Increase In Heart Rate Research Articles

Development and Preliminary Testing of the Withdrawal Assessment Tool-Alpha 2 Agonist: An Assessment Instrument for Monitoring Iatrogenic Withdrawal Symptoms in Children Receiving an Alpha-2 Agonist

Objectives: To develop and conduct preliminary testing of the Withdrawal Assessment Tool-Alpha 2 Agonist (WAT-A2A) to monitor dexmedetomidine and clonidine withdrawal symptoms in acutely ill children. Design: Three-phase instrument development study. Phase 1: retrospective chart review of symptoms exhibited by children with documented dexmedetomidine withdrawal; phase 2: WAT-A2A instrument construction based on phase 1 data; and phase 3: prospective testing of the WAT-A2A in children weaning from alpha 2 agonists (A2As). Setting: Academic free-standing children’s hospital. Patients: Acutely ill children weaning from at least 5 days of dexmedetomidine. Excluded were children concurrently weaning other sedatives. Interventions: None. Measurements and Main Results: Phase 1: In 83 of 303 children weaning from at least 5 days of dexmedetomidine who had clinician documentation and were managed for A2A withdrawal, 88% (n = 72) exhibited at least a 20% increase in heart rate (HR), 83% (n = 69) exhibited agitation or change in usual state behavior, 46% (n = 38) exhibited at least a 20% increase in diastolic blood pressure (DBP), and when documented, 56% (27/48) exhibited tremors during their A2A withdrawal episode. Phase 2: The WAT-A2A was constructed, based on phase 1 data, and includes four items: HR, state behavior, DBP, and tremors. Phase 3: The WAT-A2A was tested and performed well in 82 children weaning from A2A. The total WAT-A2A score correlated with clinician subjective assessment of A2A withdrawal (Spearman correlation = 0.5; p < 0.001). Inter-rater agreement, comparing paired ratings of prospectively collected WAT-A2A data, indicated moderate inter-rater reliability. Conclusions: Acutely ill children receiving sedation with an A2A for more than 5 days may develop physiologic dependence, requiring gradual dosing reductions. While further psychometric testing is advised, the WAT-A2A provides an objective instrument to help clinicians quantify dexmedetomidine withdrawal symptoms in acutely ill children may facilitate A2A weaning and limit unnecessary variation in practice.

Comparison of 2 Methods for Measuring Chronotropic Response to Exercise: Heart Rate–Work Rate Slope Versus Percent Change in Heart Rate–Work Rate Slope—A Cross-Sectional Study

Purpose: Chronotropic response to exercise (CRE) is an indicator of cardiovascular health and is evaluated using different methodologies. The purpose of this cross-sectional investigation was to compare 2 methods for measuring CRE: heart rate (HR)–work rate slope versus percent change in HR–work rate slope. Methods: Thirty-three participants met the inclusion criteria. Participants completed a two-stage graded exercise protocol. Heart rate and work rate data were recorded at rest (0 watts), the final minute of stage 1, and the final minute of stage 2. Heart rate–work rate slope was defined as the slope of HR increase relative to work rate increase. Percent change in HR–work rate slope was calculated as the percent change in HR–work rate slope between stage 1 and stage 2. Results: Spearman correlation coefficient indicated a significant, but relatively low, correlation between the 2 measurements (rs = 0.388, P = .01). The 95% limits of agreement (z-scores) between the 2 measurements were −2.29 to 2.29, suggesting considerable disagreement. Conclusions: The findings of this study indicated that HR–work rate slope and percent change in HR–work rate slope were not comparable. The low correlation and lack of agreement between the 2 methods could be explained by the possible measurement of different constructs (cardiorespiratory fitness vs coronary artery disease risk). Because of considerable disagreement, clinicians should not make decisions related to patient care using the 2 methodologies interchangeably. The findings of this investigation support the perspective that a standardized procedure for measuring CRE is warranted.

