Mean Maximum Heart Rate Research Articles

Analgesic efficacy of the inferior alveolar nerve block for maxillofacial cancer surgery under general anaesthesia - A randomised controlled study.

Mandibular resection during maxillofacial cancer surgery evokes a strong sympathetic response requiring high doses of opioids. We studied the effect of the inferior alveolar nerve block (IANB) for analgesia in maxillofacial cancer surgeries. This randomised controlled study was conducted over five months in a tertiary care cancer hospital following Institutional Ethics approval and trial registration. Fifty consenting adult patients belonging to the American Society of Anesthesiologists (ASA) physical status I and II requiring maxillofacial cancer surgery with unilateral mandibular resection were recruited. Twenty-five patients in the study arm received ipsilateral IANB; a mock injection was given to the control group. Fentanyl requirement and haemodynamic parameters during primary tumour excision were the primary and secondary endpoints. Student's t-test was applied to compare primary and secondary endpoints. Forty-nine patients completed the study. Both arms were comparable with respect to age, gender distribution, ASA physical status and baseline heart rate (HR) and blood pressure (BP). The mean (standard deviation) intravenous fentanyl requirement during primary tumour excision in the IANB arm was 70(32) µg, significantly lower than 183(48) µg in the control arm, P < 0.001. The mean maximum HR during primary tumour excision was 82 and 99 per minute in the IANB and control arms, respectively (P < 0.001) whereas the maximum mean BP was 88 and 101 mm Hg, respectively (P < 0.001). IANB significantly reduced intraoperative fentanyl requirement and caused fewer haemodynamic changes during maxillofacial cancer surgery requiring unilateral mandibular excision.

Heart Rate Response and Heart Rate Recovery After Harvard Step Test Between Young High Intensity Aerobic Athletes Smokers and Non-Smokers

Background: Smoking has an influence on physiological responses and exercise performance. Exercise training results in a slow resting heart rate through changes in cardiac autonomic balance in addition to intrinsic remodeling of the sinoatrial node. Compared with athletes in static sports, heart rate is slower in athletes involved in dynamic sports. However, not many studies have examined how smoking affects the heart rate response and heart rate recovery in high-intensity aerobic athletes. Methods: This cross-sectional observational study. Data on age, gender, body mass index, smoker or non-smoker status, resting heart rate, and blood pressure before the test were collected. Maximum heart rate, heart rate 1 minute after maximum, heart rate recovery, and blood pressure after the test were measured. Data were analyzed using the SPSS version 24 program: unpaired t-test, Mann-Whitney test, ANCOVA. Results: A total of 50 samples were involved in the study, divided into 25 smoking athletes and 25 non-smoking athletes. The mean resting heart rate in smoking athletes was significantly higher (75 vs 66, p&lt;0.001). The mean maximum heart rate was higher in smoking athletes but not statistically significant (149.5 vs 147.6, p=0.635). The mean 1-minute heart rate after the test was found to be significantly higher in smoking athletes (123 vs 112, p=0.018). The mean heart rate recovery was significantly lower in the smoking athletes (26.3 vs 35.2, p=0.002). Covariate analysis of age, gender, and body mass index did not have a simultaneous effect on resting heart rate, maximum heart rate, 1-minute heart rate after the test, and heart rate recovery (p&gt;0.05). Conclusion: Resting heart rate and 1-minute heart rate after the Harvard Step Test were higher in young high-intensity aerobic athletes who were smokers. Heart rate recovery was lower in young high-intensity aerobic athletes who were smokers.

