risk predictor, HRV.

Adult↗

Age related reference ranges for respiration rate and heart rate from 4 to 16 years.

BACKGROUND: Clinical vital signs in children (temperature, heart rate, respiration rate, and blood pressure) are an integral part of clinical assessment of degree of illness or normality. Despite this, only blood pressure and temperature have a reliable evidence base. The accepted ranges of heart and respiration rate vary widely. METHODS: This study examined 1109 children aged 4-16 years in their own schools. Age, sex, height, weight, and resting respiration rate and heart rate were recorded. The data were used to produce age related reference ranges for everyday clinical use. RESULTS: Reference intervals are presented for the range of heart rate and respiration rate of healthy resting children aged 4-16 years. The recorded values are at variance with standard quoted ranges in currently available texts.

Adolescent↗

Blood pressure, heart rate, and heart rhythm changes in patients with heart disease during talking.

Blood pressure and heart rate were recorded in 37 patients with cardiac disease while they were resting quietly and talking. Heart rate, systolic blood pressure, and diastolic blood pressure were all significantly greater while the patients were speaking than while they were resting silently. In addition, ventricular and atrial arrhythmias were more frequent while they were talking than while they were quiet. Higher resting systolic blood pressure levels also were associated with larger blood pressure increases while the patients were speaking. Older patients exhibited significantly greater systolic pressure increases while talking than younger patients. Therapeutic doses of antihypertensive medications, including beta-blockers, calcium channel blockers, and diuretics did not block the heart rate and blood pressure increases while the patients were talking. These findings suggest that more attention needs to be paid to the hemodynamic consequences of communication in patients with coronary heart disease. Coupled with previous research findings, these data also suggest that clinicians need to attend to verbal communications during routine diagnostic procedures for evaluating cardiovascular function.

Adult↗

Comparison of heart rate variability and heart rate between individuals with different emotional stability in two situations.

OBJECTIVE: To compare heart rate variability (HRV) and heart rate (HR) between individuals with different emotional stabilities in two situations and to discuss the relationship between situation, emotional stability and HRV. METHOD: Ninety-six healthy male flying students were assessed after 60 h flying exercises by senior pilots using Criterion Assessment Scale of Emotional Stability of Flying Cadets (CASESFC) compiled by our department. They were divided into groups of high emotional stability and low stability. ECG were recorded in situations of Sternberg Dual Task and Flying and HRV components and HR were analyzed and compared. RESULT: When subjects were exposed to Sternberg dual task situation, individuals with high emotional stability had lower LFnorm (P<0.05), HFnorm (P<0.05), LF/HF ratio and HR (P<0.05) than those with low emotional stability. When it comes to flying situation, individuals with high emotional stability had higher LFnorm and HFnorm, but LF/HF ratio and HR (P<0.05) were still lower than those with low emotional stability. CONCLUSION: We found that there is a tendency which implies the situational separation of fluctuation of autonomic nervous system related to emotional stability. It suggests that the ability of an individual to adjust to outer environment depends not only on personality, temperament and cognitive module, but also on a physiological basis.

Adolescent↗

Effects of halothane and isoflurane on mean arterial blood pressure, heart rate, and respiratory rate in adult Pekin ducks.

Although the cardiovascular and respiratory effects of halothane and isoflurane have been documented in a variety of common mammalian laboratory animals, they have not been investigated in birds. In this study, the effects of halothane and isoflurane anesthesia on respiratory rate, heart rate, heart rhythm, and mean arterial pressure in adult Pekin ducks were evaluated. Both anesthetics significantly increased heart rate and depressed blood pressure and respiration. Halothane induced a more profound alteration in heart rate and respiratory rate. With the ducks under halothane anesthesia, abnormal cardiac rhythms included ventricular fibrillation, ventricular bigeminy, and multifocal ventricular rhythms. Other than cardiac tachycardia, isoflurane induced no changes in cardiac rhythm.

Anesthesia↗

Twenty-four hour time domain heart rate variability and heart rate: relations to age and gender over nine decades.