Effectiveness of Endorphin Massage and Positive Affirmations in Reducing Anxiety Levels Among Pre-Sectio Caesarea Patients

Introduction: Facing a Caesarean section (C-section), patients often imagine the surgical process and various discomforts, leading to anxiety. Anxiety can result in both physical and psychological changes, such as an increased heart rate, elevated blood pressure, rapid breathing, fatigue, and an increase in fetal heart rate. Endorphin massage and positive affirmations offer benefits such as comfort and pain relief. This sense of relaxation and comfort is expected to reduce the anxiety experienced by patients before delivery. Objective: This study aimed to evaluate the effectiveness of endorphin massage and positive affirmations in reducing anxiety levels among pre-C-section patients. Method: This experimental study employed a pre-experimental design with a one-group pretest-posttest approach. The respondents included 30 pre-C-section patients at Sayang Hospital, Cianjur, selected through a total sampling technique. The research instrument used was the Hamilton Anxiety Rating Scale (HARS) questionnaire, which assessed the patients' anxiety levels before and after the intervention. Result: The study results, analyzed using the Paired Samples T-Test, showed a p-value of 0.000, which is <0.05. Conclusion: The findings indicate a significant reduction in anxiety levels among pre-C-section patients before and after receiving endorphin massage and positive affirmation interventions.

Surgeon experience affects perioperative pain in cats undergoing elective ovariohysterectomy: a randomized clinical trial.

This study aimed to compare the outcomes between surgeries performed by either experienced or inexperienced surgeons by assessing intraoperative nociception and perioperative analgesia. 16 healthy, client-owned female cats were randomly allocated into 2 groups of 8: one undergoing surgery by an experienced surgeon (GES group) and the other by inexperienced surgeons (GIS group). Both groups received IM premedication with acepromazine (0.05 mg/kg) and methadone (0.3 mg/kg). After 20 minutes, venipuncture and induction with propofol (dose-response, IV) were performed. Maintenance was achieved with inhaled isoflurane. Intraoperative vital parameters were monitored, and fentanyl (2.5 µg/kg, IV) was administered as rescue analgesia when needed. Postoperatively, pain was assessed with a visual analog scale and the multidimensional pain scale of the Universidade Estadual Paulista in Botucatu; morphine (0.2 mg/kg, IM) was used for rescue analgesia, as necessary. In the GIS group, significant increases in heart rate and systolic blood pressure were noted during surgery, especially during pedicle clamping. Respiratory rate and end-tidal isoflurane levels were higher in the GIS group at specific surgical stages. Survival analysis indicated that the GIS group had a greater need for fentanyl. Postoperative pain scores were generally low, but a higher proportion of GIS cats required rescue analgesia. Surgeon experience influences intraoperative parameters and fentanyl consumption. Inexperienced surgeons contribute to increased postoperative pain and poorer wound healing outcomes in cats undergoing elective ovariohysterectomy. Ovariohysterectomy is a common procedure in veterinary practice, and surgical expertise significantly impacts pain management and recovery. Yet, its effects have been underexplored, potentially compromising animal welfare.

Gestational hypoxia elicits long-term cardiovascular dysfunction in female guinea pigs

BackgroundGestational hypoxia (GH) has been implicated in the developmental programming of cardiovascular diseases (CVDs) in the offspring, with most studies focusing on males, conversely, the effects on female cardiovascular health remain understudied. We aimed to investigate the impact of GH on the cardiovascular system of female guinea pig offspring from the early postnatal period to adulthood. MethodsPregnant guinea pigs were subjected to normoxic or hypoxic conditions from gestational day 30 until delivery (∼70 days). Female offspring were monitored with biometric parameters and peripheral vascular function (ultrasound) from birth to one year old. In addition, we assessed cardiovascular structure, oxidative stress, inflammatory state (IHC, qPCR, and immunoblot assays), and thoracic aorta reactivity (wire-myography) at one year of age. Key findingsGH increased heart rate and peripheral pulsatility index. At one year old, GH-exposed females exhibited cardiac remodeling, characterized by increased left ventricular luminal area and coronary artery muscle occupation. Furthermore, GH increased aortic vascular wall, intima-media thickness and contractile capacity. This was accompanied by reduced endothelium-dependent vasodilation and enhanced oxidative stress. Additionally, GH increased collagen deposition and oxidative stress in the right ventricle, accompanied by reduced antioxidant enzymes expression and reduced inflammatory mediator levels. SignificanceGH exerts long-lasting effects on the cardiovascular health of female guinea pig offspring, contributing to cardiac remodeling, vascular dysfunction, oxidative stress, and inflammatory changes. These findings highlight the importance of GH as a risk factor for developing CVDs in female offspring and emphasize the need for sex-specific interventions to mitigate adverse long-term gestational effects.

