scholarly journals Valsalva maneuver techniques for supraventricular tachycardias: Which and how?

2017 ◽  
Vol 24 (6) ◽  
pp. 298-302
Author(s):  
Salih Ekinci ◽  
Gökçe Akgül ◽  
Eda Arş ◽  
Alp Aydin ◽  
Ekrem Musalar ◽  
...  
Keyword(s):  
Heart Rate ◽  
Repeated Measures ◽  
Valsalva Maneuver ◽  
Study Objective ◽  
T Wave ◽  
Wave Inversion ◽  
Heart Rate Decrease ◽  
Significant Difference ◽  
Supraventricular Tachycardias ◽  
Adult Volunteers

Study objective: While some research has been done on Valsalva maneuvers in treating supraventricular tachycardia, there is no standardized algorithm on which technique has been the most effective for the termination of supraventricular tachycardias. In this study, we compare different Valsalva maneuver techniques in order to determine the exact technique needed for maximal vagal response. Methods: This was a repeated measures clinical study, which enlisted a sample of healthy adult volunteers. Participants performed four different Valsalva maneuver techniques (40 mm Hg—10 s, 40 mm Hg—15 s, 50 mm Hg—10 s, and 50 mm Hg—15 s) while lying in a supine position. The maneuvers were repeated three times. An electrocardiography printout was obtained during each trial, and heart rate differences between pre-maneuver and post-maneuver were measured. Results: Among the 97 volunteers who participated in the study, 7 were excluded because the target Valsalva maneuver pressures were not reached, and 1 volunteer was excluded due to T-wave inversion that developed after Valsalva maneuver. We enrolled 89 participants. There was no significant difference in the heart rate decrease among the four techniques. In addition, there was no difference between the vagal responses in terms of age, gender, and body mass index. Conclusion: This study shows that the four different Valsalva maneuver techniques were not superior to one another in terms of decreased heart rate.

Cardiac autonomic responses to volume overload in normal subjects and in patients with dilated cardiomyopathy

1999 ◽  
Vol 277 (4) ◽  
pp. H1361-H1368 ◽  
Author(s):  
L. Spinelli ◽  
M. Petretta ◽  
F. Marciano ◽  
G. Testa ◽  
M. A. E. Rao ◽  
...  
Keyword(s):  
Heart Rate ◽  
Dilated Cardiomyopathy ◽  
Repeated Measures ◽  
Volume Expansion ◽  
Normal Subjects ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Significant Difference ◽  
Frequency Power

This study evaluated the effects of acute isotonic volume expansion on heart rate variability (HRV) in 10 patients with dilated cardiomyopathy (DCM) and in 10 age- and sex-matched normal volunteers. Echocardiographic left ventricular volumes and HRV measurements by continuous Holter recording were assessed at baseline, at 60 and 120 min during intravenous saline load (0.9% NaCl, 0.25 ml ⋅ kg−1 ⋅ min−1), and 60 min after infusion was terminated. Data analysis was performed by repeated-measures ANOVA. After volume expansion, left ventricular ejection fraction increased ( F = 9.8; P < 0.001) in normal subjects and decreased ( F = 8.7; P < 0.001) in DCM patients. During volume expansion a significant difference was also detectable between the two groups in root-mean-square successive difference ( F = 25.2; P < 0.001), percentage of differences between successive normal R-R intervals >50 ms ( F = 97.6; P < 0.001), high-frequency power ( F = 50.1; P < 0.001), and low-frequency power ( F = 41.6; P < 0.001), all of which reflect parasympathetic modulation of heart rate; in fact, these measurements increased in normal subjects and decreased in DCM patients. In normal subjects, the increase in HRV measurements during volume expansion suggests a parasympathetic activation, mediated by stimulation of cardiopulmonary and arterial mechanoreceptors. On the contrary, in DCM patients the parasympathetic withdrawal, already detectable at baseline, increases during volume expansion.

scholarly journals Cardiovascular Response to Defecating Postures with and without Valsalva Maneuver in Healthy Individuals

2016 ◽  
Vol 02 (01) ◽  
pp. 010-014
Author(s):  
Priyanka Bhagat ◽  
Mariya Jiandani ◽  
Amita Mehta
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiovascular Response ◽  
Valsalva Maneuver ◽  
Rate Pressure Product ◽  
Healthy Population ◽  
Rubber Tube ◽  
Healthy Individuals ◽  
Sitting Posture ◽  
Significant Difference