OBJECTIVES: This study sought to define the effects of age and gender effects on the normal range of time domain heart rate variability (HRV) over nine decades in healthy subjects. BACKGROUND: Low HRV is considered an independent marker of mortality risk. However, the age-related decline in HRV may limit its predictive value, particularly in the elderly. Delineation of the range of HRV in healthy subjects over the life span is needed. Gender-related differences in HRV also need clarification. METHODS: We determined, according to decade, 24-h heart rate (HR) and HRV of 260 healthy subjects (10 to 99 years old; 112 male, 148 female) by means of five standard time domain measures: standard deviation of all normal sinus RR intervals over 24 h (SDNN), standard deviation of the averaged normal sinus RR intervals for all 5-mm segments (SDANN), mean of the standard deviations of all normal sinus RR intervals for all 5-min segments (SDNN index), root-mean-square of successive normal sinus RR interval difference (rMSSD) and the percentage of successive normal sinus RR intervals >50 ms (pNN50). RESULTS: 1) HRV decreased with aging, the pattern of change being measure dependent. HRV (SDNN and SDANN) decreased only very gradually, reaching 60% of baseline (second-decade values) by the tenth decade. With the SDNN index, HRV decreased linearly with aging, reaching 46% of baseline by the tenth decade. Using pNN50 and rMSSD, HRV decreased most rapidly, reaching 24% and 47% of baseline, respectively, by the sixth decade and then stabilized. 2) Using the SDNN index, rMSSD and pNN50, HRV of subjects >65 years old fell below published cutpoints for increased risk of mortality in 25%, 12% and 4%, respectively. 3) At age <30 years, HRV for all measures was lower in female than male subjects. Gender differences decreased at age >30 years and disappeared at age >50 years. 4) HR also declined with aging but much more slowly. HR at age <50 years was faster in female than in male subjects. Gender differences disappeared thereafter. CONCLUSIONS: 1) Using all measures, HRV of healthy subjects declines with aging, with measure-dependent patterns. 2) Using the SDNN index, rMSSD and pNN50, HRV of healthy subjects, particularly those >65 years old, may decrease to below levels associated with increased risk of mortality. 3) Gender influences HRV. Gender differences in HRV are age and measure dependent. 4) Age and gender also affect heart rate.

Adolescent↗

Does heart rate identify sudden death survivors? Assessment of heart rate, QT interval, and heart rate variability.

The objective was to test whether the circadian variability of several electrocardiographic variables distinguishes sudden cardiac death survivors from heart disease patients without a history of cardiac arrest and from normal subjects. Heart rate, heart rate variability, and QT interval have been reported to identify survivors of sudden cardiac death. Computer-assisted continuous QT measurement and heart rate variability analysis were performed on 24-hour Holter records for three groups: (1) 14 sudden death survivors; (2) 14 control patients with diagnosis and therapy matched to survivors; and (3) 14 healthy subjects. There were no significant differences in 24-hour mean RR and QT intervals between groups. However, heart rate was significantly different between the three groups at night but not during the day because the expected nighttime decline was markedly blunted in survivors and somewhat blunted in control patients. The QT interval and frequency domain heart rate variability measures followed a similar circadian pattern. The mean QTc was significantly longer in control patients. The QTc had a wide range in all groups, but less in sudden death survivors. Of ten common time and frequency domain heart rate variability indices, only SDANN and SDNN were significantly lower in sudden death survivors. Reduced circadian variation of heart rate, with marked blunting of the nighttime heart rate decline, identifies sudden cardiac death survivors as well as does SDANN and SDNN, and, in contrast to heart rate variability measures, can easily be obtained from a Holter report without complex calculations.

Case-Control Studies↗

Effect of endurance exercise training on heart rate onset and heart rate recovery responses to submaximal exercise in animals susceptible to ventricular fibrillation.

