Increase In Heart Rate Research Articles

Subcostal TAP Block Versus Lateral TAP Block for Postoperative Analgesia in Patients Undergoing Total Abdominal Hysterectomy

Abstract Background Total abdominal hysterectomy surgeries are associated with severe postoperative pain. Effective pain management reduces the incidence of postoperative cardiac and pulmonary complications, decreases risk of postoperative deep venous thrombosis through early mobilization, provides patient satisfaction and reduces cost of hospital stay. A number of analgesic strategies have been adopted to minimize postoperative pain after abdominal surgeries. Studies suggest that abdominal wall blocks provide effective pain relief and faster postoperative rehabilitation than systemic analgesia. Objective To compare the effectiveness of subcostal versus lateral TAP blocks for post- operative pain management in patients undergoing total abdominal hysterectomy. Patients and Methods This study was a prospective randomised clinical study conducted in Ain Shams University Hospitals from October 2021 till October 2022 with a sample size of 100 patients undergoing total abdominal hysterectomy under general anaesthesia, divided into 2 groups, 50 patients each: Group A: Subcostal TAP Block group, Group B: lateral TAP Block group. Results These results demonstrated that performing postoperative bilateral subcostal TAP block in group (A) was associated with significant increase in heart rate, mean arterial blood pressure, pain scores and pethidine requirements postoperatively in comparison to bilateral lateral TAP block in group (B) which provided more effective analgesia than subcostal approach. Conclusion The quality of postoperative analgesia was more effective in patients received lateral TAP block than those received subcostal TAP block regarding hemodynamic changes, pain scores, doses of pethidine required for pain relief and postoperative mobilization.

The influence of heart rate on the relationship between pulse transit time and systolic blood pressure

Pulse transit time (PTT) is a popular indicator of blood pressure (BP) changes. However, the relationship between PTT and BP is somehow individual dependent, resulting in the inaccuracy of PTT-based BP estimation. Confounding factors, e.g., heart rate (HR), of PTT and BP could be the primary cause. In this study we attempt to explore the impact of HR as a window to look at the influence of confounding factors on the relationship between PTT and BP. We investigated the relationship between PTT and systolic BP (SBP) at different HR levels by introducing the heterogeneous treatment effects (HTE) as a quantitative indicator. Compared to the average HR calculated using traditional indicators (e. g. regression coefficient, correlation coefficient), the HTE calculation method can compute the relationship between PTT and SBP at different HR levels, and reduce the influence of confounding factors. We analyzed the HTE of PTT and SBP of 47 subjects who are resting healthy young people with varying levels of HR. The results showed that the strength of the HTE of PTT and SBP varied with HR, indicating that the strength of the causal relationship between PTT and SBP is subject to HR levels. Whereas the correlation between SBP and PTT was individual dependent; either the strength or the direction of the correlation can vary with HR. We further investigated the group in which PTT and SBP exhibited a negative correlation, and found that about 50% of the subjects showed enhanced strength of HTE in with an increase in HR and the remaining showed the opposite. This study means that HR needs to be considered when PTT is used as an indicator of SBP.

Simulation of plaque formation in a realistic geometry of a human aorta: effects of endothelial layer properties, heart rate, and hypertension.

Nowadays, cardiovascular diseases are the most common cause of death worldwide. Besides, atherosclerosis is a cardiovascular disease that occurs with persistent narrowing of arteries, especially medium and large-sized arteries. Atherosclerosis begins with a local elevation in the permeability of the arterial wall as a result of endothelial inflammation. Subsequently, excess LDL permeates into the arterial wall. Then, through several chemical responses and reactions, foam cells are produced. These foam cells serve as a crucial indicator for assessing the development of atherosclerosis within the arteries. In this study, the effect of endothelial layer modeling, heart rate (HR) and hypertension on the foam cell accumulation is numerically investigated in a patient-specific geometry of the human thoracic aorta. Navier-Stokes, Darcy, and mass transfer equations are used to obtain the velocity and concentration field within the domain. Regarding the dependence of endothelial cell properties on time-averaged wall shear stress, it is observed that foam cells are mainly concentrated in the outer curvature of the aortic arch, downstream of the left subclavian artery. However, considering oscillatory-shear-rate as the determinant of endothelial cell properties leads to the accumulation of foam cells in the inner curvature of the descending aorta. Regarding the HR, with the increase of HR, the volume average concentration of the foam cell decreases. However, there is no substantial difference between the cases of different HRs. Moreover, foam cell concentration significantly increases in the hypertension case. This result implies that a slight increase in the blood pressure may induce irreparable problems in the circulatory system.