Abstract Aims: To assess the cardiovascular response to defecating postures of bridging and sitting lean forward with and without Valsalva maneuver in healthy individuals. Study design: Prospective interventional cross-over study in healthy population. Study material: Stop watch, Rubber tube, Nostril clip, Pillow, Mercury Sphygmomanometer, Cardioscope (Model no.: Iris 50, Maestros company). Materials and methods: A total of 100 healthy individuals participated in the study. They maintained sitting lean forward and in bridging position for 5 minutes with and without Valsalva maneuver. Valsalva maneuver was performed at 40 mm Hg pressure for 15 seconds. Blood pressure and heart rate were recorded. Mean arterial pressure and rate pressure product were derived. Data analysis: The data was analyzed using Statistical Package for the Social Sciences v 16. Shapiro–Wilk test was used to test normality, and nonparametric Mann-Whitney test was used with p < 0.05 as statistically significant. Results: Sitting in lean forward position showed statistical significant increase in heart rate (p < 0.05) compared to bridging position with Valsalva maneuver. There was a significant rise in blood pressure with bridging as compared to sitting lean forward with Valsalva. There was no statistically significant difference in heart rate and blood pressure between sitting lean forward position and bridging position without Valsalva maneuver. Conclusion: Sitting lean forward position and bridging position increase hemodynamic load compared to relaxed sitting posture. With Valsalva maneuver sitting lean forward posture causes greater rise in heart rate compared to bridging position.

scholarly journals Validity of the Actiheart step test for the estimation of maximum oxygen consumption in endurance athletes and healthy controls

2019 ◽  
Author(s):  
Juliane Heydenreich ◽  
Yves Schutz ◽  
Katarina Melzer ◽  
Bengt Kayser
Keyword(s):  
Heart Rate ◽  
Oxygen Consumption ◽  
Repeated Measures ◽  
Resting Metabolic Rate ◽  
Total Sample ◽  
Step Test ◽  
Maximum Oxygen Consumption ◽  
Entry Modes ◽  
Significant Difference ◽  
Level Of Significance

Submaximal step tests are often used for estimation of maximum oxygen consumption (VO2max) in humans. The validity of the Actiheart step test for VO2max estimation was not fully studied yet. Therefore, purpose of the study was to estimate VO2max using the Actiheart step test and to compare the data with measured VO2max in endurance trained athletes (ATH) and healthy non-athletes (CON).68 ATH (54% men, 28.0±5.4 yrs, 20.9±1.7 kg∙m-2) and 63 CON (46% men, 27.6±5.1 yrs, 22.1±1.7 kg∙m-2) performed the Actiheart step test and a spiroergometry for assessment of VO2max. In addition, resting metabolic rate (RMR; indirect calorimetry), maximum heart rate (HRmax; heart rate monitoring system during spiroergometry), and sleeping heart rate (SHR; Actiheart 6-day long term measurement) were determined. Validity of two different Actiheart software entry modes was assessed: (1) AHraw (estimated RMR [Schofield] and HRmax [Tanaka], SHR = 70 bpm) and (2) AHcomplete (measured RMR, HRmax, and SHR). Validity was investigated using linear regression (R2 and standard error of the estimate (SEE)) and repeated-measures ANOVA with a Bonferroni post-hoc correction. The level of significance was set to α=0.05.VO2max estimated by AHraw was significant related to measured VO2max in women CON (R2=0.22; p<0.05), whereas when VO2max was estimated by AHcomplete the relation was significant in women ATH and CON, and in men CON (R2=0.17-0.24; p<0.05). AHraw significantly underestimated VO2max in the total sample by 8% (51.4±10.2 vs. 55.9±7.6 ml∙kg-1∙min-1; p<0.0001), whereas no significant difference between AHcomplete and the criterion method was found (57.0±11.1 vs. 55.9±7.6 ml∙kg-1∙min-1; p=0.26).The Actiheart step test is an acceptable tool for the estimation of VO2max if an error within 8% can be tolerated. However, accuracy of the VO2max prediction is much improved when entering measured variables, such as RMR, SHR, and HRmax, into the software.

scholarly journals Acute Effects of Heart Rate Variability Biofeedback on H-reflex and Maximal Voluntary Isometric Strength

2020 ◽  
Author(s):  
Jeffrey Pagaduan ◽  
Sam SX Wu ◽  
James W. Fell ◽  
Yung-Sheng Chen
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Soleus Muscle ◽  
Repeated Measures ◽  
H Reflex ◽  
Visually Guided ◽  
Plantar Flexors ◽  
Maximal Voluntary Isometric Contraction ◽  
Heart Rate Variability Biofeedback ◽  
Significant Difference