Both a large heart rate (HR) increase at exercise onset and a slow heart rate (HR) recovery following the termination of exercise have been linked to an increased risk for ventricular fibrillation (VF) in patients with coronary artery disease. Endurance exercise training can alter cardiac autonomic regulation. Therefore, it is possible that this intervention could restore a more normal HR regulation in high-risk individuals. To test this hypothesis, HR and HR variability (HRV, 0.24- to 1.04-Hz frequency component; an index of cardiac vagal activity) responses to submaximal exercise were measured 30, 60, and 120 s after exercise onset and 30, 60, and 120 s following the termination of exercise in dogs with healed myocardial infarctions known to be susceptible (n = 19) to VF (induced by a 2-min coronary occlusion during the last minute of a submaximal exercise test). These studies were then repeated after either a 10-wk exercise program (treadmill running, n = 10) or an equivalent sedentary period (n = 9). After 10 wk, the response to exercise was not altered in the sedentary animals. In contrast, endurance exercise increased indexes of cardiac vagal activity such that HR at exercise onset was reduced (30 s after exercise onset: HR pretraining 179 +/- 8.4 vs. posttraining 151.4 +/- 6.6 beats/min; HRV pretraining 4.0 +/- 0.4 vs. posttraining 5.8 +/- 0.4 ln ms(2)), whereas HR recovery 30 s after the termination of exercise increased (HR pretraining 186 +/- 7.8 vs. posttraining 159.4 +/- 7.7 beats/min; HRV pretraining 2.4 +/- 0.3 vs. posttraining 4.0 +/- 0.6 ln ms(2)). Thus endurance exercise training restored a more normal HR regulation in dogs susceptible to VF.

Animals↗

Minute-by-minute association of heart rate variation with basal heart rate in developing infants.

Particular types of heart rate variation are enhanced during periods of slow heart rate and diminished when heart rate is high. We examined how the correlations between heart rate and various types of heart rate variation developed in normal infants. Polygraphic recordings were obtained from 25 infants at 1 week and at 1, 2, 3, 4 and 6 months of age. Median heart rate and the extents of heart rate variation at three distinct frequencies were determined for each 1-minute epoch. Pearson's r was used to assess the correlation of median heart rate in each epoch with each of three types of heart rate variation. For each recording, correlations were assessed separately for quiet sleep, rapid eye movement (REM) sleep and waking. The maturational patterns of heart rate by heart rate variation correlations were strongly influenced by sleep-waking state and were dissimilar to those previously reported for correlations between cardiac and respiratory measures. The findings suggest dissimilar developmental patterns for autonomic and somatic motor systems, and include a discontinuity in autonomic development at approximately 1 month of age. We speculate that these trends reflect a change in the nature of sleep states as forebrain connections develop.

Aging↗

Increased heart rate and reduced heart-rate variability are associated with subclinical inflammation in middle-aged and elderly subjects with no apparent heart disease.

AIM: Elevation of inflammation markers, high heart rate, and reduced heart-rate variability are all strong markers of mortality in a broad spectrum of patients. The association between these markers has not been clarified thoroughly. We investigated the associations between markers of inflammation, heart rate, and heart-rate variability. METHODS AND RESULTS: Six hundred and forty-three healthy men and women between 55 and 75 years of age and with no prior history of cardiovascular disease or stroke were included in the study. The baseline study included a physical examination, fasting laboratory tests, and 24-h ambulatory ECG monitoring. We selected the time-domain components of heart-rate variability for further analyses. C-reactive protein concentration and white blood cell count were selected as markers of inflammation. After identifying parameters related to measures of heart-rate variability, we used regression analyses to evaluate independent associations. Heart-rate variability, as measured by the standard deviation of the time between normal-to-normal complexes or the standard deviation of the average of normal-to-normal intervals for each 5-min period, was negatively associated with smoking, C-reactive protein, white blood cell count, blood sugar and triglyceride concentration, female gender, and diabetes. In contrast, physical activity was strongly associated with higher heart-rate variability. In multivariate regression analyses, increased heart-rate and reduced heart-rate variability were significantly and independently related to white blood cell count or C-reactive protein concentration. CONCLUSION: Increased heart rate and reduced heart-rate variability are associated with subclinical inflammation in healthy middle-aged and elderly subjects. The increased mortality that has been reported in these settings may thus have a common aetiology. An autonomic imbalance in favour of the sympathetic system may interact with inflammatory processes to play a more important role in the process of atherosclerosis than previously thought.

Aged↗

Breathing rates and heart rate spectrograms regarding body position in normal subjects.

The right lateral body position has been proposed as an effective vagal enhancer. However, the possibility of breathing affecting heart rate power spectra in different body positions has not been assessed. The level of vagal modulation in various body positions in normal subjects was estimated by calculating heart rate power spectra. The results suggest that the levels of vagal modulation do not necessarily reflect a change due to assuming different body position, but might be the consequence of changed breathing patterns. Before adopting the right lateral body position as vagal enhancing, the contribution of varying breathing pattern should be eliminated.

Adult↗