scholarly journals 522 A strange case of bradycardia in a 38-year-old woman postpartum

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Gianmarco Bastianoni ◽  
Federico Paolini ◽  
Giulia Stronati ◽  
Michela Casella ◽  
Dello Russo Antonio ◽  
...  
Keyword(s):  
Heart Rate ◽  
Sinus Rhythm ◽  
Sinus Bradycardia ◽  
Post Partum ◽  
D2 Receptors ◽  
Preserved Ejection Fraction ◽  
Gadolinium Enhancement ◽  
Junctional Rhythm ◽  
Structural Alterations ◽  
D Dimer

Abstract Methods and results A 38-year-old woman at her 4th day postpartum from a twin pregnancy, presented to the Emergency Room with general malaise, headache, and dyspnoea. Her symptoms had started to show 2 days prior to her ER admission and were worsened by bilateral pitting oedema. In particular they had started when she was administered cabergoline to suppress lactation. Her blood pressure was elevated (160/80 mmHg) and her heart rate was 40 b.p.m. On examination she was oriented in time and space. Her laboratory exams showed anaemia (Hb 8.8 g/dl), with negative D-dimer and troponin. She had no urine proteinuria, which allowed pre-eclampsia to be excluded from the diagnostic hypotheses. A 12-lead ECG was performed and showed junctional rhythm with isorhythmic dissociation at 40 b.p.m. She was admitted to the cardiology ward for diagnostic workup. Her echocardiogram showed no structural alteration and preserved ejection fraction. A cardiac magnetic resonance confirmed the absence of structural alterations or late gadolinium enhancement. During her hospital stay, sinus rhythm was spontaneously restored at 42 b.p.m.; in addition to this, restoration of sinus rhythm, although bradycardic, was associated to the resolution on both her symptoms and of her pitting oedema. She was discharged with a diagnosis of bradycardia secondary to carbegoline use. Her Holter ECG, performed 7 days after discharge, showed sinus bradycardia with occasional isorhythmic dissociation. Conclusions Cabergoline is an ergot-derived dopamine agonist usually used in the treatment of Parkinson’s disease. It acts selectively on D2 receptors. It can be associated to orthostatic hypotension, cardiac valvular fibrosis, and angina pectoris. No cases of cabergoline-induced bradycardia can be currently found in literature; however, a similar effect was seen with the use of methylergometrine in a women during her post-partum period. Furthermore, studies on mice have shown that ergot derivatives may cause reduction of heart rate. It therefore seems possible that in our case, the use of cabergoline induced the patient’s bradyarrhythmia.

scholarly journals Heart Rate–Induced Myocardial Ca 2+ Retention and Left Ventricular Volume Loss in Patients With Heart Failure With Preserved Ejection Fraction

2020 ◽  
Vol 9 (17) ◽  
Author(s):  
Daniel N. Silverman ◽  
Mehdi Rambod ◽  
Daniel L. Lustgarten ◽  
Robert Lobel ◽  
Martin M. LeWinter ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Left Ventricular ◽  
Atrial Pacing ◽  
Preserved Ejection Fraction ◽  
Volume Loss ◽  
Heart Rates ◽  
Patients With Heart Failure