Impact of a brief series of soccer matches on vascular conditions in youth women

BackgroundAccumulative excessive physical load elevates central arterial stiffness and smooth muscular tone of peripheral vascular beds in endurance athletes. The aim of this study was to test the hypothesis that a brief series of soccer matches would increase central arterial stiffness and arterial wave reflection from the periphery in young female football players.MethodsFifteen subjects (17.2 ± 0.7 years, mean ± SD) participated in four matches over five consecutive days (one match per day, with two consecutive days of matches followed by one rest day, repeated twice) in the Youth Girls Soccer Tournament, either as starters or substitutes. Heart rate, blood pressure (BP), and the second derivative of the photoplethysmogram (SDPTG) were assessed the night before and 4 h after each match. The ratios of the first and second descending waves to the first ascending wave of SDPTG (B/A ratio and D/A ratio) were calculated as indices of central arterial stiffness and peripheral wave reflection, respectively. The intra-individual relationship among interest variables was evaluated using the repeated-measures correlation analysis (rmcorr).ResultsPost-match D/A ratio, systolic and diastolic BP were lower compared to the pre-match value, while the B/A ratio did not change significantly. Heart rate was higher post-than pre-match. Rmcorr demonstrated significant intra-individual correlations of the D/A ratio with diastolic BP (rrm = 0.259, P = 0.008) and heart rate (rrm = −0.380, P< 0.001).ConclusionContrary to our hypothesis, a brief series of matches did not increase central arterial stiffness in young female football players. Instead, the matches induced a repeated, temporary attenuation of arterial wave reflection. This attenuated arterial wave reflection from the periphery appeared to be associated with reduced diastolic BP and a compensatory increase in heart rate.

Efficacy of a 6-week VR exergame for older adults with essential hypertension: a randomized controlled pilot trial

This study aimed to examine the initial efficacy of a virtual reality (VR) exergame for blood pressure (BP), body composition, lung function, physical working capacity, and mobility in older hypertensive adults. Furthermore, the objective was to explore the exercise intensities that can be reached during the training. This study was designed as a randomized controlled pilot trial. The exergame group (EG) completed 6-week training using VR; the conventional training group (CTG) performed conventional group training over the same time period. The sample included thirty-five participants with essential hypertension randomized with a ratio of 2:1 to EG (n = 23) and CTG (n = 12). The training was performed twice a week and consisted of strength endurance and endurance training sessions in alteration, which lasted from 20 to 30 min. Within the groups, systolic and diastolic BP were significantly reduced only in the EG. There were no group differences with regard to BP. The heart rate (HR) results showed no significant differences within and between groups in the pre–post comparison. Overall, a significant increase in HR during exercise was observed in both groups. On average, only the EG was able to reach the target intensity of 40–60%. In addition, blood pressure was significantly lower 5 min after training in EG than in CTG. This pilot study showed that 6 weeks of training with VR can lead to reaching the target heart rate during exercise and indicate a greater reduction in BP after training in older adults with hypertension. This pilot study provides useful insights into the potential of VR exergaming and for future research.

Relationship Between Heart Rate and Perceived Stress in Intensive Care Unit Residents: Exploratory Analysis Using Fitbit Data.