Evaluation of the relationship between monocyte to HDL ratio with STEMI, STEMI severity, thrombosis, and early repolarization

Introduction Due to the relationship between high maximum heart rate (MHR) values ​​and the severity of coronary atherosclerosis and cardiac events, as well as standard features and clinical outcomes of early repolarization significant and myocardial infarction with ST-segment elevation, this study investigated the relationship between monocyte to HDL ratio and STEMI, STEMI severity, Thrombosis, and early repolarization were performed. Method This cross-sectional prospective observational study was performed on STEMI patients referred to Imam Khomeini Hospital in Ahvaz in 1399. In this study, STEMI patients and individuals with referred early repolarization patterns are evaluated during the first 12 hours after the onset of pain and used for statistical analysis of SPSS software version 22. Results: In this study, 36 patients have studied with a mean age of 61.6±14.4; 23 patients were male, and the rest were female. The ratio of monocytes to HDL in STEMI patients varied based on the age and sex of the patients. The mean MHR in STEMI patients based on PCI need was 16.4±2.9 in patients in need and 20.5±2.1 in patients who were candidates for CABG. The ratio of monocytes to HDL in STEMI patients varied based on the occurrence and severity of thrombosis.

Preconditioning Effects of Photobiomodulation on Repeated-Sprint Ability of Professional Basketball Players.

Giovanini, B, Altimari, LR, de Paula Ramos, S, Alves Okazaki, VH, Okuno, NM, and Junior, AF. Preconditioning effects of photobiomodulation on repeated-sprint ability of professional basketball players. J Strength Cond Res 37(1): 224-229, 2023-The purpose of this study was to investigate the preconditioning effects of photobiomodulation on repeated-sprint ability of professional basketball players. Ten professional basketball players took part in this randomized, double-blind, placebo-controlled, crossover study. The subjects attended 2 repeated-sprint test sessions. In each session, the subjects performed a general warm-up, followed by a familiarization sprint. Afterward, the subjects received either the photobiomodulation (660 and 850 nm, 12 J·cm-2, 83.4 J per point, 10 points, light-emitting diode [LED] treatment) or placebo intervention and performed the repeated-sprint test. The repeated-sprint test consisted of ten 30-m sprints with 1 change of direction (15 + 15 m), interspersed by 30 seconds of passive recovery. Sprint times and heart rate responses were monitored during the test. To compare moments and conditions, linear mixed-effects models were applied with statistical significance set at p < 0.05, and Cohen's d was used as effect size (ES). The LED treatment could not improve total time (p = 0.662; ES = -0.06), best time (p = 0.869; ES = 0.02), fatigue index (p = 0.169; ES = 0.64), or sprint decrement (p = 0.124; ES = -0.75) when compared with the placebo condition. In addition, mean heart rate (p = 0.687; ES = 0.07) and maximal heart rate (p = 0.837; ES = -0.03) were similar between conditions. We concluded that the LED condition could not improve the repeated-sprint ability of professional basketball players.

Impact of Anti-Hepatitis C Therapy on Cardiac rhythm

Abstract Background The use of direct-acting antiviral (DAA) has raised some concerns about the possibilities of cardiac toxicity after US Food and Drug Administration (FDA) issued a safety announcement of serious slowing of the heart rate when Amiodarone was used with hepatitis C treatment . Aim The aim of the present study was to assess the impact of Anti-Hepatitis C Therapy on cardiac rhythm using 24 hours Holter monitoring. Methods The current study was conducted on fifty consecutive adult patients with chronic hepatitis C infection eligible for DAA therapy supplied in the outpatient clinic of Ain shams University Virology Center .Patients have received Sofosbuvir 400 mg and Daclatasvir 60 mg / day for 12 weeks. All patients underwent 24 hour Holter monitoring before and after the completion of therapy. Both recordings were compared as regards: heart rate, minimum and maximum heart rate, the presence and frequency of ectopic atrial or ventricular activity. The measurement of QRS intervals such PR, corrected QT intervals in msec. Results The pre and post analysis of the Holter recording was done with comparing different baseline and post therapy parameters, The pre and post therapy mean average heart rates were 79.44±10.14 bpm vs.79.96±8.77 bpm respectively (p = 0.534) which are non-significant changes. There is also non-significant change was observed in mean maximum and mean minimum heart rate 129.08±20.07 bpm 128.98±16.89 bpm (p = 0.964), 55.88±9.20 bpm 56.66±9.45 bpm (p = 0.457) respectively. And as regard corrected QT duration and PR interval duration, the mean pre-therapy PR interval was 154.00 ± 25.95 ms as compared to the mean post-medication PR interval duration 151.40 ± 23.82 ms (p = 0.124) and The mean premedication Corrected QT duration was 397.34 ± 29.38ms vs. post therapy 395.04 ± 30.23ms ( p = 0.403) Which showing a non-significant change of both intervals. And as regard the median pre-therapy and post medication PACs and PVCs numbers and the median pre-therapy and post medication attacks of tachycardia and bradycardia, they showed non-significant changes with P-value &amp;gt; 0.05 . Conclusions Novel DAAs are safe to use as regards its effect on cardiac rhythm