Influence of Management Systems on Severity of Heat Stress and Reproductive Performance of Rams in the Tropics – A Review

Abstract Sheep are an important source of protein for humans, and recent decades have seen a significant increase in the production of sheep-based products, thus indicating an increase in demand for this commodity. At a time when this sector is growing, sheep are exposed to various challenges. These include climate change, which can cause heat stress in sheep, including rams, which later negatively affects their growth and reproductive performance. Exposure to heat stress results in physiological and reproductive behaviour responses in rams, which could also be used to visually identify the effect of heat stress as it will affect the productivity of livestock. In addition, the year-round hot and humid climate of the tropics is expected to contribute to a higher probability of heat stress occurrences in rams reared in developing countries around the equator. Nevertheless, the adaptability of rams to heat stress varies according to their origin, whereby native breeds tend to adapt better. Despite that, native breeds still can be affected by adverse environmental conditions and rely on thermoregulation mechanisms to mitigate heat stress. This results in numerous negative physiological changes, such as sweating and increased heart rate. This review highlights the effects of heat stress on the physiology, reproductive behaviour and reproductive performance of male sheep. The review also discusses the impact of management systems on heat stress in rams, which affects sheep productivity.

Long-Term Differences in AutonomicAlterations After Cryoballoonvs Radiofrequency AtrialFibrillation Ablation.

The long-term natural history of autonomic alterations following catheter ablation of drug-refractory paroxysmal atrial fibrillation is poorly defined. The authors sought to define the long-term impact of thermal catheter ablation on the cardiac autonomic system. The study included 346 patients with drug-refractory paroxysmal atrial fibrillation undergoing pulmonary vein isolation using thermal ablation energy (radiofrequency or cryoballoon ablation). All patients underwent insertion of a Reveal LINQ implantable cardiac monitor prior to ablation. The implantable cardiac monitor continuously recorded physical activity, heart rate variability (HRV) (measured as the standard deviation of the average normal-to-normal), daytime heart rate, and nighttime heart rate (NHR). Longitudinal autonomic data in the 2-month period prior to the date of ablation were compared with the 3 years following ablation. Following ablation, there was a significant decrease in HRV (10-20ms; P< 0.0001) and significant increases in daytime heart rate and NHR (10 beats/min [P< 0.0001] and 7 beats/min [P< 0.0001], respectively). Changes in autonomic parameters were greatest in the first 3months following ablation but remained significantly different from baseline for 36months following ablation. Greater changes in NHR and HRV were associated with improved freedom from recurrent arrhythmia. The type of thermal ablation energy had no influence on the heart rate and autonomic parameters. Pulmonary vein isolation using thermal ablation energy results in significant sustained changes in the heart rate parameters related to autonomic function. These changes are independent of the ablation technology employed and are associated with procedural success. (Cryoballoon vs Irrigated Radiofrequency Catheter Ablation: Double Short vs Standard Exposure Duration [CIRCA-DOSE]; NCT01913522).

Binge Alcohol Consumption Elevates Sympathetic Transduction to Blood Pressure: A Randomized Controlled Trial.