Intensive care unit (ICU) residents are exposed to high stress levels due to the intense nature of their work, which can impact their mental health and job performance. Heart rate measured through wearable devices has the potential to provide insights into residents' self-reported stress and aid in developing targeted interventions. This exploratory study aims to analyze continuous heart rate data and self-reported stress levels and stressors in ICU residents to examine correlations between physiological responses, stress levels, and daily stressors reported. A secondary data analysis was conducted on heart rate measurements and stress assessments collected from 57 ICU residents over a 3-week period using Fitbit Charge 3 devices. These devices captured continuous physiological data alongside daily surveys that assessed stress levels and identified stressors. The study used Spearman rank correlation, point-biserial correlation analysis, 2-tailed paired t tests, and mixed-effect models to analyze the relationship between heart rate features and stress indicators. The findings reveal complex interactions between stress levels and heart rate patterns. The correlation analysis between stress levels and median heart rate values across different percentile ranges showed that lower percentile heart rates (bottom 5%, 10%, 25%, and 50%) had modest correlations with stress, whereas higher percentiles (top 50%, 25%, 10%, and 5%) did not correlate significantly (all P>.05). The 2-tailed paired t test indicated significant differences in stress levels reported in midday versus end-of-day surveys (P<.001), although these changes in stress levels were not consistently reflected in heart rate patterns. Additionally, we explored and found that stressors related to "other health" issues had the highest positive correlation with stress level changes from midday to end-of-day surveys. However, the weak effect of these stressors on peak heart rate suggests that their impact on physiological measures like heart rate is not yet clear. According to our mixed-effects model, stress levels significantly influenced heart rate variations when hierarchical data were taken into account (P=.03), meaning that as the stress level increased, there was a significant increase in mean heart rate. This study highlights the complexity of using heart rate as an indicator of stress, particularly in high-stress environments like the ICU. Our findings suggest that while heart rate is found to correlate with self-reported stress in the mixed-effect model, its impact is modest, and it should be combined with other physiological and psychological measures to obtain a more accurate and comprehensive assessment of residents' stress levels.

Can standing replace upright tilt table testing in the diagnosis of postural tachycardia syndrome (POTS) in the young?

We compared standing and upright tilt in patients with postural tachycardia syndrome (POTS) and healthy volunteers to determine whether standing accurately tests for POTS in youngsters < 19years. POTS in adolescents is defined by orthostatic intolerance plus sustained excessive upright tachycardia, without hypotension during upright tilt. We examined whether active standing is a valid classifier for POTS in adolescents compared to tilt. Patients with POTS (N = 36, 12.2-18.8years) and healthy volunteers (N = 39, 13.1-18.9years) performed stand for a minimum of 5-min and were tilted to 70° for 10min. Receiver operating characteristics analyses (ROC) were performed at 5-min stand, and at 5 and 10min tilt for optimal threshold for heart rate (HR) increase (ΔHR), and test sensitivity and specificity. Most subjects were unable to stand for 10min. ΔHRs at 5min stand were higher in POTS (31 ± 3) compared with control (21 ± 2) and elevated at 5- or 10-min tilt in POTS (51 ± 3 and 51 ± 2) versus control (26 ± 2 and 25 ± 2) compared with standing. ΔHR in POTS and controls for 10min were not different from 5min. For 5min stand ROC threshold was 26beats per min (bpm), sensitivity of 70.6%, and specificity of 68.2% compared with 39bpm, 88.2%, and 95.1% for 5min tilt, and 40bpm, 94.1%, and 95.1% for 10-min tilt. A precision-recall graph confirmed the superior discriminating ability of 5min and 10min tilt compared to 5min stand. The stand test is relatively non-specific and imprecise compared to tilt and does not satisfactorily distinguish POTS from control in patients aged < 19years old.

Cardiorespiratory Responses to Flywheel-Based Inertial Training Squats With Varying Moments of Inertia.

Mitchinson, CJ, Best, S, Caruso, J, and Bollinger, LM. Cardiorespiratory responses to flywheel-based inertial training squats with varying moments of inertia. J Strength Cond Res XX(X): 000-000, 2024-Flywheel-based inertial training (FIT) has gained popularity as a means to enhance muscle hypertrophy. Other applications, such as aerobic exercise training, remain unexplored. The aim of this study was to determine the cardiorespiratory responses to acute FIT with varying moments of inertia (MOIs). Methods: Overall, 20 (10 M, 10 F) healthy, physically active subjects underwent maximal graded exercise testing and completed 3 bouts of FIT exercise (1 familiarization session and 2 identical data collection sessions). Subjects completed quarter squats (60° peak knee flexion) at a pace of 50 squats·minute-1 until volitional fatigue. Flywheel-based inertial training MOI was increased by 0.005 kg·m2 every 3 minutes until a final workload of 0.020 kg·m2. Heart rate and gas exchange data were collected continuously and averaged over the final 60 s of each stage. Data were analyzed by a linear mixed model. Results: During the final testing session, there was a main effect of MOI to increase heart rate (HR), V̇o2, and RER. Men displayed greater oxygen consumption, but asimilar %V̇o2peak compared with women. We noted a significant inertia × sex interaction where RER tended to be lesser in women at higher MOI. In the final stage of exercise (MOI: 0.020 kg·m2), HR and V̇o2 were approximately 75-80 and 55% of peak, respectively, and RER was approximately 0.95-1.00. Conclusions: FIT quarter squats elicit moderate HR and V̇o2 responses, but near-maximal RER suggests a novel metabolic training stimulus. This exercise may supersede thelactate threshold and may not be sustainable for prolonged times. The physiological and performance effects of training in this manner are unclear.

