Short- and long-term reproducibility of autonomic measures in supine and standing positions

2004 ◽  
Vol 106 (1) ◽  
pp. 61-66 ◽  
Author(s):  
M. A. KOWALEWSKI ◽  
M. URBAN
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Response ◽  
Blood Pressure Response ◽  
Body Position ◽  
Valsalva Manoeuvre ◽  
Deep Breathing ◽  
Autonomic Nervous ◽  
Short And Long Term

Autonomic nervous tests and heart rate variability (HRV) have been used to assess cardiac autonomic function and to evaluate long-term prognosis. The aim of this study was to evaluate the short- and long-term reproducibility of HRV parameters and autonomic nervous tests according to body position (supine or standing). The study group consisted of 26 healthy subjects. Autonomic nervous tests and HRV were performed twice during the day and the results were averaged. The protocol was then repeated 3 days after each examination and also after 6 and 24 months. Autonomic nervous tests included deep breathing, Valsalva manoeuvre and isometric muscle exercise (handgrip), as well as blood pressure and heart rate in response to standing. ECG recordings were taken for 10 min during spontaneous breathing for HRV analysis. We found that the reproducibility of some parameters of the autonomic nervous test were independent of body position [E/I ratio (heart rate response to deep breathing)], whereas other parameters were dependent on body position (Valsalva manoeuvre and blood pressure response to sustained handgrip). In addition, within-day measurements of those parameters varied from non-reproducible (Valsalva ratio, handgrip and blood pressure response to standing) to moderately reproducible [E/I ratio and 30/15 ratio (heart rate response to standing)]. Among the HRV parameters, we found that total power (TP), low (LF)- and high (HF)-frequency were reproducible not only for measurements made within the same day, but also during short- and long-term observations, and only the LF/HF ratio was dependent on body position. We conclude that only a few autonomic nervous tests are reproducible in the short- and long-term. Because HRV parameters obtained during spontaneous respiration showed high reproducibility for measurements made within the same day as well as in the short- and long-term, they should be used instead of autonomic nervous tests when long-term observations are carried out in a healthy population.

Cardiac autonomic dysfunction in obese subjects

1989 ◽  
Vol 76 (6) ◽  
pp. 567-572 ◽  
Author(s):  
Marco ROSSI ◽  
Giuliano Marti ◽  
Luigi Ricordi ◽  
Gabriele Fornasari ◽  
Giorgio Finardi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Heart Rate ◽  
Autonomic Dysfunction ◽  
Cross Correlation ◽  
Heart Rate Response ◽  
Valsalva Manoeuvre ◽  
Deep Breathing ◽  
Cardiac Autonomic Dysfunction ◽  
Obese Subjects

1. The prevalence of cardiac autonomic alterations was evaluated in 23 obese subjects with body mass index 37.2 ± 3.03 kg/m2 (mean ± sd), compared with 78 controls with body mass index 22.5 ± 2.6 kg/m2 (P < 0.001). 2. Cardiac autonomic function was assessed by four standard tests (heart rate response to deep breathing and to the Valsalva manoeuvre, systolic blood pressure fall after standing and diastolic pressure rise during handgrip) and by the cross-correlation test, a new method of computerized analysis of respiratory sinus arrhythmia based on spectral analysis of electrocardiographic and respiratory signals. 3. Considering tests indicative of parasympathetic function, only the heart rate response to the deep breathing and the cross-correlation test were significantly lower in the obese than in the control group [deep breathing = 13.95 ± 8.65 beats/min (mean ± sd) vs 24.5 ± 7.65, P < 0.001; cross-correlation 4.28 ± 0.74 units vs 5.14 ± 0.63, P < 0.001]. Deep breathing and/or cross-correlation were abnormal in 10 (43.5%) obese subjects (deep breathing: seven subjects, cross-correlation: eight subjects). No significant difference between groups was found for the response to the Valsalva manoeuvre: the Valsalva ratio was 1.69 ± 0.45 in obese subjects and 1.88 ± 0.33 in controls (P = NS). The Valsalva ratio was abnormal in three obese subjects. 4. No significant differences were found between groups for tests indicative of sympathetic function. The rise in diastolic blood pressure after handgrip was 12.6 ± 6.2 mmHg (1.67 ± 0.82 kPa) in obese subjects and 18.2 ± 4.9 mmHg (2.42 ± 0.65 kPa) in controls (P = NS), and the fall in systolic blood pressure after standing was −6.8 ± 8.6 mmHg (−0.90 ± 1.14 kPa) in obese subjects and −6.9 ± 10.4 mmHg (−0.91 ± 1.38 kPa) in controls (P = NS). The handgrip test was abnormal in four obese subjects, while no obese subject had an abnormal blood pressure response to standing. 5. Our findings suggest a high incidence of cardiac autonomic dysfunction in obese subjects. Since cardiac autonomic alterations have been shown to be involved in the mechanisms of cardiac sudden death, our data suggest a possible role of autonomic dysfunction in the increased risk for sudden death in obesity.