Alcohol consumption is associated with cardiovascular disease, and the sympathetic nervous system is a suspected mediator. The present study investigated sympathetic transduction of muscle sympathetic nerve activity to blood pressure at rest and in response to cold pressor test following evening binge alcohol or fluid control, with the hypothesis that sympathetic transduction would be elevated the morning after binge alcohol consumption. Using a randomized, fluid-controlled (FC) crossover design, 26 healthy adults (12 male, 14 female, 25±6 years, 27±4 kg/m2) received an evening binge alcohol dose and a FC. All participants underwent next-morning autonomic-cardiovascular testing consisting of muscle sympathetic nerve activity, beat-to-beat blood pressure, and heart rate during a 10-minute rest period and a 2-minute cold pressor test. Sympathetic transduction was assessed at rest and during the cold pressor test in both experimental conditions. Evening alcohol increased heart rate (FC: 60±9 versus alcohol: 64±9 bpm; P=0.010) but did not alter resting mean arterial pressure (FC: 80±6 versus alcohol: 80±7 mm Hg; P=0.857) or muscle sympathetic nerve activity (FC: 18±9 versus alcohol: 20±8 bursts/min; P=0.283). Sympathetic transduction to mean arterial pressure (time×condition; P=0.003), diastolic blood pressure (time×condition; P=0.010), and total vascular conductance (time×condition; P=0.004) was augmented after alcohol at rest. Sympathetic transduction during the cold pressor test was also elevated after evening binge alcohol consumption (P=0.002). These findings suggest that evening binge alcohol consumption leads to augmented morning-after sympathetic transduction of muscle sympathetic nerve activity to blood pressure, highlighting a new mechanism whereby chronic or excessive alcohol consumption contributes to cardiovascular disease progression via altered end-organ responsiveness to sympathetic neural outflow. URL: https://clinicaltrials.gov/study/NCT03567434; Unique identifier: NCT03567434.

Distance-dependent neuromodulation effect during thermal ablation for atrial fibrillation.

Thermal atrial fibrillation (AF) ablation exerts an additive treatment effect on the cardiac autonomic nervous system (CANS). This effect is mainly reported during ablation of the right superior pulmonary vein (RSPV), modulating the right anterior ganglionated plexus (RAGP), which contains parasympathetic innervation to the sinoatrial node in the epicardial fat pad between RSPV and superior vena cava (SVC). However, a variable response to neuromodulation after ablation is observed, with little to no effect in some patients. Our objective was to assess clinical and anatomic predictors of thermal ablation-induced CANS changes, as assessed via variations in heart rate (HR) postablation. Consecutive paroxysmal AF patients undergoing first-time PV isolation by the cryoballoon (CB) or radiofrequency balloon (RFB) within a 12-month time frame and with preprocedural cardiac computed tomography (CT), were evaluated. Preablation and 24-h postablation electrocardiograms in sinus rhythm were collected and analyzed to assess HR. Anatomic evaluation by CT included the measurement of the shortest distance between the SVC and RSPV ostium (RSPV-SVC distance). A total of 97 patients (CB, n = 50 vs. RFB, n = 47) were included, with similar baseline characteristics between both groups. A significant HR increase postablation (ΔHR ≥ 15 bpm) occurred in a total of 37 patients (38.1%), without difference in number of patients between both thermal ablation technologies (CB, 19 [51%]), RFB, 18 [49%]). Independent predictors for increased HR were RSPV-SVC distance (odds ratio [OR]: 0.49, CI: 0.34-0.71, p value < .001), and age (OR: 0.94, CI: 0.89-0.98, p value = .003). Thermal balloon-based PV isolation influences the CANS through its effect on the RAGP, especially in younger patients and patients with shorter RSPV-SVC distance.

High-altitude cerebral oxygen saturation detection using wireless wearable cerebral oximeter.

Hypobaric hypoxic conditions encountered at high altitudes can significantly impact the physiological functions of human body. Therefore, accurate and real-time monitoring of physiological characteristics is crucial for the prevention of brain injuries in individuals with acute and chronic high-altitude exposure. In this study, a wireless wearable cerebral oximeter (WORTH band) was used for the continuous, real-time monitoring of physiological parameters, including regional cerebral oxygen saturation (rSO2) and heart rate (HR), among subjects with high-altitude exposure. During the high-altitude (from 46 m to 4300 m) expedition task, there was a significant decrease in rSO2 accompanied by a corresponding increase in heart rate as the altitude increased. Additionally, during the long-term (52 days) high-altitude (from 356 m to 4658 m) cycling task, the altitudes were significantly correlated with the rSO2 and SpO2 in the elderly subjects. The current findings indicate that the WORTH band oximeter can serve as a promising instrument for measuring rSO2 at high altitudes. We hope that the insights derived from this study could contribute to the management of cerebral oxygenation for individuals with high-altitude exposure and further expand the existing understanding of brain functional detection at high altitudes.