Effects of different postures on the hemodynamics and cardiovascular autonomic control responses to exercise in postural orthostatic tachycardia syndrome.

To assess the effects of two different body positions on the cardiovascular autonomic profile during a single bout of exercise in patients with postural orthostatic tachycardia syndrome (POTS). Thirteen patients with POTS and thirteen healthy controls (C) participated in the study. ECG, respiration, beat-by-beat arterial pressure and O2 consumption (VO2) were continuously recorded while on a cycle ergometer in supine and upright positions, before and during exercise (6min, 50 Watts). Spectral analysis of RR intervals and systolic arterial pressure (SAP) variability provided indexes of cardiac sympathovagal interaction (LF/HF ratio), cardiac vagal modulation (HFRR, high-frequency component of RR variability, ~ 0.25Hz), sympathetic vasomotor control (LFSAP, low-frequency component of SAP variability, 0.1Hz) and baroreflex sensitivity (BRS, αLF). While supine, patients with POTS showed lower HFRR and αLF, greater heart rate (HR), LF/HF and LFSAP, compared with C, suggesting cardiovascular sympathetic over-activity and reduced BRS. While sitting upright, POTS showed greater HR and reduced HFRR and αLF compared with C. During supine exercise, SAP, HR, LF/HF increased and HFRR and αLF decreased similarly in POTS and C. In POTS, upright sitting exercise was associated with slightly higher , a greater increase in HR whereas LFSAP was lower than in C. Upright exercise was associated with excessive enhancement of HR and a blunted increase of the sympathetic vasomotor control in POTS. Conversely, supine exercise-induced hemodynamic and autonomic changes similar in POTS and C, thus making supine exercise potentially more suitable for physical rehabilitation in POTS.

Acute Effects of Cannabis Inhalation on Arterial Stiffness, Vascular Endothelial Function, and Cardiac Function.

The cardiovascular impact of cannabis use is incompletely understood. Although evidence links chronic use to an increased risk of disease and adverse cardiovascular events, few studies have investigated the acute effects of cannabis inhalation on subclinical dysfunction. Furthermore, it remains unknown how method of inhalation and cannabinoid profile modify risk. While controlling for inhalation method and the effects of either Δ-9-tetrahydrocannabinol (THC) or cannabidiol (CBD), we examined the acute cardiovascular effects of cannabis use on arterial stiffness, vascular endothelial responsiveness, and cardiac function, as markers of cardiovascular impairment. Twenty-two young, healthy, cannabis users were assessed for arterial stiffness via pulse wave velocity, vascular endothelial function via brachial artery flow mediated dilation, and cardiac function via echocardiography, before and after (1) smoking THC-predominant cannabis (S-THC), (2) vaporizing THC-predominant THC (V-THC), and (3) vaporizing cannabidiol-predominant cannabis (V-CBD). S-THC and V-THC increased heart rate (S-THC: ∆17±15 bpm, V-THC: ∆16±16 bpm;both P<0.0001) and mean arterial pressure (S-THC: ∆7±6 mm Hg, V-THC: ∆5±5 mm Hg;both P<0.0001) whereas V-CBDdid not (∆1±4 bpm, ∆3±4 mm Hg;both P>0.05). After inhalation, pulse wave velocity increased (S-THC: ∆0.29±0.75 m/s, V-THC: ∆0.42±0.74 m/s, V-CBD: ∆0.10±0.44 m/s; P=0.002) and diastolic function was reduced ([early/late ratio] S-THC: ∆-0.2±0.53, V-THC: ∆-0.33±58, V-CBD: ∆0.01±66; P=0.03). Differences in heart rate were related to changes in pulse wave velocity (r2=0.2; P=0.0002) and diastolic function (r2=0.26; P<0.0001). Inhalation method did not alter these cannabinoid-dependent responses. THC predominant, but not cannabidiol predominant, cannabis elicits increases in heart rate and blood pressure irrespective of inhalation method, which may increase arterial stiffness and reduce diastolic function. These findings implicate THC as a relevant factor for cannabis-related subclinical cardiovascular dysfunction. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04693884.

