Reduced Sympathetic Reserve Detectable by Heart Rate Response after Dipyridamole in Anginal Patients with Normal Coronary Arteries

Background. Patients with ischemia and normal coronary arteries (INOCA) may show abnormal cardiac sympathetic function, which could be unmasked as a reduced heart rate reserve (HRR) during dipyridamole stress echocardiography (SE). Objectives. To assess whether HRR during dipyridamole SE predicts outcome. Methods. Dipyridamole SE was performed in 292 patients with INOCA. HRR was measured as peak/rest heart rate and considered abnormal when ≤1.22 (≤1.17 in presence of permanent atrial fibrillation). All-cause death was the only endpoint. Results. HRR during SE was normal in 183 (63%) and abnormal in 109 patients (37%). During a follow-up of 10.4 ± 5.5 years, 89 patients (30%) died. The 15-year mortality rate was 27% in patients with normal and 54% in those with abnormal HRR (p < 0.0001). In a multivariable analysis, a blunted HRR during SE was an independent predictor of outcome (hazard ratio 1.86, 95% confidence intervals 1.20–2.88; p = 0.006) outperforming inducible ischemia. Conclusions. A blunted HRR during dipyridamole SE predicts a worse survival in INOCA patients, independent of inducible ischemia.

Assessment of cardiovascular sympathetic function tests in premenstrual syndrome patients visiting tertiary care hospital: A case–control study

Background: Premenstrual syndrome (PMS) is a stress-induced disorder and is showing a rising prevalence but its etiopathogenesis is not yet understood. Stress disturbs the balance of the sympathetic and parasympathetic nervous system. Alteration in heart rate and blood pressure is the most important physiological response following stress-induced sympathetic changes. Aims and Objectives: The present study was designed to test the hypothesis of an association between sympathetic functions and PMS and to observe the degree of changes (if any) in these sympathetic functions. The study also aims to provide timely interventions to prevent the development of cardiovascular complications and improve lifestyle. Materials and Methods: A Menstrual Distress Questionnaire was used to evaluate physical, emotional, and behavioral symptoms accompanying the menstrual cycle of the subjects who fulfilled the inclusion criteria. Based on the scores obtained by their questionnaire, subjects with the higher scores formed the PMS group, while the age-matched females with low score served as controls. Cardiovascular sympathetic functions were assessed by standardized, simple, non-invasive tests which included Handgrip test and orthostatic hypotension test. Unpaired Student’s t-test was used for statistical analysis. Results: The results revealed that the sympathetic reactivity is insignificantly higher in PMS group during the follicular phase. During the luteal phase, sympathetic activity is significantly increased. Conclusion: PMS involves psychoneuroendocrinal turmoil, thus early screening of high-risk groups and interventions such as relaxation techniques and lifestyle modification can prevent further cardiovascular complications in patients of high sympathetic responses.

Sympathetic and sensory nerve fiber function in multiple system atrophy and idiopathic Parkinson’s disease

Objective To explore small fiber somatosensory and sympathetic function in PD and MSA. Methods We recruited 20 PD patients (7 women, median age 65.5 years; IQR 54.75–70.0), 10 MSA patients (4 women; median age 68 years; IQR 66.25–74.0), and 10 healthy subjects (HC; 4 women, median age 68; IQR 59.0–71.0 years). Autonomic testing included forehead cooling, intradermal microdialysis of norepinephrine (NE; 10–5; 10–6; 10–7; and 10–8), and orthostatic hypotension (OH); somatosensory testing included quantitative sensory testing (QST) according to the protocol of the German Research Network on Neuropathic Pain (DFNS). Results OH occurred more frequently in PD (p = 0.018) and MSA (p = 0.002) compared to HC. Vasoconstriction responses were stronger in PD compared to MSA during forehead cooling (p = 0.044) and microdialysis of physiologically concentrated NE solutions (10–7; 10–8; p = 0.017). PD and MSA had impaired cold (PD: p < 0.01; MSA: p < 0.05) and warm detection thresholds (PD and MSA, both p < 0.05). The mechanical detection threshold was higher in PD (p < 0.01). Conversely, mechanical pain thresholds were decreased in PD and MSA (both p < 0.001), indicating mechanical hyperalgesia. Conclusion In contrast to MSA, we found evidence of peripheral adrenoreceptor hypersensitivity in PD, probably caused by peripheral sympathetic denervation. Sensory testing revealed peripheral neuropathy and central pain sensitization in PD and MSA. Jointly, our data demonstrate autonomic and somatosensory dysfunction in PD and MSA.

A Blunted Sympathetic Function and an Enhanced Nitrergic Activity Contribute to Reduce Mesenteric Resistance in Hyperthyroidism

We aimed to determine whether an experimental model of hyperthyroidism could alter the function of sympathetic and nitrergic components of mesenteric innervation. For this purpose, male Wistar rats were divided into (1) control rats (CT) and (2) rats infused with L-Thyroxine (HT). Body weight gain and adipose tissue accumulation were lower in HT rats, while systolic blood pressure and citrate synthase activity in the soleus muscle were increased by HT. In segments from the superior mesenteric artery, the application of an electrical field stimulation (EFS) induced a vasoconstrictor response, which was lower in arteries from HT animals. The alpha-adrenoceptor antagonist phentolamine diminished EFS-induced vasoconstriction to a lower extent in HT arteries, while the purinergic receptor antagonist suramin reduced contractile response to EFS only in segments from CT. In line with this, noradrenaline release, tyrosine hydroxylase expression and activation and dopamine β hydroxylase expression were diminished in HT. The unspecific nitric oxide synthase (NOS) inhibitor L-NAME increased EFS-induced vasoconstriction more markedly in segments from HT rats. NO release was enhanced in HT, probably due to an enhancement in neuronal NOS activity, in which a hyperactivation of both PKC and PI3K-AKT signaling pathways might play a relevant role. In conclusion, perivascular mesenteric innervation might contribute to reduce the vascular resistance observed in hyperthyroidism.