Comparison of Standard and Prone-Position Electrocardiograms in COVID-19 Patients With Pulmonary Complications: Correlations and Implications.

Previous research highlighted variability in electrocardiogram (ECG) readings across patient positions, particularly in the context of COVID-19 patients with pulmonary complications requiring prone positioning as part of the treatment. This study aimed to elucidate the effects of prone positioning on ECG parameters and explore its association with the severity of COVID-19. A prospective cohort study involved 60 patients diagnosed with COVID-19 and presenting pulmonary complications. ECGs were recorded in both supine and prone positions, and analyzed for various parameters including heart rate, QRS axis, and QTc interval. Clinical severity was assessed using APACHE II scores and SpO2/FiO2 ratios. Prone positioning led to an increase in heart rate (mean difference: 2.100, 95% CI: 0.471-3.729, p = 0.012), with minor shifts in the QRS axis. Heart rate and QRS axis demonstrated strong positive correlations between positions, with Pearson's correlation coefficients of 0.927 and 0.894, respectively. The study also found a significant association between prolonged QTc intervals in the prone position and elevated APACHE II scores, with a relative risk of 10.75 (95% CI: 1.82-63.64, p = 0.008). The prone positioning caused minor yet significant changes in heart rate and QRS axis. The correlation of prolonged QTc intervals in the prone position with higher APACHE II scores suggests the prognostic relevance of prone ECG in COVID-19 patients. However, further research is needed to fully understand the clinical implications and mechanisms of these findings.

Exploring the Relationship Between Examination-Induced Anxiety and Cardiovascular Responses Among PT Students

This study explores the relationship between examination-induced anxiety and cardiovascular responses among physical therapy (PT) students. A quasi-experimental repeated measures design was utilized to examine heart rate (HR), blood pressure (BP), and heart rate variability (HRV) at three stages: before, during, and after high-stakes Objective Structured Clinical Examinations (OSCEs). A total of 120 PT students (60 male, 60 female) were recruited using purposive sampling, with data collection extended over two academic years to ensure balanced gender representation. Anxiety was measured using the State-Trait Anxiety Inventory (STAI), while cardiovascular responses were continuously monitored using wearable devices. Results revealed significant increases in HR and BP, alongside decreases in HRV during the examination, reflecting heightened autonomic stress. Post-exam, cardiovascular markers demonstrated partial recovery but remained elevated compared to pre-exam levels, indicating lingering physiological effects of anxiety. Qualitative data from student interviews revealed cognitive impairments and lingering anxiety post-exam, corroborating the physiological findings. Repeated measures ANOVA indicated significant changes in cardiovascular responses over time, with no significant interaction effects for gender. These findings underscore the impact of examination-induced anxiety on both physiological and psychological outcomes in PT students. The persistent elevation in cardiovascular markers post-exam suggests that students may not fully recover from stress immediately, highlighting the need for targeted interventions, such as mindfulness or biofeedback, to help manage anxiety. Addressing examination stress could enhance both student well-being and academic performance, mitigating the long-term risks associated with chronic stress.

Optimal Heart Rate in patients in sinus rhythm and heart failure

The incidence of heart failure in the Polish population ranges from 1.0 to 1.3 million cases. Although the optimal heart rate is unknown, it should be sought to exceed 70/min. A higher heart rate increases the risk of death, arrhythmic events, and hospitalization due to deterioration of heart function. The association of increased heart rate with deterioration of long-term prognosis applies to both patients with reduced and preserved ejection fraction. In patients with heart failure, the resting heart rate should be lowered to below 70/min. Patients with the greatest reduction in heart rate within 3 months of hospitalization due to deterioration of heart function are particularly beneficial. It seems that lowering the resting frequency to &lt; 65/min and reducing it of more than 20/min do not bring any additional benefits.