Sportspecific performance diagnosis in ski mountaineering — comparison of a sportspecific cardiopulmonary exercise test on a treadmill versus outdoors and at altitude, a pilot study

Background: Ski mountaineering is a competitive sport that has gained popularity during the last years. As most competitions are held in altitudes between 1500 m and 3500 m, a considerable amount of training occurs at various hypobaric hypoxia degrees. It was establishing a sport-specific cardiopulmonary exercise protocol using standard ski mountaineering equipment on a treadmill. This study investigated altitude’s effects on a self-regulated incremental exercise field test at 3100 m with this protocol. Methods: Six athletes were tested (24.2 ± 4.2 years) from the German Ski Mountaineering National Team with a portable telemetric cardiopulmonary exercise test equipment. First, an incremental indoor step test with skis on a treadmill (altitude 310 m) and four days later outdoor on glacier snow (3085 m) after three days of acclimatization. All athletes were exposed to repetitive intermittent hypoxia during the weeks before the test. Standard cardiopulmonary exercise parameters were recorded while individual training zones were defined according to ventilatory thresholds. Results: In highly trained athletes, mean V̇ O2peak (72/ml kg KG/min) was reduced by 25% or 9% per 1000 m altitude gain and by 18% and 23% at the first and second ventilatory thresholds, respectively. Mean maximum heart rate and the heart rate at the ventilatory thresholds were reduced at altitude compared to sea-level, as was the O2 pulse. Conclusion: Due to distinctive individual reactions to hypoxia, cold, etc., an individual and sport-specific field performance analysis, representing the daily training environment, is highly useful in world-class athletes for precise training control. Our self-regulated cardiopulmonary field protocol could well prove to serve in such a way.

English

Background: Long distance practice running are growing and nutritional ergogenic are commonly used as a potential aid in final training and competition performance. Caffeine (CAF) and carbohydrates (CHO) are among the most commonly used supplements due to their expected ergogenic properties that can optimize energetic systems. The objective of this study was to examine potential changes in 10-km running performance with acute isolated and combined CAF and CHO supplementation. Material and method: Fifteen recreational endurance-trained runners performed four 10-km running performance on an official athletic track (400 m) under four supplementation conditions: placebo and placebo (PLA+PLA), placebo and caffeine (PLA+CAF), placebo and carbohydrates (PLA+CHO), caffeine and carbohydrates (CAF+CHO). CAF and CHO supplementation consisted of capsules of 6 mg·kg-1 and 8% CHO solution (1 g·kg-1) respectively, ingested 60 and 30 minutes before the performance tests. Placebo was obtained through empty capsules for CAF and juice for CHO without sugar (Clight®). During each trial running speed to calculate 10-km mean velocity (MV) and maximum heart rate (HRmax) were analyzed. Results: There was a difference in the pacing strategy adopted by the runners with higher MV during the initial phase for PLA+CAF and CAF+CHO groups and in the final phase for PLA+ CHO. However, there was no statistically significant difference in 10-km running performance between the conditions, as well as for HRmax. Conclusions: The use of acute, isolated and combined CAF+CHO supplementation had influence in the pacing strategy, but no in 10- km final performance, of recreational runners.