Cardiovascular reflex responses in Bangladeshi and European subjects

1991 ◽  
Vol 80 (1) ◽  
pp. 39-45 ◽  
Author(s):  
M. A. Rahman ◽  
I. Farquhar ◽  
T. Bennett
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Vascular Resistance ◽  
Cardiovascular Responses ◽  
Mean Blood Pressure ◽  
Valsalva Manoeuvre ◽  
Deep Breathing ◽  
Reflex Responses ◽  
Forearm Vascular Resistance

1. Cardiovascular responses to three different interventions, namely the Valsalva manoeuvre, deep breathing and a cold stimulus on the face, were studied in two ethnic groups (European and Bangladeshi) that have been shown to differ in the prevalence of hypertensive-vascular disease. The data obtained consisted of systolic blood pressure, diastolic blood pressure, mean blood pressure, heart rate measured by using a beat-by-beat non-invasive blood pressure monitor (the Finapres), forearm blood flow determined by venous occlusion plethysmography, and calculated forearm vascular resistance. 2. The resting haemodynamic status was similar in European and Bangladeshi subjects. However, Bangladeshi subjects showed a greater increase in heart rate, but only after 20 s into the Valsalva manoeuvre, and greater overshoots in mean blood pressure after the manoeuvre than the European subjects. Furthermore, after cold face stimulation the fall in forearm vascular resistance to baseline levels was delayed in Bangladeshi subjects relative to that in the European subjects. 3. There were no inter-group differences in the reflex bradycardia relative to mean blood pressure or in the cardiac baroreflex sensitivity estimated from systolic blood pressure and pulse interval after the Valsalva manoeuvre. In addition, values for the mean difference between maximum and minimum pulse intervals during deep breathing did not differ in Bangladeshi and European subjects. 4. These findings together suggest that, although cardiac vagal reflex responses appear similar in the two groups, sympatho-adrenal influences on the heart and vasculature may be greater in Bangladeshi subjects than in European subjects.

Cardiovascular and Autonomic Reflexes in Haemodialysis Patients

1981 ◽  
Vol 60 (2) ◽  
pp. 165-170 ◽  
Author(s):  
R. B. Naik ◽  
C. J. Mathias ◽  
C. A. Wilson ◽  
J. L. Reid ◽  
D. J. Warren
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Plasma Noradrenaline ◽  
Valsalva Manoeuvre ◽  
Induced Hypotension ◽  
Autonomic Nervous ◽  
Control Subjects ◽  
Head Up Tilt ◽  
And Control ◽  
Noradrenaline Levels

1. Blood pressure and heart rate responses to head-up tilt, standing, the Valsalva manoeuvre, sustained handgrip and cutaneous cold were measured in 27 haemodialysis patients (10 of whom had episodes of haemodialysis-induced hypotension) and 15 control subjects to assess autonomic nervous function. Plasma nor-adrenaline levels were measured at rest and during head-up tilt. 2. Mean resting supine blood pressure, heart rate and plasma noradrenaline levels were higher in haemodialysis patients than in the control subjects. There was no fall in blood pressure during head-up tilt or standing. The ratio of the R-R intervals of the thirtieth and the fifteenth heart beat after standing (30: 15) was lower in the patients; this may be related to their higher resting heart rate. Head-up tilt raised plasma noradrenaline levels in both groups. Heart rate responses to the Valsalva manoeuvre were similar in the patients and control subjects. 3. Systolic blood pressure and heart rate responses to sustained handgrip were similar in both groups. Diastolic and mean blood pressure changes, however, were lower in the patients. The blood pressure and heart rate responses to cutaneous cold were similar in the patients and control subjects. 4. We conclude that generalized autonomic nervous dysfunction does not appear to cause haemodialysis-induced hypotension in patients with chronic renal failure on maintenance haemodialysis.

