Clinical application of visceral thoracic osteopathic manipulations in heart rate variability measurement with photoplethysmography for stress-related symptoms: a case report

Heart rate variability (HRV) is the change in frequency from one heartbeat to the next, due to the adaptation of the heart’s rhythm in response to an internal or external stimulus. Increased HRV has been reported as a potential indicator of general health. The relationship between structure and function is one of the guiding principles of osteopathy; it considers anatomy essential for explaining physiological dysfunction. There is a paucity of research on the effects of Osteopathic manipulative medicine (OMM) on the effects of HRV. We hypothesize that OMM can be used safely and to help promote healthier HRV. We herein report on a case of improved HRV after serial OMM sessions.

Heart rate variability: Measurement and emerging use in critical care medicine

Variation in the time interval between consecutive R wave peaks of the QRS complex has long been recognised. Measurement of this RR interval is used to derive heart rate variability. Heart rate variability is thought to reflect modulation of automaticity of the sinus node by the sympathetic and parasympathetic components of the autonomic nervous system. The clinical application of heart rate variability in determining prognosis post myocardial infarction and the risk of sudden cardiac death is well recognised. More recently, analysis of heart rate variability has found utility in predicting foetal deterioration, deterioration due to sepsis and impending multiorgan dysfunction syndrome in critically unwell adults. Moreover, reductions in heart rate variability have been associated with increased mortality in patients admitted to the intensive care unit. It is hypothesised that heart rate variability reflects and quantifies the neural regulation of organ systems such as the cardiovascular and respiratory systems. In disease states, it is thought that there is an ‘uncoupling’ of organ systems, leading to alterations in ‘inter-organ communication’ and a clinically detectable reduction in heart rate variability. Despite the increasing evidence of the utility of measuring heart rate variability, there remains debate as to the methodology that best represents clinically relevant outcomes. With continuing advances in technology, our understanding of the physiology responsible for heart rate variability evolves. In this article, we review the current understanding of the physiological basis of heart rate variability and the methods available for its measurement. Finally, we review the emerging use of heart rate variability analysis in intensive care medicine and conditions in which heart rate variability has shown promise as a potential physiomarker of disease.