The autonomic balance predicts cardiac responses after the first dose of fingolimod

2014 ◽  
Vol 21 (2) ◽  
pp. 206-216 ◽  
Author(s):  
S Rossi ◽  
C Rocchi ◽  
V Studer ◽  
C Motta ◽  
B Lauretti ◽  
...  
Keyword(s):  
Valsalva Maneuver ◽  
P Wave ◽  
Cardiac Response ◽  
Vagal Activity ◽  
Deep Breathing ◽  
Autonomic Balance ◽  
Cardiac Side Effects ◽  
Dose Monitoring ◽  
Pr Interval ◽  
Normalized Units

Background: Predictive markers of cardiac side effects would be helpful for the stratification and individualized monitoring of multiple sclerosis (MS) patients prescribed with fingolimod. Objective: To test whether the autonomic balance predicts a cardiac response after the first dose of fingolimod. Methods: A total of 55 consecutive relapsing–remitting MS (RRMS) patients underwent ‘head-up tilt’, Valsalva maneuver, deep breathing and handgrip tests before their first dose of fingolimod. The normalized unit of the high frequency (HF) component (HF normalized units; HFnu), reflecting mostly vagal activity; and the low frequency (LF) component (LF normalized units; LFnu) reflecting mostly sympathetic activity, were considered for the analysis of heart rate (HR) variability. The patients’ HR and electrocardiographic parameters ((the interval between P wave and ventricular depolarization (PR); the interval between Q and T waves (QT)) were recorded during 6-hour post-dose monitoring. Results: We found significant correlations between measures of parasympathetic function and fingolimod-induced bradycardia. Subjects with higher Valsalva ratio and HR variation during deep breathing had, in fact, nadir HR ≤ 50 beats/minute (bpm) after the first fingolimod dose. Conversely, significant negative correlations were found between measures of sympathetic function and fingolimod-induced PR interval increase. Subjects with lower LFnu at rest and less increase of blood pressure on the handgrip test showed a PR interval increase > 20 ms after fingolimod. Conclusions: Assessing autonomic control of cardiovascular functions can be useful to predict cardiac effects after the first fingolimod dose.

Electrocardiographic interpretation of the nasopharyngealresponse in conscious rabbits

2016 ◽  
Author(s):  
Jafrin Ara Ahmed ◽  
Juneet Kour ◽  
Nawab Nashiruddullah ◽  
Dibyendu Chakraborty
Keyword(s):  
Heart Rate ◽  
Cigarette Smoke ◽  
Ventricular Myocardium ◽  
P Wave ◽  
Vagal Activity ◽  
Qrs Complex ◽  
Clinically Normal ◽  
Pr Interval ◽  
Sympathetic Influence ◽  
Formaldehyde Vapour

The present study was conducted to recognize by part, the cardiovascular events of the nasopharyngeal reflex, through electrocardiographic interpretations. ECG patterns were traced in twelve clinically normal and healthy New Zealand White rabbits of both sexes, weighing between 2-3 kg and aged between 1-3 years with inhalant irritants. Immediately after induction of formaldehyde vapour, the heart rate fell by 69% from a mean of 192 ± 7.310 bpm to 60 ± 1.296 bpm, whereas exposure with cigarette smoke caused a fall in heart rate by 74% from a mean of 205 ± 9.605 bpm to 53 ± 3.065 bpm. With both irritants, P wave becomes smaller and totally disappeared, indicating an increased vagal activity inducing a sinoatrial node arrest. The amplitude of QRS complex also significantly decreased; and so did the duration of P wave and PR interval, presumably due to junctional escape. T wave duration decreased with slow ventricular repolarization. Bradycardia was also evident with increased QT interval. However, there was no change in QRS complex or ventricular depolarization, mediated perhaps via compensatory sympathetic influence on the ventricular myocardium. The study demonstrates that both formaldehyde and cigarette smoke provoked a similar protective response of rabbits against noxious fumes.

scholarly journals Pregabalin-induced first degree atrioventricular block in a young patient treated for pain from extrapulmonary tuberculosis

2017 ◽  
Vol 87 (3) ◽  
Author(s):  
Alessandra Schiavo ◽  
Francesca M. Stagnaro ◽  
Andrea Salzano ◽  
Alberto M. Marra ◽  
Emanuele Bobbio ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Renal Function ◽  
Severe Pain ◽  
Kidney Diseases ◽  
Extrapulmonary Tuberculosis ◽  
Renal Diseases ◽  
Av Block ◽  
Unique Case ◽  
Cardiac Side Effects ◽  
Pr Interval

<p>Pregabalin, widely used in the treatment of several pain disorders, is usually well tolerated. Uncommonly, the drug may induce cardiac side effects, rarely prolongation of the PR interval. The latter has never been described in patients with healthy heart or normal renal function. We characterize a unique case of a young man with extrapulmonary tuberculosis and no detectable or known cardiac or kidney diseases, treated with pregabalin to control the severe pain due to the involvement of the spinal cord by the tuberculosis, showing an atrioventricular (AV) block due to pregabalin administration. The reported case emphasizes the need of monitoring PR interval during treatment with pregabalin, even in patients without background of cardiac or renal diseases. </p>