Physiological Response to Different Kata Performances

Summary During a karate competition, a competitor in the kata discipline may choose one kata of 102 katas on the list. This kata must not be repeated. Katas differ in duration, complexity, number of fast and slow techniques, which also means different intensity, physiological response of the karateka body and energy coverage. Problems and Aim. In our study, we focused on the identification and assessment of the duration and difficulty of selected katas by monitoring the internal response of the human body (heart rate, lactate) of three top women´s Slovak national team karate competitors of kata individual categories during training and competition. Methods. The research sample consisted of 3 karate kata athletes (age 17.3 years, body height 161.7 cm, body weight 55.7 kg), who trained kata on average 7 years. To evaluate the indicators of the internal body load in selected katas we used mean, standard deviation, min-max. Results. The highest mean maximum heart rate values athletes had during performance kata Gojushi Ho (187 ± 8.2 bpm). The highest average heart rate values were observed during performance kata Chatanyara Kushanku (171 ± 9.9). Similarly, we found the highest mean values of blood lactate 4 minutes after performance kata Chatanyara Kushanku. (7.6 ± 2.5 mmol.l-1). The longest duration had the kata Suparinpei (204 ± 13 s). There was a significant difference in level of blood lactate reached in different katas (p ≤ 0.05) and the duration of katas. Conclusions. The duration of 5 most common katas used at the high level competition is different (p ≤ 0.05), thus the intensity expressed by the frequency of the techniques, and heart rate and blood lactate concentration. ATP-PCr energy system seems to be the major contributor while contribution of the aerobic energy system rises with the increase in duration of kata.

Egzersiz Testinin Ekshale Karbon Monoksit Oranı Üzerindeki Akut Etkisi

Objective: The aim of this study is to analyze the acute effect of exercise on the rate of exhaled carbon monoxide (CO) in healty young smokers. Material and Methods: Twenty four male smokers were included in the study. Pulmonary functions of the participants were evaluated by spirometer forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC, peak flow rate (PEF) and forced expiratory flow at 25 to 75% of FVC (FEF 25%-75%). Exercise testing was performed by using bicycle ergometer. Maximal load, maximum oxygen uptake (VO2max), rest and maximal heart rate were recorded. CO levels before and after the test were mesured with portable breath CO monitor. CO levels and changes were assessed and compared on the exercise test day and rest day (without exercise test). Results: 25% of the participants have dyspnea, 20.8% have cough and 50% have sputum complaints. The results of the pulmonary function test and exercise test of young healthy smokers are as follows: % FEV1=89.7±9.9, % FEV1/FVC=87.4±8.2, % PEF=77.4±9.5, mean rest heart rate=94.8±9.8 bpm, mean maximal heart rate=170.3±9.7 bpm and mean VO2max=30.9±6.5 mL/min/kg. There is a statistically significant difference between the first and the second CO values of the participants measured on both days (p<0.001). There is a significant difference between the mean change of CO on the exercise test day and rest day (p<0.001). Conclusion: Our results show that smoking causes respiratory symptoms, impaired cardiopulmonary responses to exercise and increased CO level and exercise increases to the exhaled CO rate in young and healthy male.

In vivo cardiac pacemaker function of differentiated human mesenchymal stem cells from adipose tissue transplanted into porcine hearts.