Astrocytic inhibition of lateral septal neurons promotes diverse stress responses

Inhibitory neuronal circuits within the lateral septum (LS) play a key role in regulating mood and stress responses. Even though glial cells can modulate these circuits, the impact of astrocytes on LS neural circuits and their functional interactions remains largely unexplored. Here, we demonstrate that astrocytes exhibit increased intracellular Ca²⁺ levels in response to aversive sensory and social stimuli in both male and female mice. This astrocytic Ca²⁺ elevation inhibits neighboring LS neurons by reducing excitatory synaptic transmissions through A1R-mediated signaling in both the dorsal (LSd) and intermediate LS (LSi) and enhancing inhibitory synaptic transmission via A2AR-mediated signaling in the LSi. At the same time, astrocytes reduce inhibitory tone on distant LS neurons. In the LSd, astrocytes promote social avoidance and anxiety, as well as increased heart rate in socially stressed male mice. In contrast, astrocytes in the LSi contribute to elevated heart rate and heightened blood corticosterone levels in unstressed male mice. These results suggest that the dynamic interactions between astrocytes and neurons within the LS modulate physiological and behavioral responses to stressful experiences.

The Role of Sex in the Effects of Smoking and Nicotine in Cardiovascular Function, Atherosclerosis, and Inflammation.

Cigarette smoke (CS) invokes an inflammatory response associated with vascular dysfunction and atherosclerosis. The role of sex and nicotine in CS effects on cardiovascular function and atherosclerosis is unexplored. Male and female C57Bl/6 WT (wild type) and ApoE-/- mice were exposed to CS and nicotine with access to chow and water ad libitum for 16 weeks to fill this gap. Heart rate and endothelial function were measured in the aorta of WT mice, while the lipid profile, cytokines, chemokines, and plaque area and composition were assessed in ApoE-/- mice. CS increased heart rate similarly in both sexes and induced a more substantial impairment in endothelial function in males and more plaque in females than nicotine. Necrotic core areas were similar for both treatments in both sexes, while females had higher collagen deposition across treatments. Both treatments elevated senescence-associated GLB1/-galactosidase (SA-GLB1) and interleukin 17A (IL17A) similarly in both sexes. CS upregulated cholesterol in both sexes, triglycerides, VLDL, HDL, and C-X-C motif chemokine ligand-5 (CXCL5/LIX) only in males, and LDL and IL1A only in females. Additionally, nicotine metabolism showed sex-specific responses to nicotine but not smoking. Findings suggest sex influences cardiovascular function and atherosclerosis following exposure to nicotine and CS. The purpose of this study was to fill the existing literature gap through assessment of the differential sex effects of CS and nicotine on vascular function and atherosclerosis to identify sex-specific risk factors. We show sex-specific differences in endothelial function, plaque, inflammation, and extracellular matrix (ECM) regulators with exposure to CS and nicotine, which underscore the importance of assessing sex in tobacco and nicotine exposure studies. This study also shows the negative effect of oral nicotine administration as many oral dissolvable nicotine products, like pouches and gum, are becoming increasingly popular among adolescents and young adults.

PTSD Increases Risk for Hypertension Development Through PVN Activation and Vascular Dysfunction in Sprague Dawley Rats.