Factors affecting the accuracy of prehospital triage application and prehospital scene time in simulated mass casualty incidents

BackgroundThe contemporary management of mass casualty incidents (MCIs) relies on the effective application of predetermined, dedicated response plans based on current best evidence. Currently, there is limited evidence regarding the factors influencing the accuracy of first responders (FRs) in applying the START protocol and the associated prehospital times during the response to MCIs. The objective of this study was to investigate factors affecting FRs’ accuracy in performing prehospital triage in a series of simulated mass casualty exercises. Secondly, we assessed factors affecting triage-to-scene exit time in the same series of exercises.MethodsThis retrospective study focused on simulated casualties in a series of simulated MCIs Full Scale Exercises. START triage was the triage method of choice. For each Full-Scale Exercise (FSEx), collected data included exercise and casualty-related information, simulated casualty vital parameters, simulated casualty anatomic lesions, scenario management times, and responder experience.ResultsAmong the 1090 casualties included in the primary analysis, 912 (83.6%) were correctly triaged, 137 (12.6%) were overtriaged, and 41 (3.7%) were undertriaged. The multinomial regression model indicated that increasing heart rate (RRR = 1.012, p = 0.008), H-AIS (RRR = 1.532, p < 0.001), and thorax AIS (T-AIS) (RRR = 1.344, p = 0.007), and lower ISS (RRR = 0.957, p = 0.042) were independently associated with overtriage. Undertriage was significantly associated with increasing systolic blood pressure (RRR = 1.013, p = 0.005), AVPU class (RRR = 3.104 per class increase), and A-AIS (RRR = 1.290, p = 0.035). The model investigating the factors associated with triage-to-scene departure time showed that the assigned prehospital triage code red (TR = 0.841, p = 0.002), expert providers (TR = 0.909, p = 0.015), and higher peripheral oxygen saturation (TR = 0.998, p < 0.001) were associated with a reduction in triage-to-scene departure time. Conversely, increasing ISS was associated with a longer triage-to-scene departure time (TR = 1.004, 0.017).ConclusionsUnderstanding the predictors influencing triage and scene management decision-making by healthcare professionals responding to a mass casualty may facilitate the development of tailored training pathways regarding mass casualty triage and scene management.

Mural infectious endocarditis in a patient with tetralogy of Fallot: a clinical case

The article presents a clinical case of development of mural infective endocarditis (IE) with formation of vegetations in the region of the upper third of the interventricular septum in patient A., 51 years old, with uncorrected tetralogy of Fallot. The patient was admitted with complaints of increased heart rate, interruptions in the heart work, feet swelling, shins up to the upper third, dyspnea at rest, general weakness, fever up to 39 оC, sweating, headache. During transthoracic echocardiography on the upper third of the interventricular septum (IVS) from the side of the RV, an additional echo-positive linear mobile formation 0.9 cm long is visualized, similar to the chords of the tricuspid valve. Thus, based on the identification of 1 major Duke criterion (imaging criterion — the presence of parietal vegetation) and 3 minor criteria (predisposing factors — congenital heart disease of the blue type; fever &gt;38 оC; positive blood culture not meeting the requirements for the major criterion), laboratory and instrumental diagnostic data and anamnesis, the following diagnosis was established: "Secondary infective endocarditis with damage to the upper third of the interventricular septum". Taking into account the sensitivity of the identified microflora, polymyxin and moxifloxacin were prescribed. During therapy, a dry cough and dry wheezing in the projection of the middle lobe on the right appeared. To exclude septic embologenic pneumonia, computed tomography of the chest organs was performed, on which no focal/infiltrative changes were detected. However, a shunt connecting the brachiocephalic trunk with the right pulmonary artery was visualized, which may explain the cause of compensation of hypoxemia that arose due to pathological hemodynamics as a result of high pulmonary stenosis. Given the incomplete effectiveness of therapy, as well as the sensitivity of the infectious agents isolated, a decision was made to change antibacterial therapy to vancomycin in combination with imipenem. Conservative treatment methods allowed not only to compensate for the existing clinical symptoms, but also to achieve reference values of laboratory parameters, despite the impossibility of surgical intervention.