BACKGROUNDMesenchymal stem cells (MSC) modified by gene transfer to express cardiac pacemaker channels such as HCN2 or HCN4 were shown to elicit pacemaker function after intracardiac transplantation in experimental animal models. Human MSC derived from adipose tissue (haMSC) differentiate into cells with pacemaker properties in vitro, but little is known about their behavior after intracardiac transplantation.AIMTo investigate whether haMSC elicit biological pacemaker function in vivo after transplantation into pig hearts.METHODShaMSC under native conditions (nhaMSC) or after pre-conditioning by medium differentiation (dhaMSC) (n = 6 pigs each, 5 × 106 cells/animal) were injected into the porcine left ventricular free wall. Animals receiving PBS injection served as controls (n = 6). Four weeks later, total atrioventricular (AV)-block was induced by radiofrequency catheter ablation, and electronic pacemaker devices were implanted for backup stimulation and heart rate monitoring. Ventricular rate and rhythm of pigs were evaluated during a follow-up of 15 d post ablation by 12-lead-ECG with heart rate assessment, 24-h continuous rate monitoring recorded by electronic pacemaker, assessment of escape recovery time, and pharmacological challenge to address catecholaminergic rate response. Finally, hearts were analyzed by histological and immunohistochemical investigations.RESULTS In vivo transplantation of dhaMSC into the left ventricular free wall of pigs elicited spontaneous and regular rhythms that were pace-mapped to ventricular injection sites (mean heart rate 72.2 ± 3.6 bpm; n = 6) after experimental total AV block. Ventricular rhythms were stably detected over a 15-d period and were sensitive to catecholaminergic stimulation (mean maximum heart rate 131.0 ± 6.2 bpm; n = 6; P < 0.001). Pigs, which received nhaMSC or PBS presented significantly lower ventricular rates (mean heart rates 47.2 ± 2.5 bpm and 37.4 ± 3.2 bpm, respectively; n = 6 each; P < 0.001) and exhibited little sensitivity towards catecholaminergic stimulation (mean maximum heart rates 76.4 ± 3.1 bpm and 60.5 ± 3.1 bpm, respectively; n = 6 each; P < 0.05). Histological and immunohistochemical evaluation of hearts treated with dhaMSC revealed local clusters of transplanted cells at the injection sites that lacked macrophage or lymphocyte infiltrations or tumor formation. Intense fluorescence signals at these sites indicated membrane expression of HCN4 and other pacemaker-specific proteins involved in cardiac automaticity and impulse propagation.CONCLUSIONdhaMSC transplanted into pig left ventricles sustainably induced rate-responsive ventricular pacemaker activity after in vivo engraftment for four weeks. The data suggest that pre-conditioned MSC may further differentiate along a pacemaker-related lineage after myocardial integration and may establish superior pacemaker properties in vivo.

Speckle Tracking Echocardiography in Pediatric Patients with Premature Ventricular Contractions.

Premature ventricular contractions (PVCs) in pediatric patients without structural heart disease and normal left ventricular systolic function rarely require therapy, though it is unknown whether these patients have subclinical cardiac dysfunction. Speckle tracking echocardiography is an additional means of evaluating cardiac function in asymptomatic pediatric PVC patients with normal standard measures of left ventricular (LV) function. Asymptomatic pediatric patients (< 21years) without congenital heart disease, LV ejection fraction (LVEF) ≥ 55% and PVC burden ≥ 5% on 24-h Holter monitor were included. Demographic information, exercise stress test results, standard echocardiographic measures of LV systolic function and PVC morphology by 12-lead ECG were collected. Peak global systolic longitudinal strain (GLS) from apical four-chamber view was analyzed offline. 29 patients were identified (mean age 11.7 ± 5.8years, 49.2 ± 25.3kg, 59% male). Mean PVC burden was 12.0 ± 7.0% (range 5-37.5%). 14/29 (48%) had exercise stress testing with evidence of PVCs; 9/14 (64%) had PVC suppression at a mean heart rate (HR) of 160 ± 23bpm and 5/14 (36%) did not suppress at a mean maximum HR of 188 ± 9bpm. All patients had normal strain values by speckle tracking echocardiography (mean LV GLS - 22.5 ± 2.0%, LV global circumferential strain - 25.3 ± 3.9 and RV GLS - 24.1 ± 3.0%). There was no correlation between PVC burden and cardiac function parameters. Asymptomatic pediatric patients without structural heart disease, preserved LVEF/shortening fraction and PVC burden ≥ 5% demonstrated normal cardiac function including strain patterns indicating no evidence of subclinical cardiac dysfunction. Larger scale studies and longitudinal evaluation of left ventricular function using speckle tracking echocardiography is warranted in this population.