Abstract Background Heart rate variability biofeedback (HRV BFB) is a visually-guided paced breathing scheme that stimulates resonance in the cardiovascular system. Up to date, the influence of HRV BFB on neuromuscular function remains unknown. The purpose of this study was to investigate the effects of a single-session HRV BFB on Hoffman reflex (H-reflex) of the soleus muscle and maximal voluntary isometric contraction (MVC) of plantar flexors. Methods Eleven male healthy participants (height: 173.6 ± 7.5 cm; weight: 74.5 ± 17.3 kg; age: 24.6 ± 4.8 yrs) volunteered to undergo a randomized-crossover intervention involving a 10-minute HRV BFB and normal breathing (CON), separated by 48-hours. Pre and post indices for H-reflex, and post-only MVC in HRV BFB were evaluated using two-way repeated measures ANOVA and independent T-test respectively. Results No significant differences in H-reflex markers between HRV BFB and CON were found. Both groups posted non-significant difference in MVC. Conclusion An acute HRV BFB was not sufficient in eliciting significant changes in motoneuron excitability of the soleus muscle and maximal muscle strength of plantar flexors.

Characterization of T Wave Alternans With Ambulatory Electrocardiography

2008 ◽  
Vol 9 (3) ◽  
pp. 223-230 ◽  
Author(s):  
Margaret B. Harvey ◽  
Jack W. Buchanan
Keyword(s):  
Heart Rate ◽  
Moving Average ◽  
Medical Systems ◽  
Average Technique ◽  
T Wave ◽  
Ambulatory Electrocardiography ◽  
Average Analysis ◽  
Significant Difference ◽  
Arrhythmia Risk Stratification ◽  
T Wave Alternans

T wave alternans (TWA) is a marker of ventricular electrical instability considered to be predictive for ventricular tachyarrhythmias. Techniques have been developed to detect TWA at the µv level as a method for arrhythmia risk stratification of persons at high risk for sudden cardiac death. Currently, TWA is typically calculated using spectral analysis, whereby TWA is presumed to assume characteristics of stationarity. In contrast, a nonspectral method known as modified moving average analysis is purported to detect transient TWA that would not be observed using a spectral approach. The purpose of this pilot study work was to establish the basic TWA signal properties obtained with a device developed by GE Medical Systems using a descriptive, correlational study design. Ambulatory electrocardiography (AECG) recordings ( N = 24) were digitized and processed, and TWA was calculated via the modified moving average technique. Findings showed that noise was positively correlated with TWA in AECG channel 1 ( r = .899, p < .01) and AECG channel 2 ( r = .758, p < .01). However, no significant difference ( p = .237) was observed in TWA values between the AECG channels. A weak positive correlation was found between TWA and heart rate, expressed as beats per min ( r = .262). Heart rate mildly predicted TWA ( R = 0.34). Nonstationarity was evaluated by testing for trend and randomness. TWA values measured from AECG recordings were found to be influenced moderately by noise and minimally by heart rate and lead placement.

scholarly journals Impact of shorter MDR tuberculosis regimen drugs on heart rate variability in MDR tuberculosis patients at tertiary care hospital

2021 ◽  
Vol 10 (7) ◽  
pp. 813
Author(s):  
Disha S. Patel ◽  
Chetankumar R. Acharya
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Nervous System ◽  
Repeated Measures ◽  
Tertiary Care ◽  
Low Frequency ◽  
Care Hospital ◽  
Active Pulmonary Tuberculosis ◽  
Significant Difference ◽  
Mdr Tb

Background: Tuberculosis is major cause of death in India. Analysis of heart rate variability is one of the most popular methods of autonomic nervous system evaluation. Shorter MDR-TB regimen drugs affect both central nervous system as well as peripheral nervous system. Existing research suggests that active pulmonary tuberculosis causes ANS dysfunction. So, by HRV measurement impact of shorter MDR-TB regimen drugs on autonomic dysfunction can be correlated. Aim of the current investigation was to evaluate effect of shorter MDR-TB regimen drugs on cardiac autonomic regulation in MDR-TB patients with respect to heart rate variability as a parameter.Methods: Fifty newly diagnosed MDR-TB patients of either gender on shorter MDR- TB regimen were enrolled in this study after taking consent. After 20 minutes rest, ECG was taken by “physiopac digital polygraph” software for 5 minutes. Two follow-up HRV assessments were done on 2nd month and 4th or 6th month of treatment. HRV was calculated by root mean square deviation of successive differences between adjacent RR intervals (RMSSD) and low frequency and high frequency ratio.Results: Repeated measures ANOVA showed no statistically significant difference in HRV parameters between baseline, 2 months and 6 months groups. So, sympathetic and parasympathetic modulation in terms of HRV remains unchanged during treatment of MDR-TB with shorter MDR-TB regimen drugs.Conclusions: Shorter MDR-TB regimen drugs don’t have any significant impact on HRV in MDR- TB patients, No correlation was observed between HRV and heart rate in MDR-TB patients.