Basic personality traits in patients with myocardial infarction

On the topic of cardiovascular diseases, textbooks usually list a psychogenic factor as one of the last risk factors, and it is defined quite vaguely and differently as stress, trauma or personality traits. The five-factor model of personality that we used in our research belongs to the field of psychology that deals with the basic structure-basic personality traits. Basic personality traits are understood as non-cognitive, time-stable and, in relation to the characteristics of the sample, invariant dispositional constructs that can explain most of the variance of individual differences. The main goal of the study is to relate heart rate variability (HRV) parameters with comprehensively described personality functioning thru NEO-PI-R inventory. Sample consists of 95 persons (65 males and 32 females) with non-fatal cardiac arrest (age between 35 and 60). HRV and personality measurements were done during their hospital treatment. Personality dimensions were measured by NEO-PI-R inventory and HRV variables were measured by five tests for cardio-vascular reflexes by Ewing and Clark and by Holter monitoring. Our results indicate that there are statistically significant correlations between Openness as psychological variable on one side, and different parameters of functioning of autonomic nervous system, measured indirectly thru HRV variables, on the other side. In our study product-moment correlation analysis was employed between personality and HRV variables and canonical analysis of covariance between linear composites extracted in two sets of variables (HRV and personality) was employed. Three statistically significant correlations were obtained. The first correlation reveals that absence of Openness is related to parameters indicating good functioning of sympathetic function. The second correlation reflects the relationship between elevated Neuroticism with good functioning of vagal segment of autonomic nervous system which is followed by slight unitability of sympathetic function registered by EKG analysis. Third correlation indicated that Extrovert persons has tendency of good sympathetic functioning which is followed by slight vagal disfunction measured by short term analysis. There is not only one, but several mechanisms through which the connection between the functioning of the basic structure of personality and ANS is realized. This means that the influence of the basic structure on the ANS is not unambiguous, and that, as we have said, it is realized through different mechanisms. Overcoming opposite theoretical orientations through an integral and multidisciplinary approach to coronary heart disease is becoming topical. It is emphasized that research should include equally variables of biological, psychological, and sociological order. Also, in accordance with this type of research, it insists on a modern methodology that will include multivariate designs, adequate multidimensional techniques, controlled samples and variables and precise statistical methods. It is believed that in this way, some of the controversial issues in this area will be resolved, such as: the share and mechanisms of action of psychological factors in the chain in which emotions and physical illness intertwine and continue on each other. We hope that this paper is one in this direction.

Comparison of Heart Rate Variability among Young Malay Male Adult with Different BMI and Level of Adiposity

INTRODUCTION: Subclinical changes that occur in the heart at an early age may provide valuable information to outline prevention strategies for cardiovascular diseases. Heart rate variability (HRV) reflects regulation of autonomic balance, heart, and vascular tone, which are the determinants of blood pressure. Therefore, this study aimed to determine the difference in heart rate variability (HRV) of Malay male young adult with their BMI and adiposity level. MATERIALS AND METHODS: A total of 201 Malay male young adult aged between 19 to 24 years old were screened and their BMI and adiposity level were measured. Three non -invasive tests; Valsalva Manoeuvre, orthostatic response and 30/15 ratio of heart rate were performed. Short term HRV time and frequency domains were recorded. RESULTS: Despite few significant differences in HRV parameters of overweight/obese subjects, the result is inconclusive to conclude any reduced variability. However, those with high adiposity regardless of their BMI reported significantly lower mean of R -R SD in time domain and lower mean of LF/HF ratio in frequency domain. The orthostatic reflex results revealed that high adiposity subjects had significantly lower mean of LF and HF. A decrement of -0.28 ms2 HF/LF during Valsalva manoeuvre, -0.35 LF ms2 in orthostatic reflex and 0.33 ms2 in orthostatic reflex per 1% of body fat percentage were observed. CONCLUSION: HRV parameters were inversely proportional to the adiposity level which was suggestive of modulation of sympathetic function can occur at an early age.

Ross Syndrome: A Patient with a 23-Year History

We present a 60-year-old female with a 23-year history of anhidrosis with concomitant heat intolerance. At examination, we found a right-sided tonic pupil, absent tendon reflexes, and a segmental patch of compensatory hyperhidrosis in the left lower quadrant of her trunk. To further confirm this finding, a minor test (a starch-iodine test, which is used to evaluate the sudomotor function, sweating) was performed. Nerve conduction studies revealed evidence of a mild distal sensory polyneuropathy of the axonal type. Tilt-table testing showed signs of orthostatic hypotension with evidence of reduced sympathetic function. Skin biopsy excluded pathology in the sweat glands. Our patient met the criteria for a diagnosis of Ross syndrome. This case describes the long-term outcome of this rare entity and highlights how careful examination and bedside autonomic testing can confirm the diagnosis of autonomic neurological disorders.