Mussel acclimatization to high, variable temperatures is lost slowly upon transfer to benign conditions.

Climate change is increasing the temperature variability animals face, and thermal acclimatization allows animals to adjust adaptively to this variability. Although the rate of heat acclimatization has received some study, little is known about how long these adaptive changes remain without continuing exposure to heat stress. This study explored the rate at which field acclimatization states are lost when temperature variability is minimized during constant submersion. California mussels (Mytilus californianus) with different acclimatization states were collected from high- and low-zone sites (∼12 versus ∼5°C daily temperature ranges, respectively) and then kept submerged at 15°C for 8weeks. Each week, the cardiac thermal performance of mussels was measured as a metric of acclimatization state: critical (Tcrit) and flatline (Tflat) temperatures were recorded. Over 8weeks of constant submersion, the mean Tcrit of high-zone mussels decreased by 1.07°C from baseline, but low-zone mussels' mean Tcrit was unchanged. High- and low-zone mussels' mean maximum heart rate (HR) and resting HR decreased ∼12 and 35%, respectively. Tflat was unchanged in both groups. These data suggest that Tcrit and HR are more physiologically plastic in response to the narrowing of an animal's daily temperature range than Tflat is, and that an animal's prior acclimatization state (high versus low) influences the acclimatory capacity of Tcrit Approximately 2months were required for the cardiac thermal performance of the high-zone mussels to reach that of the low-zone mussels, suggesting that acclimatization to high and variable temperatures may persist long enough to enable these animals to cope with intermittent bouts of heat stress.

LABORATORY-INSTRUMENTAL COMPARISONS OF CARDIAC RHYTHM VARIABILITY IN NEWBORNS FOLLOWING HYPOXIA

Summary Introduction. Determination of the state of autonomic regulation of cardiac activity has been widely used in various disorders in neonatal practice. Hypoxia is known to have a significant adverse effect on myocardial function and autonomic cardiac control processes. Early detection of the development of posthypoxic damage to the autonomic nervous regulation of cardiac activity by analyzing the variability of cardiac rhythm and finding its relationship with other characteristics of cardiac rhythm variability (CRV) may be useful for determining the subsequent therapeutic approach for such infants. The aim of the study is to improve early diagnosis of posthypoxic myocardial damage by studying cardiac rhythm variability of (CRV) in newborns following hypoxia and comparing its characteristics with laboratory-instrumental indicators of cardiovascular system. Material and methods. 187 newborns were examined in the early neonatal period. The study involved assessment of medical records, biochemical blood test (AST, ALT, KFK, KFK-MV, LDH, GGTF),daily monitoring of ECG according to Holter (HMEGG) with determination of the main temporal indicators of heart rate variability, Doppler echocardiography (DEchoCG) and statistical processing. Results and discussion. Depending on the Apgar scale at the 1st minute, the children were divided into 2 main groups: newborns with Apgar score less than 6 points which comprised the 1st group (n=132), newborns with Apgar score of 7 points or more were included into the 2nd group (n=55). Depending on the gestational peculiarities at birth, children were subdivided into subgroups of full–term and preterm infants: group 1a (n=15) were full–term infants with hypoxia at birth, group 1b (n=117) were premature newborns with hypoxia at birth, group 2a (n=43) were full– term neonates without hypoxia at birth, group 2b (n=12) were prematurely born without hypoxia at birth. According to HMEGG findings, the mean, mean minimum and mean maximum heart rates were higher in the group of infants who underwent hypoxia, with the highest rates in the group of premature infants. Circadian index scores were lower in the group of newborns who underwent hypoxia, with the lowest in the group of preterm infants. Assessment of correlation dependencies of CRV time parameters with laboratory parameters and DECHOCG parameters showed that SDANN had the highest percentage of relationships with laboratory and instrumental indicators of CVS status. With the parameters of DECHOCG in all groups, rMSSD and pNN50 indicators had the highest number of relationships, which most fully characterized the state of hemodynamics in the group of newborns with existing disorders of adaptation at birth secondary to hypoxic events (group 1) and in the subgroup of premature children (group 1b). SDNN was associated with CPK-MB and gammaglutamyltransferase values, as an indicator of the antioxidant system of body protection in newborns with impaired adaptation at birth following hypoxia, including in the group of premature infants. Conclusions. Prematurely born children who undergo hypoxia have a more pronounced autonomic imbalance in the regulation of cardiac activity. Comprehensive CRV assessment with determination of all parameters characterizing the state of sympathetic and parasympathetic regulation in comparison with biochemical parameters of CVS and DECHOCG will allow to improve the early diagnosis of posthypoxic myocardial injury and to develop further approach of patient management.