Valsalva Maneuver Versus Carotid Sinus Massage for Supraventricular Tachycardia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Supraventricular tachycardia (SVT) is one of the most common cardiac arrhythmias, characterized by a sudden increase in heart rate. Initial management often involves vagal maneuvers, including the Valsalva maneuver (VM) and carotid sinus massage (CSM). VM can be categorized into standard VM (sVM) and modified VM (mVM). This study aimed to synthesize the first evidence from published randomized controlled trials (RCTs) comparing the efficacy of VM versus CSM. A comprehensive search across databases, including PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar, was conducted up to July 29, 2024. The primary endpoint was the success rate of converting SVT to sinus rhythm. The dichotomous outcome was analyzed using a fixed-effect model to calculate the risk ratio (RR) and 95% confidence intervals (CI). The Risk of Bias (RoB) tool, version 2, was employed to assess bias in the included RCTs. In total, three RCTs with 346 cases were analyzed. Concerns were noted regarding potential bias related to the randomization process in all three studies. The meta-analysis of these RCTs (comprising four arms) revealed that VM had a higher success rate than CSM for treating SVT, with an RR of 1.82 (95% CI: 1.29-2.57, p<0.001). Subgroup analysis showed that the rate of conversion to sinus rhythm was significantly higher in the sVM compared to CSM (RR=1.61, 95% CI (1.13-2.29), p=0.01). Additionally, subgroup analysis of one study indicated that mVM was associated with a higher rate of SVT conversion to sinus rhythm compared to CSM (RR=9.28, 95% CI (1.25-69.13), p=0.03). In conclusion, VM demonstrated a higher success rate compared to CSM in treating SVT. Specifically, mVM was more effective than CSM in both terminating SVT and restoring sinus rhythm, though this evidence was based on a single RCT; hence, the related conclusion should be interpreted with caution and requires validation using additional RCTs. Further research in diverse patient populations and clinical settings is necessary to validate these findings and potentially support the broader use of mVM in practice. Additional well-designed, multi-center studies with diverse populations are needed to confirm these observations and provide more comprehensive guidance on SVT management. This is important to enhance the generalizability of results across different demographics and clinical settings. This approach helps ensure that treatment effectiveness is applicable to a broader range of patients, accounting for variations in age, gender, comorbidities, and regional practices.

The Effects of Pediatric Acute Lymphoblastic Leukemia Treatment on Cardiac Repolarization.

Background: In recent years, cardiac dysfunction in childhood cancer survivors has become an important issue. Studies are focusing on identifying means for the early identification of patients at risk. Considering this, our study aims to investigate 24-hour Holter electrocardiogram (ECG) repolarization changes throughout doxorubicin (DOX) and cyclophosphamide (CPM) administration in pediatric patients treated for acute lymphoblastic leukemia (ALL). Methods: This was an investigator-driven, single-center, prospective, observational study. Enrolled children had a baseline bedside ECG examination performed before starting chemotherapy (T0). Serial Holter ECG examinations were conducted at three moments during their treatment protocol: day 8 (T1), day 29 (T2), and day 36 (T3). This study evaluated several ECG repolarization parameters, such as the QT interval, corrected QT interval (QTc), and QTc dispersion, as well as ST segment variations. Results: We evaluated 37 children diagnosed with ALL. The T0 examination revealed that over a third of patients had a resting heart rate (HR) outside the normal range for their age and sex. During chemotherapy, statistically significant increases in both HR as well as QT and QTc dispersion values were noticed, especially during the first DOX administration. What is more, a significant increase in the percentage of patients with ST segment depression from T1 to T2 and T3 was noticed. Rhythm disturbances were rare in the study population, with only a few patients presenting ventricular or supraventricular extrasystoles. Conclusions: This study reveals silent repolarization changes occurring early during anticancer treatment in children treated for ALL. These findings could aid in a better understanding of the cardiac toxicity mechanism, and they could potentially improve cardiac risk stratification for oncologic patients. Because of the small number of patients, our results need to be validated by larger studies.