Dynamics of spectral components of heart rate variability during changes in autonomic balance

1998 ◽  
Vol 275 (1) ◽  
pp. H213-H219 ◽  
Author(s):  
Michael V. Højgaard ◽  
Niels-Henrik Holstein-Rathlou ◽  
Erik Agner ◽  
Jørgen K. Kanters
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Supine Position ◽  
Low Frequency ◽  
Power Spectral Analysis ◽  
Frequency Domain Analysis ◽  
Autonomic Balance ◽  
Power Spectral ◽  
Normalized Units ◽  
Semiquantitative Method

Frequency domain analysis of heart rate variability (HRV) has been proposed as a semiquantitative method for assessing activities in the autonomic nervous system. We examined whether absolute powers, normalized powers, and the low frequency-to-high frequency ratio (LF/HF) derived from the HRV power spectrum could detect shifts in autonomic balance in a setting with low sympathetic nervous tone. Healthy subjects were examined for 3 h in the supine position during 1) control conditions ( n = 12), 2) acute β-blockade ( n = 11), and 3) chronic β-blockade ( n = 10). Heart rate fell during the first 40 min of the control session (72 ± 2 to 64 ± 2 beats/min; P < 0.005) and was even lower during acute and chronic β-blockade (56 ± 2 beats/min; P < 0.005). The powers of all spectral areas rose during the first 60 min in all three settings, more so with β-blockade ( P < 0.05). LF/HF was found to contain the same information as powers expressed in normalized units. LF/HF detected the shift in autonomic balance induced by β-blockade but not the change induced by supine position. In conclusion, none of the investigated measures derived from power spectral analysis comprehensively and consistently described the changes in autonomic balance.

Comparative effects of surgical and percutaneous repair on P-wave and atrioventricular conduction in patients with atrial septal defect – ostium secundum type

2012 ◽  
Vol 23 (1) ◽  
pp. 132-137
Author(s):  
Hassan Javadzadegan ◽  
Mehrnoush Toufan ◽  
Ali Reza Sadighi ◽  
Joyce M. Chang ◽  
Nader D. Nader
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
P Wave ◽  
P Value ◽  
Device Closure ◽  
Wave Duration ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
P Wave Duration ◽  
Pr Interval

AbstractBoth surgical and percutaneous closures of atrial septal defects have been successful in reversal of atrial dilatation. We compared the effects of surgical and percutaneous transvenous device closure of atrial septal defect on post-operative changes of P-wave duration, PR segment, and PR interval. Electrocardiographic data were prospectively collected from 30 patients following either surgical (n equal to 16) or percutaneous (n equal to 16) repair of atrial septal defects between 2004 and 2010. A cardiologist blinded to the closure technique performed the electrocardiographic analyses. P-wave duration (98.5 plus or minus 15.4 to 86.4 plus or minus 13.2 milliseconds, p-value less than 0.05) and PR interval (162.9 plus or minus 18.5 to 140.6 plus or minus 15.2 milliseconds, p-value less than 0.05) were reduced after percutaneous transvenous device closure. P-wave duration (104.5 plus or minus 24.7 versus 83.2 plus or minus 13.3 milliseconds, p-value less than 0.05) and PR interval (173.2 plus or minus 38.7 versus 144.3 plus or minus 32.0 milliseconds, p-value less than 0.05) were also reduced after surgical closure. PR segment in the percutaneous group was significantly reduced (63.4 plus or minus 14.5 to 52.1 plus or minus 10.8 milliseconds, p-value less than 0.05), but not in the surgical group (68.6 plus or minus 18.7 versus 61.1 plus or minus 24.7 milliseconds). However, the difference in PR segment changes between the two groups was not significant (−11.3 plus or minus 15.0 versus −7.6 plus or minus 20.5 milliseconds, p-value equal to 0.18). Our analysis demonstrates that the changes between the two groups were not different and that both closure techniques reduce P-wave duration, PR segment, and PR interval within 6 months.

Atrioventricular conduction abnormalities and atrioventricular blocks: ECG patterns and diagnosis

2018 ◽  
Author(s):  
S. Serge Barold
Keyword(s):  
P Wave ◽  
Conduction Time ◽  
Type I ◽  
Type Ii ◽  
Av Block ◽  
Ventricular Extrasystoles ◽  
Av Conduction ◽  
Pr Interval ◽  
Before And After ◽  
Second Degree

The diagnosis of first-degree and third-degree atrioventricular (AV) block is straightforward but that of second-degree AV block is more involved. Type I block and type II second-degree AV block are electrocardiographic patterns that refer to the behaviour of the PR intervals (in sinus rhythm) in sequences (with at least two consecutive conducted PR intervals) where a single P wave fails to conduct to the ventricles. Type I second-degree AV block describes visible, differing, and generally decremental AV conduction. Type II second-degree AV block describes what appears to be an all-or-none conduction without visible changes in the AV conduction time before and after the blocked impulse. The diagnosis of type II block requires a stable sinus rate, an important criterion because a vagal surge (generally benign) can cause simultaneous sinus slowing and AV nodal block, which can resemble type II block. The diagnosis of type II block cannot be established if the first post-block P wave is followed by a shortened PR interval or by an undiscernible P wave. A narrow QRS type I block is almost always AV nodal, whereas a type I block with bundle branch block barring acute myocardial infarction is infranodal in 60–70% of cases. All correctly defined type II blocks are infranodal. A 2:1 AV block cannot be classified in terms of type I or type II block, but it can be AV nodal or infranodal. Concealed His bundle or ventricular extrasystoles may mimic both type I or type II block (pseudo-AV block), or both