Pharmacologic strategies to prevent hemodynamic changes after intubation in parturient women with hypertensive disorders of pregnancy: A systematic review and network meta-analysis protocol.

Hypertensive disorders of pregnancy are major health issues affecting mothers and infants. General anesthesia is inevitable for certain mothers with these conditions and they may exhibit pronounced hemodynamic instability, especially during induction and airway manipulation. The aims of this study are to combine direct and indirect comparisons of the efficacies of different medications used in attenuating reflex hemodynamic responses and generate intervention ranking by network meta-analysis (NMA). A systematic and comprehensive search will be performed using MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar databases, beginning from their inceptions to November 2019. Only randomized clinical trials evaluating the efficacy and safety of pharmacologic interventions for preventing hemodynamic changes after intubation in parturient women with hypertensive disorders of pregnancy will be included. The primary endpoints will be maximal mean arterial pressure (MAP) and maximal heart rate after intubation. Maximal systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and maternal/fetal blood gas analysis, as well as safety issues, including Apgar score at 1 minute and 5 minutes after delivery, will be also assessed.We will conduct both pairwise meta-analysis and network meta-analysis. We will use surface under the cumulative ranking curve (SUCRA) values and rankograms to present the hierarchy of pharmacologic interventions. A comparison-adjusted funnel plot will be used to assess the presence of small-study effects. The quality of the studies included will be assessed using the risk of bias tool 2.0. All statistical analyses will be performed using Stata SE, version 15.0 (StataCorp, College Station, TX). The results of this systematic review and NMA will be published in a peer-reviewed journal. This NMA will enable us to determine the order of effectiveness and safety of pharmacological interventions used in attenuating hemodynamic responses for mothers with hypertensive disorders of pregnancy. CRD42019136067.

Hemodynamic changes in patients undergoing office-based sinus procedures under local anesthesia.