This study investigates the impact of single prolonged stress (SPS), a model of post-traumatic stress disorder (PTSD), on cardiovascular responses, hypothalamic paraventricular nucleus (PVN) activity, and vascular function to elucidate the mechanisms linking traumatic stress to hypertension. Although SPS did not directly cause chronic hypertension in male Sprague Dawley (SD) rats, it induced acute but transient increases in blood pressure and heart rate and significantly altered the expression of hypertension-associated genes, such as vasopressin, angiotensin II type 1 receptor (AT1R), and FOSL1 in the PVN. Notably, mitochondrial reactive oxygen species (mtROS) were predominantly elevated in the pre-autonomic regions of the PVN, colocalizing with AT1R- and FOSL1-expressing cells, suggesting that oxidative stress may amplify sympathetic activation and stress responses. SPS also increased mRNA levels of pro-inflammatory cytokines (TNFα and IL1β) and inducible nitric oxide synthase (iNOS) in the aorta, and impaired vascular reactivity to vasoconstrictor and vasodilator stimuli, reflecting compromised vascular function. These findings suggest that SPS-sensitize neuroendocrine, autonomic, and vascular pathways create a state of cardiovascular vulnerability that could predispose individuals to hypertension when exposed to additional stressors. Understanding these mechanisms provides critical insights into the pathophysiology of stress-related cardiovascular disorders and underscores the need for targeted therapeutic interventions that address oxidative stress and modulate altered PVN pathways to mitigate the cardiovascular impact of PTSD and related conditions.

Tachycardia-Desaturation Episodes in Neonatal Intensive Care Unit Patients with and without Bronchopulmonary Dysplasia.

Much attention has been paid to measuring physiological episodes of bradycardia-oxygen desaturation (BDs) in the neonatal intensive care unit (NICU). NICU patients also have spells of tachycardia-desaturation (TDs), but these have not been well-characterized. We hypothesized that TDs would be more common among infants with bronchopulmonary dysplasia (BPD). We aimed to quantify daily TDs compared to BDs in NICU patients across a range of gestational and postmenstrual ages (GA and PMA) and determine whether TDs are associated with BPD. We analyzed every 2-second heart rate (HR) and peripheral saturation of oxygen (SpO2) throughout the NICU stay of all infants with 24 to 39 weeks GA admitted to a single, level IV NICU from 2012 to 2015. BDs were defined in our prior work (HR <100 bpm for ≥4 seconds with concurrent SpO2 <80% for ≥10 seconds) and TDs as a 20% increase in HR from the previous 2-hour mean baseline and concurrent SpO2 <80% for ≥10 seconds. We calculated the median daily BDs and TDs across a range of GAs and PMAs. For infants ≤32 weeks GA, we compared TDs for those with and without BPD at 36 weeks PMA and discharge on supplemental oxygen. We analyzed 782,424 hours of HR and SpO2 data from 1,718 neonates, with a median of 271 hours analyzed per infant. TDs frequency increased with increasing PMA across all GAs. BDs occurred most frequently in infants <29 weeks GA and decreased as infants approached term equivalent age. For infants with ≤32 weeks GA, one or more TD per day from 33 to 35 weeks PMA was associated with BPD and home oxygen. Episodes of TD at the thresholds defined in this analysis occurred more frequently at later PMA and were more common in infants with BPD and those requiring home oxygen. · Desaturation episodes occur often in preterm infants.. · Bradycardia or tachycardia can coincide with desaturation.. · TD occurs later and with BPD..

Decatecholaminization of Septic Shock Patients in Intensive Care Unit: an Economic Assessment in the Italian Setting

INTRODUCTION: Prolonged administration of norepinephrine to critically ill patients can lead to serious adverse events. In this context, the concept of “decatecholaminization” has emerged over the past decade, involving the association of vasopressin with norepinephrine to reduce catecholamines need. Additionally, beta-blockers can help prevent increased heart rate resulting from sepsis treatments. This study presents an economic analysis evaluating the economic implications of the decatecholaminization use in patients with septic shock treated in intensive care unit (ICU) from the Italian National Health Service (NHS) perspective.METHODS: Two analyses were conducted: (1) a patient-level comparison of costs between two real-world cases, one treated with decatecholaminization and one without this approach, and (2) a cohort-level analysis using a pharmacoeconomic model to project cost differences for the Italian National Health Service (NHS) before and after implementing decatecholaminization.RESULTS: In the patient-level analysis, the use of decatecholaminization results in increased pharmacological expenses (+€210), and cost reduction in resource utilization (-€30,412). Similarly, the cohort-level shows higher pharmacological costs (+€192 per patient) and lower cost for other resources (-€1,264 per patient) in the future vs current scenario, resulting in a cumulative cost reduction of -€1,072 per patient. Considering an eligible population of 39,207 patients, decatecholaminization results in a total cost reduction of approximately €42.4 million.CONCLUSION: This analysis supports the economic viability of decatecholaminization as an effective treatment for comprehensive management of septic shock. Further evaluation in real-world settings is needed to validate these findings and optimize clinical application.