Background Increases in heart rate are thought to result in incomplete left ventricular (LV) relaxation and elevated filling pressures in patients with heart failure with preserved ejection fraction (HFpEF). Experimental studies in isolated human myocardium have suggested that incomplete relaxation is a result of cellular Ca 2+ overload caused by increased myocardial Na + levels. We tested these heart rate paradigms in patients with HFpEF and referent controls without hypertension. Methods and Results In 22 fully sedated and instrumented patients (12 controls and 10 patients with HFpEF) in sinus rhythm with a preserved ejection fraction (≥50%) we assessed left‐sided filling pressures and volumes in sinus rhythm and with atrial pacing (95 beats per minute and 125 beats per minute) before atrial fibrillation ablation. Coronary sinus blood samples and flow measurements were also obtained. Seven women and 15 men were studied (aged 59±10 years, ejection fraction 61%±4%). Patients with HFpEF had a history of hypertension, dyspnea on exertion, concentric LV remodeling and a dilated left atrium, whereas controls did not. Pacing at 125 beats per minute lowered the mean LV end‐diastolic pressure in both groups (controls −4.3±4.1 mm Hg versus patients with HFpEF −8.5±6.0 mm Hg, P =0.08). Pacing also reduced LV end‐diastolic volumes. The volume loss was about twice as much in the HFpEF group (controls −15%±14% versus patients with HFpEF −32%±11%, P =0.009). Coronary venous [Ca 2+ ] increased after pacing at 125 beats per minute in patients with HFpEF but not in controls. [Na + ] did not change. Conclusions Higher resting heart rates are associated with lower filling pressures in patients with and without HFpEF. Incomplete relaxation and LV filling at high heart rates lead to a reduction in LV volumes that is more pronounced in patients with HFpEF and may be associated with myocardial Ca 2+ retention.

Heart rate as a determinant of the decay rate of the cardiac inotropic response to sympathetic nervous activity

1983 ◽  
Vol 61 (11) ◽  
pp. 1374-1381 ◽  
Author(s):  
Yukitaka Masuda ◽  
Matthew N. Levy
Keyword(s):  
Heart Rate ◽  
Sinus Rhythm ◽  
Nervous Activity ◽  
Ventricular Myocardium ◽  
Sympathetic Nervous Activity ◽  
Inotropic Response ◽  
Sympathetic Stimulation ◽  
Junctional Rhythm ◽  
Decay Times ◽  
Inotropic Responses

The cardiac responses to sympathetic nerve stimulation were measured in a series of open-chest, anesthetized dogs. In half the animals, the hearts were in a sinus rhythm; in the remaining animals, the hearts were in an atrioventricular (AV) junctional rhythm. Cocaine markedly prolonged the decay times of the chronotropic responses after cessation of sympathetic stimulation, regardless of the type of rhythm. The decay times of the inotropic responses were only slightly prolonged by cocaine in animals with a sinus rhythm, but the prolongations were pronounced in animals with an AV junctional rhythm. The lower basal heart rate appeared to be more responsible for the greater decay times of the inotropic responses in the animals with an AV junctional rhythm than in those with a sinus rhythm. In a second series of dogs, complete heart block was produced, cocaine was given, AND the hearts were paced at four different frequencies. The mean decay time of the inotropic response to sympathetic stimulation varied inversely AND substantially with the pacing frequency. The change in contraction frequency probably affects the rate of neurotransmitter dissipation from the ventricular myocardium, by altering either the coronary blood flow or the massaging action of the cardiac contractions.

scholarly journals Functional capabilities of the heart rate depending on the characteristics of homeostasis among primary-school-age children

2021 ◽  
pp. 30-37
Author(s):  
T.B. Ihnatova ◽  
◽  
I.S. Maidan ◽  
Keyword(s):  
Heart Rate ◽  
Nervous System ◽  
Spectral Analysis ◽  
Sinus Rhythm ◽  
Primary School ◽  
Sinus Bradycardia ◽  
Sinus Node ◽  
Heart Rhythm ◽  
School Age ◽  
Primary School Age

