Abstract
.Autonomic nervous system dysfunction (ANSD) is a significant cause of mortality in tetanus. Currently, diagnosis relies on nonspecific clinical signs. Heart rate variability (HRV) may indicate underlying autonomic nervous system activity and represents a potentially valuable noninvasive tool for ANSD diagnosis in tetanus. HRV was measured from three 5-minute electrocardiogram recordings during a 24-hour period in a cohort of patients with severe tetanus, all receiving mechanical ventilation. HRV measurements from all subjects—five with ANSD (Ablett Grade 4) and four patients without ANSD (Ablett Grade 3)—showed HRV was lower than reported ranges for healthy individuals. Comparing different severities of tetanus, raw data for both time and frequency measurements of HRV were reduced in those with ANSD compared with those without. Differences were statistically significant in all except root mean square SD, indicating HRV may be a valuable tool in ANSD diagnosis.
Highlights
Tetanus is a severe disease characterized by toxin-mediated disinhibition of autonomic and motor nervous systems
Heart rate variability is altered in pathological states, such as ischemic heart disease, and reduced variability is predictive of worse outcomes.[5]
Frequency domain variables are generated from ECG spectral analysis, usually following fast Fourier transformation.[5]
Summary
Tetanus is a severe disease characterized by toxin-mediated disinhibition of autonomic and motor nervous systems. When mechanical ventilation is available, spasms can be controlled, but autonomic nervous system dysfunction (ANSD) remains a principal cause of mortality.[1,2] Robust methods of detecting ANSD suitable for implementation in resource-limited settings where most tetanus occurs would allow earlier intervention and may improve outcome. Sykora et al.[6] analyzed baroreflex sensitivity and time domain variables in an 87-year-old woman with tetanus and reported decreased baroreceptor sensitivity compared with a control of similar age; the patient, but not control, received mechanical ventilation and a beta-blocker, both of which can influence sensitivity.
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