Optimizing heart failure therapy with enhanced medical management: focus on heart rate management

Heart failure (HF) is a significant global health issue, affecting over 60 million people worldwide, with its prevalence expected to rise due to aging populations and the increasing incidence of comorbidities like hypertension and diabetes. Despite therapeutic advances, including quadruple therapy with renin-angiotensin-system inhibitors, beta blockers (BB), mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors, HF remains a condition with a poor prognosis, particularly for those with reduced ejection fraction (HFrEF), who are predominantly found in low- and middle-income countries like India. Elevated resting heart rate (HR) is a critical prognostic factor in HF, correlating strongly with cardiovascular mortality and morbidity. For every five-beat increase in HR, there is a 16% rise in cardiovascular mortality and HF hospitalization, emphasizing the need for effective HR management. However, challenges persist in optimizing HF treatment, such as the underutilization of BBs, despite their proven efficacy in reducing mortality. In India, the "double burden" of age-related and contemporary diseases complicates HF management further. Addressing unmet needs in HF care requires optimizing therapeutic strategies and improving treatment adherence, particularly in the context of HR control. Studies indicate that tailored approaches, including the use of BBs and ivabradine, could reduce HR and improve clinical outcomes. The ongoing challenges in accessing guideline-directed therapy and ensuring adherence highlight the need for comprehensive strategies to enhance patient outcomes, while personalized treatments and further research remain essential in navigating the complex landscape of HF management.

Consumption of energy drinks among medical university students in Kazakhstan.

Due to lack of information and deceptive advertising, young people widely consume energy drinks, although they should be careful because of their contents. Energy drinks contain high amounts of caffeine, sugar, and other additives that can stimulate the body. They can cause irritability, anxiety, insomnia and can increase heart rate, blood pressure and respiratory rate. Aim of this research was to study consumption of energy drinks among medical university students in Kazakhstan. Cross-sectional study was conducted. A web-based questionnaire was used to collect information. Students enrolled in various courses at the medical university, including interns and residents, were invited to participate. Atotal of 764 respondents took part in the survey. Among the trainees, 41.4 % had consumed caffeinated energy drinks in the past six months, and at the time of the survey, 16.2 % of the respondents had consumed these drinks. Respondents who do not drink alcohol are 3 times (p<0.001) more likely not to use energy drinks compared to those who drink alcohol. Those who do not exercise are 4.7 times (p<0.001) more likely not to consume energy drinks compared to active athletes. Participants who had not consumed caffeinated energy drinks in the past six months were 1.8 times (p<0.001) more likely not to consume energy drinks compared to those who drank them. Consumption of energy drinks by students can temporarily increase physical and mental performance, improve mood and raise energy levels, while at the same time, they also come with serious health risks. Therefore, educating students about the potential risks and the importance of a healthy lifestyle is essential.

The Prevalence of Anxiety and Depression in Children With Postural Orthostatic Tachycardia Syndrome (POTS): A Retrospective Study.