Cardiovascular Reflexes in Patients With Vascular Headache

Cephalalgia ◽  
1992 ◽  
Vol 12 (6) ◽  
pp. 360-364 ◽  
Author(s):  
Rosario Martín ◽  
Cristina Ribera ◽  
Jose Manuel Moltó ◽  
Carolina Ruiz ◽  
Luz Galiano ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Healthy Volunteers ◽  
Migraine Without Aura ◽  
Autonomic Function ◽  
Heart Rate Response ◽  
Cardiovascular Reflexes ◽  
Deep Breathing ◽  
Vascular Headache ◽  
Cardiovascular Reflex

We have investigated the autonomic function of 75 patients with migraine by examining cardiovascular reflex function. The results were compared with those of 78 healthy volunteers. Measurements were made between attacks. Patients with migraine showed a smaller heart-rate response to deep breathing but a greater heart-rate response and higher blood pressure to standing when compared to controls. Migraine patients had a higher percentage of established sympathetic lesions (51% vs 17%) and severe (25% vs 5%) or atypical (24% vs 11.5%) global autonomic dysfunction. No significant differences were found among patients with migraine with aura, migraine without aura, and migraine with prolonged aura. Our findings indicate that patients with migraine have sympathetic hypofunction.

Antidiuretic hormone response to volume depletion in diabetic patients with cardiac autonomic dysfunction

1985 ◽  
Vol 68 (5) ◽  
pp. 545-552 ◽  
Author(s):  
André Grimaldi ◽  
Wojciech Pruszczynski ◽  
Francis Thervet ◽  
Raymond Ardaillou
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Antidiuretic Hormone ◽  
Autonomic Dysfunction ◽  
Heart Rate Response ◽  
Plasma Aldosterone ◽  
Valsalva Manoeuvre ◽  
Diabetic Patients ◽  
Volume Depletion ◽  
Cardiac Autonomic Dysfunction

1. Thirty-three insulin-dependent diabetic patients were separated into two groups from the results of three different tests for cardiac vagal neuropathy: heart rate response to deep breathing, Valsalva manoeuvre and heart rate response to postural change. Seventeen patients were considered as without ('intact’ patients) and 16 as with ('denervated’ patients) cardiac autonomic dysfunction. One patient with a transplanted heart was also studied. 2. Plasma antidiuretic hormone (ADH), plasma aldosterone and plasma renin activity (PRA) were measured immediately before and 60 min after intravenous administration of frusemide and passage from lying to standing. The kinetics of hormonal responses were analysed more precisely (five blood collections) in six patients of each group who were studied again. Heart rate and blood pressure were recorded before each blood collection. 3. Volume depletion estimated from the rise in plasma protein (+ 11.9 and + 12.2% in ‘denervated’ and ‘intact’ patients respectively) and heart rate response (+ 10.6 and + 14.7%) were similar in both groups. Mean blood pressure was unchanged in the ‘intact’ patients whereas it fell in the ‘denervated’ patients (−13.5%). PRA (+ 161.5 and + 231.2% in ‘denervated’ and ‘intact’ patients respectively) and plasma aldosterone (+ 318.2 and 279%) increased in both groups whereas plasma ADH was stimulated only in ‘intact’ patients (+ 55.3%). The failure of ADH to respond significantly to the volume stimulus in ‘denervated’ patients was confirmed by the results of the time-course study. Plasma ADH remained at the same levels in ‘denervated’ patients whereas it increased significantly (+ 82.4%) in ‘intact’ patients. There was no ADH response in the transplanted patient. 4. These results suggest that, in humans, cardiac receptors and vagal pathways play a role in ADH response to volume depletion.