scholarly journals Treatment of supraventricular tachycardias in patients with non-cardiac surgery by dexmedetomidine during the perioperative period

2020 ◽  
Author(s):  
Yan Xu ◽  
CuiWen Hu ◽  
Xuan Guo ◽  
ZhiHong Hu ◽  
Hui Shi ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Surgery ◽  
Therapeutic Effect ◽  
Cardiac Disease ◽  
Perioperative Period ◽  
Adult Patients ◽  
Significant Difference ◽  
Supraventricular Tachycardias ◽  
Group D ◽  
Frequency Power

Abstract Background: Supraventricular tachycardias (SVTs) can increase the risk of adverse events in perioperative period. Previous studies have shown that application of dexmedetomidine (DEXm) combined anesthesia during surgery can significantly reduce postoperative cardiovascular and cerebrovascular complications and mortality in patients with cardiac disease. In fact, many anesthetic drugs have cardiac protection effects. However, it is a pity that these findings are not well applied in clinical practice to treat cardiac disease. Therefore, the aim of this study was to explore the therapeutic effect of DEXm on perioperative SVTs in adult patients with non-cardiac surgery. Methods: Forty-two patients with SVTs, aged between 35 and 61 years, were randomly divided into DEXm group (group D) and midazolam group (group M). The patients undergoing elective surgery in two groups were infused intravenously DEXm 0.5-1µg/kg or midazolam 0.06-0.08mg/kg using a micro-pump for 10 minutes, respectively. The the Observer’s Assessment of Alertness/Sedation (OAA/S) score, heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2) and occurrence of SVTs, heart rate variability (HRV) including normalized low frequency power (LFnorm), normalized high frequency power (HFnorm) and the balance ratio of sympathetic to vagal tone (LF/HF) in two groups were recorded at T0 (before the infusion DEXm or midazolam), T1 (5 minutes after the infusion), T2 (at the end of the infusion), T3 (5 minutes after the end of the infusion), and T4 (10 minutes after the end of the infusion). Results: The OAA/S score in two groups at T4 was obviously decreased compared with T0. And the OAA/S score in group M was lower than in group D at T4 (P<0.05). Compared to T0, HR and MAP in two groups were obviously decreased, and HR and MAP in group D were apparently lower than group M from T1 to T4 (P<0.05). Three patients developed mild hypotension in group D. However, none of patients developed clinically significant bradycardia, hypotension, and anoxia. There was no significant difference for SpO2 from T0 to T4 in group D. Compared to T0 or group D, SpO2 in group M obviously decreased at T2 (P<0.05). In addition, SVTs in all patients were terminated until T4 in group D after DEXm infusion. However, only two patients were finally improved in group M. Compared to T0, HFnorm were elevated, and LFnorm and LF/HF were decreased from T1 to T4, furthermore, the changes in HFnorm, LFnorm and LF/HF had statistical significance (P<0.05) in group D. However, there was no significant difference for HFnorm, LFnorm and LF/HF in group M from T0 to T4.Conclusions: Perioperative use of dexmedetomidine had a significant therapeutic effect for supraventricular tachycardias without significant adverse effects in adult patients .Trial Registration: ClinicalTrials.gov Registration Number: NCT04284150 on 26th February 2020

scholarly journals Catecholamines are key modulators of ventricular repolarization patterns in the ball python (Python regius)

2021 ◽  
Vol 154 (2) ◽  
Author(s):  
Bastiaan J.D. Boukens ◽  
William Joyce ◽  
Ditte Lind Kristensen ◽  
Ingeborg Hooijkaas ◽  
Aldo Jongejan ◽  
...  
Keyword(s):  
Heart Rate ◽  
Nervous System ◽  
Body Temperature ◽  
Sympathetic Nervous System ◽  
Ventricular Repolarization ◽  
Perfused Heart ◽  
Python Regius ◽  
T Wave ◽  
Wave Inversion ◽  
Sympathetic Nervous