High-frequency atrial electrical activity

1961 ◽  
Vol 16 (2) ◽  
pp. 300-304 ◽  
Author(s):  
Cesar A. Caceres ◽  
George A. Kelser ◽  
Juan Calatayud
Keyword(s):  
High Frequency ◽  
Electrical Potential ◽  
P Wave ◽  
Right Atrial ◽  
High Frequencies ◽  
Pr Interval ◽  
Frequency Components ◽  
Left And Right ◽  
Electronic Filters ◽  
High Frequency Content

Left and right atrial intracavitary and conventional surface leads were used to study electrocardiographic activity during the PR interval. Electronic filters were employed for analysis of wave frequency and harmonic content from 1.7 to 1700 cps. Amplifiers permitting standardization sensitivity to 500 mm/mv were used to obtain oscilloscopic tracings recorded at a paper speed of 75 mm/sec. Frequency analysis of the electrical potential recorded during P wave inscription demonstrated the presence of high-frequency content that is excluded by conventional electrocardiographic amplifiers. The high-frequency components are associated with the time of inscription of the electrocardiographic intrinsic deflection and have a relationship to the characteristics of the pressure-pulse curve. These relationships suggest that intracavitary high frequencies and the electrocardiographic intrinsic deflection originate from electrical discharges associated with initiation of contractile events. Submitted on June 6, 1960

Changes in the Electrocardiogram and Achilles Reflex Test during Treatment of Hypothyroidism

1969 ◽  
Vol 14 (2) ◽  
pp. 59-63 ◽  
Author(s):  
R. J. Weir ◽  
J. A. Young ◽  
J. B. McGuinness
Keyword(s):  
P Wave ◽  
Qrs Complex ◽  
T Wave ◽  
St Segment ◽  
Pr Interval ◽  
Myocardial Muscle ◽  
Reflex Time

In 10 patients with hypothyroidism, the electrocardiogram and Achilles reflex test have been recorded before and during treatment with l-thyroxine sodium. Aspects of the electrocardiogram affected by hypothyroidism are the rate, duration of PR interval, height of P-wave, of QRS complex and of T-wave and the ST segment. Each of these improved with therapy, the earliest and most sensitive change being the height of the QRS complex. The Achilles reflex time as recorded by the photomotograph also showed a parallel decrease with therapy but this is considered to be less reliable as an isolated test. The prolongation of the PR interval is briefly discussed and a correlation between the changes in skeletal and myocardial muscle is suggested.

Heart Rate/Stroke Volume Relationship During Upright Exercise in Long-Term Diabetics

1993 ◽  
Vol 18 (2) ◽  
pp. 148-162
Author(s):  
R. G. Haennel ◽  
K. K. Teo ◽  
A. Suthijumroon ◽  
M. P. J. Senaratne ◽  
M. Hetherington ◽  
...  
Keyword(s):  
Heart Rate ◽  
Stroke Volume ◽  
Cardiac Function ◽  
Autonomic Function ◽  
Valsalva Maneuver ◽  
Peak Exercise ◽  
Initial Increase ◽  
Key Words Diabetes Mellitus ◽  
Key Words Diabetes ◽  
Deep Breathing

The changes in stroke volume (SV) during upright exercise were studied in 20 insulin-dependent diabetics (IDDM) and 20 age- and sex-matched controls. None of the diabetics had any cardiovascular symptoms. In addition, tests of autonomic function were conducted in the diabetics, assessing changes in heart rate (HR) during deep breathing and the Valsalva maneuver. During exercise the SV in the controls gradually increased and then remained essentially unchanged until maximum HR was achieved. Seven of the diabetics failed to sustain an initial increase in SV (fall > 15%), eight showed a "delayed" increase in SV, and the remaining five demonstrated an increasing SV over the range from rest to peak exercise. Abnormal autonomic function results were found during deep breathing (four diabetics) and the Valsalva maneuver (four diabetics). Findings indicate that cardiac function could be abnormal in IDDM without evidence of autonomic dysfunction. This abnormality could be due to a specific cardiomyopathy. Key words: diabetes mellitus, cardiac function, upright exercise, autonomic neuropathy, cardiomyopathy

PR interval, P-wave duration, and mortality: New insights, additional questions

Heart Rhythm ◽  
2014 ◽  
Vol 11 (1) ◽  
pp. 99-100 ◽  
Author(s):  
Alvaro Alonso ◽  
Lin Y. Chen
Keyword(s):  
P Wave ◽  
Wave Duration ◽  
P Wave Duration ◽  
Pr Interval
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