Pitfalls in the assessment of cardiovascular reflexes in patients with sympathetic failure but intact vagal control

1989 ◽  
Vol 76 (5) ◽  
pp. 523-528 ◽  
Author(s):  
J. J. van Lieshout ◽  
W. Wieling ◽  
K. H. Wesseling ◽  
J. M. Karemaker
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Time Course ◽  
Blood Pressure Response ◽  
Stress Test ◽  
Cold Pressor Test ◽  
Cold Pressor ◽  
Valsalva Manoeuvre ◽  
Cardiovascular Reflexes ◽  
Vagal Control

1. Two patients are described who presented with orthostatic hypotension as the main symptom. The diagnosis was sympathetic failure with intact vagal control. 2. Unusual test result's were obtained. Assessment of the integrity of the total baroreflex arc by the Valsalva manoeuvre measuring only heart rate changes proved impossible, since the magnitude and time course of the heart rate response were normal notwithstanding the presence of a blood pressure response typical of sympathetic failure. 3. Sustained handgrip, cold pressor test and mental stress test all could induce a rise in blood pressure, despite the presence of sympathetic vasomotor lesions, but only when accompanied by a rise in heart rate. Efferent parasympathetic blockade by atropine, resulting in an increase in heart rate, was also accompanied by a substantial rise in blood pressure. These findings seem to result from a heart rate rise dependent increase in cardiac output unopposed by reflex vasodilatation. 4. In these patients the only baroreflex way to control blood pressure is by varying heart rate. This condition can be evaluated only if blood pressure and heart rate are measured on a beat-by-beat basis.

scholarly journals Autonomic Influence on Heart Rate for Deep Breathing and Valsalva Maneuver in Healthy Subjects

2018 ◽  
Vol 56 (211) ◽  
pp. 670-673 ◽  
Author(s):  
Reena Kumari Jha ◽  
Amrita Acharya ◽  
Ojashwi Nepal
Keyword(s):  
Heart Rate ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Heart Rate Response ◽  
Valsalva Maneuver ◽  
Deep Breathing ◽  
Resting Heart Rate ◽  
Autonomic Nervous ◽  
Male Subjects ◽  
Deep Breathing Test

Introduction: The Autonomic nervous system is responsible for regulation and integration of visceral functions. Disturbance of autonomic nervous system play crucial role in pathogenesis and clinical course of many diseases. In the present study deep breathing test and valsalva maneuver have been described to monitor parasympathetic function genderwise. Methods: A cross-sectional study was conducted among 100 subjects, aged 18-25 years, from May to November 2017, in exercise physiology laboratory, Kathmandu University School of Medical Sciences, Chaukot, Kavre. Electrocardiograph recorded by AD instrument was used to calculate the resting heart rate and the heart rate response to deep breathing test and valsalva maneuver. Results: Heart rate response to deep breathing test (31.69±14.79 Vs. 36.08±18.65, P=0.195) and valsalva ratio (1.59±0.39 Vs. 1.69±0.54, P=0.314) tend to be higher in female than male subjects but not significant. The resting heart rate of females was significantly higher than that of males (84.37 ± 11.08 Vs. 78.43 ± 12.06, P<0.05). Heart rate was significantly increased during and decreased after valsalva maneuver in both male and female subjects. Conclusions: This study concludes that both deep breathing test and valsalva maneuver activates parasympathetic system inhealthy subjects. And also dominant parasympathetic activity was found in female comparison to male subjects.

Investigating autonomic control of the cardiovascular system: a battery of simple tests

2013 ◽  
Vol 37 (4) ◽  
pp. 401-404 ◽  
Author(s):  
Christopher D. Johnson ◽  
Sean Roe ◽  
Etain A. Tansey
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiovascular System ◽  
Heart Rate Response ◽  
Blood Pressure Response ◽  
Valsalva Maneuver ◽  
Dynamic Control ◽  
Autonomic Control ◽  
Autonomic Nerves ◽  
Organ Blood Flow

Sympathetic and parasympathetic divisions of the autonomic nervous system constantly control the heart (sympathetic and parasympathetic divisions) and blood vessels (predominantly the sympathetic division) to maintain appropriate blood pressure and organ blood flow over sometimes widely varying conditions. This can be adversely affected by pathological conditions that can damage one or both branches of autonomic control. The set of teaching laboratory activities outlined here uses various interventions, namely, 1) the heart rate response to deep breathing, 2) the heart rate response to a Valsalva maneuver, 3) the heart rate response to standing, and 4) the blood pressure response to standing, that cause fairly predictable disturbances in cardiovascular parameters in normal circumstances, which serve to demonstrate the dynamic control of the cardiovascular system by autonomic nerves. These tests are also used clinically to help investigate potential damage to this control.

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