Postural orthostatic tachycardia syndrome (POTS) is a chronic form of orthostatic intolerance characterized by various symptoms such as dizziness, lightheadedness, and increased heart rate. Conflicting reports exist regarding the prevalence of anxiety and depression in adults with POTS, while data on pediatric POTS remains scarce. A retrospective analysis of pediatric patients aged 11-17 years with POTS, who underwent autonomic testing at Nemours Children's Hospital in Orlando, Florida, was conducted. The patients were screened for anxiety, using the Severity Measure for Generalized Anxiety Disorder-Child Age 11-17 years (GAD-7) questionnaire, and depression, using PHQ-9 Modified for Adolescence (PHQ-A) for depression. The prevalence rates of anxiety and depression in the study cohort were compared to historical data from similar age groups in the existing literature. The study was approved by the Nemours Children's Hospital Institutional Review Board. The cohort comprised 27 children with POTS (26 females, age 15.8±1.6 years). Overall, 74% exhibited moderate-to-severe anxiety, depression, or both, with 44% having comorbid anxiety and depression. In total, 4/27 (14%) had pure depression and 4/27 (14%) had pure anxiety. Six patients had no depression or anxiety. On average, POTS symptoms began 1.9±1.3 years before diagnosis. Eleven patients took stable doses of psychotropic medications. After a follow-up period of 5.1±1.7 months of POTS therapy, seven patients had follow-up questionnaires. In 4/7 patients, the depression severity improved, and in 3/7 patients, the anxiety severity improved. Patients were not actively treated for depression and anxiety during this time. Anxiety and depression are prevalent among pediatric patients with POTS. While preliminary data suggests POTS therapy may alleviate these psychological symptoms, further longitudinal studies are warranted to explore the therapeutic impact in greater detail.

The relative contribution of hemodynamic parameters to blood pressure decrease in classical orthostatic hypotension.

We studied the relative contributions of total peripheral resistance (TPR), stroke volume (SV) and heart rate (HR) to low blood pressure in classical orthostatic hypotension (cOH) on group and individual levels. We retrospectively analyzed tilt test records from cOH patients and age/sex-matched controls. We quantified relative effects of HR, SV and TPR on mean arterial pressure (MAP) with the log-ratio method. We studied relations of changes of HR, SV or TPR with the change of MAP across patients and variability of contributions of HR, SV and TPR to MAP. We also explored neurogenic vs. nonneurogenic causes. MAP responded to tilt with a decrease in patients (n = 80) and an increase in controls (n = 80). A too small TPR-increase contributed most to cOH, followed by a too large SV-decrease; both effects were partially corrected by a larger increase of HR. Only TPR changes consistently affected MAP change in patients and controls. TPR decreased almost exclusively in patients, most in those with severe cOH. Contributions of HR, SV and TPR to MAP did not differ between probable neurogenic and nonneurogenic causes. HR, SV and TPR all contributed to cOH, with a key role for TPR; a decrease of TPR was almost unique to patients and may be due to hyperventilation. The lack of differences between neurogenic and nonneurogenic causes needs further study.

Evaluation of perfusion index to predict hypotension in lower segment caesarean section under spinal anaesthesia

Background: Spinal Anaesthesia is the most popular choice for elective caesarean section. Both general anaesthesia and regional anaesthesia are acceptable techniques for anaesthesia for elective and emergency caesarean sections. Objectives: The study aimed to investigate the role of the perfusion index in predicting the incidence of hypotension following spinal anaesthesia in parturients undergoing elective lower segment caesarean sections. Methods: A prospective, observational study was carried out among sixty parturients posted for elective caesarean section. The study was conducted in the operation theatres of Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. About 60 participants were interviewed for the study. Data were entered and analysed with the help of the Statistical Package for Social Science (SPSS) version.16. Results: Sixty eligible ASAI (American society of anaesthesiologist’s physical status classification) parturients scheduled for elective caesarean section were divided into two groups pre-operatively after determining their baseline Perfusion Index (PI) as those with PI ≤ 3.5 and those with PI &gt; 3.5 using a Masimo® pulse oximeter probe. When comparing the heart rate at time intervals among the two groups, it became increasingly clear that those with baseline PI &gt; 3.5 had generally higher heart rate especially immediately after the block and at 2nd, 4th, 6th,8th, 10th, 12th, 14th and 20th minutes. Conclusion: The study concludes that a Perfusion Index &gt; 3.5 is associated with a higher incidence of hypotension in lower segment caesarean section under spinal anaesthesia. The hemodynamic parameters such as increased heart rate and significantly lower systolic, diastolic and mean arterial pressures in parturients with baseline PI &gt; 3.5 suggest that these patients have lower baseline SVR and depleted autonomic resilience to hypotension compared to those with baseline PI ≤ 3.5. High BMI seems to be significantly associated with high baseline PI.