One of the most common diseases of the cardiovascular system is cardiac arrhythmias. Assessment of the heart rate is one of the obligatory methods of pediatric examination and its deviation from the age norm may indicate a change in the child's health and be one of the first manifestations of the disease. Heart rhythm disturbances accompany various diseases, namely: congenital heart defects, cardiomyopathies, rheumatic and infectious diseases, intoxication, vegetative crises, endocrine diseases, diseases of the nervous system and others. Most often, in children's practice, it is not always possible to establish the cause of heart rhythm disturbances, as well as to classify the presence of organic or functional disorders without conducting morphological studies. Purpose — to study the features of heart rhythm and the state of the autonomic nervous system (ANS) among the children of primary school age with sinus bradycardia. Materials and methods. Children of primary school age with sinus bradycardia were examined (210 children). All children underwent: clinical examination, ECG at rest and after exercise, daily monitoring of ECG and heart rate, echocardiography, cardiointervalography with spectral analysis of heart rate. Results. Assessment of the cardiovascular system among children with bradycardia revealed the following features: 80.0% of children had no complaints, 68.0% of children at the age of 6–7 years and 55.0% of children at the age of 8–10 years had moderate bradycardia, 32.0% of children at the age of 6–7 years and 45.0% of children at the age of 8–10 years had significant bradycardia. After the exercise test, 71.0% of children still had bradycardia, which is typical for children at the age of 9–10 years and 29.0% of children had an acceleration of heart rate above the age norm. Holter monitoring revealed the following cardiac arrhythmias: sinus rhythm driver migration, ectopic rhythm, sinoatrial block, 2 grade atrioventricular block, atrial extrasystole and ventricular extrasystole. Different duration of sinoatrial pauses was detected: in the range from 1300–1400 ms among the most children (78.0%) to 1700–1800 ms among 1.8% of children. Data from spectral analysis of sinus rhythm showed the predominance of parasympathetic nervous system tone among the 84.0% of children, asympathicotonic (40.5%) and normal (44.9%) autonomic reactivity. Conclusions. Examination of the children of the primary school age revealed sinus bradycardia and bradyarrhythmia among the 80.7% of children. Bradyarrhythmia is typical for children at the age of 6–7 years, bradycardia — for children at the age of 9–10 years. Spectral analysis of the ANS showed an imbalance in the regulation of sinus rhythm: the predominance of the parasympathetic link, regardless of the initial state of the ANS and the violation of adaptive mechanisms. According to Holter monitoring, the duration of pauses is longer than normal for the given age (more than 1300 ms) indicates sinus node dysfunction and requires closer monitoring due to the risk of developing sinus node weakness syndrome and other threatening conditions in later life. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: children, bradycardia, bradyarrhythmia, vegetative homeostasis.

scholarly journals Association of heart rate with mortality in sinus rhythm and atrial fibrillation in heart failure with preserved ejection fraction

2019 ◽  
Vol 21 (4) ◽  
pp. 471-479 ◽  
Author(s):  
Ulrik Sartipy ◽  
Gianluigi Savarese ◽  
Ulf Dahlström ◽  
Michael Fu ◽  
Lars H. Lund
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Preserved Ejection Fraction

scholarly journals Left atrial 4D flow cardiovascular magnetic resonance: a reproducibility study in sinus rhythm and atrial fibrillation

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Marco Spartera ◽  
Guilherme Pessoa-Amorim ◽  
Antonio Stracquadanio ◽  
Adam Von Ende ◽  
Alison Fletcher ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Heart Rate ◽  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Peak Velocity ◽  
4D Flow ◽  
Mean Velocity

Abstract Background Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) allows sophisticated quantification of left atrial (LA) blood flow, and could yield novel biomarkers of propensity for intra-cardiac thrombus formation and embolic stroke. As reproducibility is critically important to diagnostic performance, we systematically investigated technical and temporal variation of LA 4D flow in atrial fibrillation (AF) and sinus rhythm (SR). Methods Eighty-six subjects (SR, n = 64; AF, n = 22) with wide-ranging stroke risk (CHA2DS2VASc 0–6) underwent LA 4D flow assessment of peak and mean velocity, vorticity, vortex volume, and stasis. Eighty-five (99%) underwent a second acquisition within the same session, and 74 (86%) also returned at 30 (27–35) days for an interval scan. We assessed variability attributable to manual contouring (intra- and inter-observer), and subject repositioning and reacquisition of data, both within the same session (same-day scan–rescan), and over time (interval scan). Within-subject coefficients of variation (CV) and bootstrapped 95% CIs were calculated and compared. Results Same-day scan–rescan CVs were 6% for peak velocity, 5% for mean velocity, 7% for vorticity, 9% for vortex volume, and 10% for stasis, and were similar between SR and AF subjects (all p > 0.05). Interval-scan variability was similar to same-day scan–rescan variability for peak velocity, vorticity, and vortex volume (all p > 0.05), and higher for stasis and mean velocity (interval scan CVs of 14% and 8%, respectively, both p < 0.05). Longitudinal changes in heart rate and blood pressure at the interval scan in the same subjects were associated with significantly higher variability for LA stasis (p = 0.024), but not for the remaining flow parameters (all p > 0.05). SR subjects showed significantly greater interval-scan variability than AF patients for mean velocity, vortex volume, and stasis (all p < 0.05), but not peak velocity or vorticity (both p > 0.05). Conclusions LA peak velocity and vorticity are the most reproducible and temporally stable novel LA 4D flow biomarkers, and are robust to changes in heart rate, blood pressure, and differences in heart rhythm.