Prognostic value of heart rate and oxygen pulse response in heart failure with left ventricular ejection fraction over 40.

Heart rate (HR) and stroke volume (SV)-the components of cardiac output-have a complementary relationship. Poor HR increase during exercise is associated with poor exercise tolerance in heart failure (HF) with preserved ejection fraction (HFpEF), but its prognostic impact remains unclear. Furthermore, whether the compensation for poor HR increase with SV during exercise is associated with prognosis remains unknown. We evaluated 129 consecutive hospitalized HF patients with sinus rhythm and left ventricular ejection fractions > 40% who underwent cardiopulmonary exercise testing before discharge from the index hospitalization. Patients (age: 66 [55-74] years; 73% male) were divided into four groups by median HR reserve (HRR; peak-rest HR: 34bpm) and O2 pulse, a surrogate for SV, reserve (peak-rest O2 pulse: 4.8mL/beat). During a mean follow-up of 562 [294-961] days, cardiovascular events (cardiovascular death and/or HF rehospitalizations) occurred in 24 patients. Kaplan-Meier analysis identified significant differences in outcomes among the four groups (χ2 = 27.3, p < 0.001). Using the preserved HRR/preserved O2 pulse reserve group (n = 33) as a reference, the impaired HRR/impaired O2 pulse reserve group (n = 37) was associated with poor outcomes (adjusted hazard ratio: 5.66, 95% CI 1.15-27.74, p = 0.033), whereas the impaired HRR/preserved O2 pulse reserve group (n = 31) was not (adjusted hazard ratio: 0.38, 95% CI 0.03 to 4.76, p = 0.455). The overlap of lower increases in HR and O2 pulse, a surrogate for SV, during exercise was associated with an extremely poor prognosis in HFpEF.

Orally retrieved negative autobiographical events are associated with increased heart rate as compared with fabricated ones.

While it is well-established that authentic emotional autobiographical memories elicit physiological responses, research suggests that this elicitation can also occur for fabricated autobiographical memories. Yet challenges arise from awareness discrepancies when considering two research fields: Participants in memory studies may be unaware of producing false memories, while liars are aware of fabricating false events. Hence, in two experiments, we compared the psychophysiological pattern of true autobiographical memories with fabricated memory narratives. Using noninvasive biometric devices to measure heart rate (HR) and skin conductance level (SCL), participants were tasked with recalling both true and fabricated negative and neutral autobiographical experiences in a written (Experiment 1) and oral (Experiment 2) way. While in Experiment 1, no statistically significant differences were detected in participants' physiological responses across different recall types, in Experiment 2 we found higher HR responses during the recollection of true negative memories as compared with true neutral and fabricated memory accounts. These latter findings confirm that negative autobiographical memories might be associated with increased HR responses when they are recalled verbally. Furthermore, they suggest that people's awareness of memory authenticity (i.e., recalling true versus fabricated events) may be linked to corresponding physiological reactions linked to specific recollections.

Electrocardiographic Characteristics of Brugada Syndrome Type I During Exercise Stress Test.

Brugada syndrome (BS) is a genetic channelopathy characterized by an increased risk of sudden cardiac death (SCD) in the absence of structural heart disease. Prognostic stratification is necessary to determine which patients are candidates for implantable cardioverter defibrillator (ICD). The present study aims to evaluate EKG changes during exercise stress tests in patients with BS and to identify any poor prognosis variables. This was an observational, case-control study. Three comparison groups were created: patients with Type 1 BS with or without prior arrhythmic events (BE and BNoE subgroups) and age- and sex-matched healthy individuals. Patients underwent EST and electrocardiographic variables were analyzed. The study recruited 36 patients with type 1 BS, 12 with prior Event (BE) and 24 without (BNoE). Patients in the BE group, in all postexercise recordings, had lower heart rates, notably in the first minute. A significant difference was also observed in the HR drop in the recovery phase, with a greater drop in relation to maximum HR in the first minute in the group of patients who had events. BS patients with prior events had a lower capacity to increase heart rate at peak effort and a greater proportional drop in the recovery phase. No relationship was observed between the occurrence of arrhythmic events and ST-segment elevation during the exercise test.