Ectothermic vertebrates experience daily changes in body temperature, and anecdotal observations suggest these changes affect ventricular repolarization such that the T-wave in the ECG changes polarity. Mammals, in contrast, can maintain stable body temperatures, and their ventricular repolarization is strongly modulated by changes in heart rate and by sympathetic nervous system activity. The aim of this study was to assess the role of body temperature, heart rate, and circulating catecholamines on local repolarization gradients in the ectothermic ball python (Python regius). We recorded body-surface electrocardiograms and performed open-chest high-resolution epicardial mapping while increasing body temperature in five pythons, in all of which there was a change in T-wave polarity. However, the vector of repolarization differed between individuals, and only a subset of leads revealed T-wave polarity change. RNA sequencing revealed regional differences related to adrenergic signaling. In one denervated and Ringer’s solution–perfused heart, heating and elevated heart rates did not induce change in T-wave polarity, whereas noradrenaline did. Accordingly, electrocardiograms in eight awake pythons receiving intra-arterial infusion of the β-adrenergic receptor agonists adrenaline and isoproterenol revealed T-wave inversion in most individuals. Conversely, blocking the β-adrenergic receptors using propranolol prevented T-wave change during heating. Our findings indicate that changes in ventricular repolarization in ball pythons are caused by increased tone of the sympathetic nervous system, not by changes in temperature. Therefore, ventricular repolarization in both pythons and mammals is modulated by evolutionary conserved mechanisms involving catecholaminergic stimulation.

Effect of Three Behavior Guidance Techniques on Anxiety Indicators of Children Undergoing Diagnosis and Preventive Dental Care

2019 ◽  
Vol 43 (3) ◽  
pp. 167-172 ◽  
Author(s):  
Priyanka Karekar ◽  
Mohammed Nadeem Bijle ◽  
Hrishikesh Walimbe
Keyword(s):  
Heart Rate ◽  
Dental Care ◽  
Repeated Measures ◽  
Oral Examination ◽  
Preventive Dental Care ◽  
Comparison Results ◽  
Significant Difference ◽  
Modeling Techniques ◽  
Behavior Guidance ◽  
Preventive Dental

Objective(s): To assess the effect of three behavior guidance techniques on anxiety indicators of children undergoing diagnosis and preventive dental care. Study Design: Sixty-three subjects (7–9 years) were divided into three groups as per the behavior guidance technique namely tell-show-do, live and filmed modeling (using Tablet Computer) to receive diagnostic (Oral examination & radiographic assessment using intraoral periapical radiographs) and preventive dental care (Oral prophylaxis and topical fluoride application). Anxiety indicators–Facial Image Scale (FIS) scores and heart rate were recorded before, during and after diagnosis/preventive treatment. Three-way repeated measures ANOVA with post-hoc analysis was performed at significance of p-value &lt; 0.05. Results: There was a statistically significant difference in the anxiety indicators of children under the influence of different behavior guidance approaches undergoing diagnosis/preventive treatments except for mean heart rate of children while oral examination. Multiple comparison results reveal that the mean FIS scores and heart rate of children with modeling techniques were significantly better as compared to tell-show-do technique with no significant difference between the two modeling techniques. Conclusion: This study suggests that the modeling techniques (filmed and live) seem to be an efficient behavioral guidance approach for children aged 7–9 years undergoing routine diagnosis and preventive dental care as compared to tell-show-do technique.

scholarly journals Non-invasive assessment of short and ultra-short heart rate variability during different physical and physiological tests

Kinesiology ◽  
2021 ◽  
Vol 53 (1) ◽  
pp. 122-130
Author(s):  
Tuncay Alparslan ◽  
Ramiz Arabaci ◽  
Recep Gorgulu
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Test Performance ◽  
Repeated Measures ◽  
Short Term ◽  
High Performing ◽  
Non Invasive ◽  
Significant Difference ◽  
Physiological Tests ◽  
Data Collection Procedure

The main aim of the present study was to determine the short- and ultra-short-term heart rate variability (HRV) during different physical and physiological tests and to compare HRV to different performance levels. The latter aim was to compare participants’ short- and ultra-short-term heart rate variability before-during-post-tests. Our hypothesis was that there would be a significant difference between test performance and HRV parameters, and the high performing group would have significantly higher HRV parameters than the low performing group. Fifty-three healthy men (Mage=26.9±4 years, Mheight=177.9±5.7 cm; Mweight =77.8±8.7 kg) were recruited in the current study. We completed the data collection procedure for each participant in four consecutive days. On day-1, anthropometric measurements were conducted and then participants performed isokinetic tests. On day-2, participants performed anaerobic tests; on day-3 equilibrium tests, and on day-4 aerobic capacity tests. The HRV records of all participants were obtained before, during and after all these tests. Based on the participants’ performance, they were divided into two groups: participants in G1 had lower performance and those in G2 higher performance. A two-way repeated measures ANOVA yielded significant differences in HRV values obtained in the four different tests. There was a significant difference between fitness test performance and the variation of short- and ultra-short-term HRV parameters. Also, significant differences in HRV values before, during, and after the testing were observed.

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