scholarly journals Features of heart rate variability in patients with takotsubo syndrome

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
D Evdokimov ◽  
SA Boldueva ◽  
VS Feoktistova ◽  
TA Baeva
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Sinus Rhythm ◽  
Autonomic Regulation ◽  
Deep Breathing ◽  
Takotsubo Syndrome ◽  
Orthostatic Test ◽  
Rate Regulation ◽  
Heart Rate Regulation ◽  
Deep Breathing Test

Abstract Funding Acknowledgements Type of funding sources: None. Main funding source(s): North-Western State Medical University named after I.I. Mechnikov Objective to study the features of autonomic regulation of sinus rhythm features of autonomic regulation of cardiac sinus rhythm in patients with Takotsubo syndrome (TTS) during inpatient stay in hospital. Materials and methods. The study included 25 female patients (the median age 57.5 ± 28.5 years) with TTS, diagnosis was based on the InterTAK criteria. On the 5-7th day after admission, the heart rate variability (HRV) was assessed both at rest and cardiac autonomic function tests: the deep breathing test (DBT) and active orthostatic test (AOT) with the usage of a computer diagnostic system «Valenta». RESULTS According to HRV data, initially at rest, the majority of the studied patients predominantly had a parasympathetic impact on the heart rate regulation: in 70% - increased parasympathetic influence, in 17% - increased sympathetic influence, in 13% - a balanced heart rate regulation. When performing a DBT, the predominance of the parasympathetic influence on the heart rate was noted both in spectral parameters and according to the data of time analysis (HF  during DBT  increased 1.8 times  up to  489.6 ± 114.2 ms2 (p &lt;0.05) ; LF  decreased 1.7 times  up to 254.1 ± 70.3 ms2 (p &lt;0.05); VLF  increased 2.8 times up to 402.3 ± 101.8 ms2 (p &lt;0, 05); TP  increased 1.4 times up to 1145.9 ± 251.3 ms2; CV increased 1.3 times up to 6.5 ± 0.7% (p &lt;0.05); SDNN increased 1.3 times up to - 58.7 ± 6.6 ms (p &lt;0.05). HRV measured during an AOT  showed a paradoxical  evaluation  in the parasympathetic impact on the heart rate (HF increased by 1.8 times and reached - 488.0 ± 104.7 ms2 (p &lt;0.05); LF decreased by 1.1 times up to  408 , 4 ± 103.6 ms2; VLF increased 1.2 times  up to  166.4 ± 52.2 ms2; TP increased 1.3 times  up to 1062.8 ± 181.1 ms2 (p &lt;0.05); CV increased 1.6 times  up to 8.0 ± 0.9% (p &lt;0.05); SDNN increased 1.4 times  up to 62.6 ± 7.5 ms (p &lt;0.05)). Conclusions During the index hospital inpatient stays the majority of patients with TTS have a vegetative imbalance due to increased parasympathetic influence on the heart rate, both at rest and  during a deep breathing test and an active orthostatic test. This fact is quite unexpected and requires further study.

Sign in / Sign up

Export Citation Format

Share Document