The objective of this study is to characterize changes in hemodynamics, pain, and anxiety during office-based endoscopic sinus procedures performed under local anesthesia. We conducted a prospective study of adults undergoing in-office endoscopic sinus procedures under local anesthesia. Patients with American Society of Anesthesiologists (ASA) Physical Status Classification System class 1 or 2 were included. Anesthesia was administered by topical 4% lidocaine/oxymetazoline and submucosal injection of 1% lidocaine/1:200,000 epinephrine. Vital signs and pain were measured at baseline, postinjection, and 5-minute intervals throughout the procedure. Anxiety levels were scored using the State-Trait Anxiety Inventory (STAI). Univariate and multivariate regression analyses were performed to identify factors significantly associated with changes in each hemodynamic metric. Twenty-five patients were studied. This cohort was 52% male, mean age of 57.8 ± 14.4 years, and Charlson Comorbidity Index (CCI) median of 2. Mean procedure duration was 25.0 ± 10.3 minutes. Mean maximal increase in systolic blood pressure (SBP) was 24.6 ± 17.8 mmHg from baseline. Mean maximal heart rate increase was 22.8 ± 10.8 beats per minute (bpm) from baseline. In multivariate regression analysis, when accounting for patient age, cardiac comorbidity, CCI, and ASA, older age was significantly associated with an increase of >20 mmHg in SBP (p = 0.043). Mean pain score during procedures was 1.5 ± 1.3 with a mean maximum of 4.0 ± 2.6. STAI anxiety scores did not change significantly from preprocedure to postprocedure (32.8 ± 11.6 to 31.0 ± 12.6, p = 0.46). No medical complications occurred. Although patients appear to tolerate office procedures well, providers should recognize the potential for significant fluctuations in blood pressure during the procedure, especially in older patients.

CHRONOTROPIC INSUFFICIENCY AS CAUSE OF EXERCISE LIMITATION IN PATIENTS UNDERGOING CARDIOPULMONARY EXERCISE TESTING FOR DYSPNEA

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Chronotropic incompetence is defined as the inability of the heart to increase its rate in response to increased activity or demand. It has been recognized as predictor for major cardiovascular event, mortality and exercise intolerance.The purpose of this study was to identify the proportion of patients who underwent cardiopulmonary exercise testing(CPET) in whom chronotropic incompetence was deemed to be the primary cause of exercise limitation and to describe the characteristic exercise response in these patients. METHODS: The results of all CPET studies done in a tertiary referral center from January 2015 to May 2018 were reviewed. The results of patients in whom chronotropic incompetence was inferred to be the primary cause of exercise limitation were analyzed to describe the characteristic exercise response. RESULTS: A total of 260 CPET studies were done during the study period. Chronotropic incompetence was identified as the primary cause of exercise limitation in 37(14%) of the studies. The mean maximum oxygen uptake(VO2) was normal at 81.78%(SD 18.97), mean VO2/kg was reduced at 65%(SD 13.5%). The mean resting heart rate(HR) was 67 (SD 11). Mean maximum HR was reduced at 103 (SD 19). Mean maximum HR percent predicted was reduced at 67%(SD 9.5). Mean oxygen(O2) pulse was increased at 122% (SD 22). Mean maximum ventilation (Ve) was normal at 53.5%(SD 10.66). Mean Respiratory exchange ratio (RER) 1.14 (SD 0.12). Information about the medication use was present in 24 of the 38 patients. Of the 24, 20 patients were on beta blockers, 2 were on calcium channel blockers and 2 were not on any AV nodal blocking agents. CONCLUSIONS: Chronotropic incompetence was the reason for exercise limitation in 14% of all patients that underwent cardiopulmonary exercise testing for evaluation of their dyspnea. These patients demonstrated a characteristic exercise response with preserved maximum oxygen uptake, decreased maximum heart rate, increased oxygen pulse and normal breathing reserve.The most common cause of chronotropic incompetence in this patient population was use of AV nodal blocking agents, specifically beta blockers. CLINICAL IMPLICATIONS: Chronotropic incompetence is an under recognized and under reported cause of exercise limitation in patients presenting with dyspnea. It is easily recognizable on cardiopulmonary exercise stress testing. The most common culprit are beta blockers. Clinicians need to be aware of the characteristic exercise response. If CI is present, clinicians should consider discontinuing beta blockers unless there is a strong indication. More research is needed to see if discontinuation of the culprit medications helps with decreasing dyspnea. The exact mechanism by which chronotropic incompetence could lead to dyspnea on exertion is not well known but could be due to increased left sided end diastolic pressures during exercise. DISCLOSURES: No relevant relationships by Abhishek Agarwal, source=Web Response No relevant relationships by Melvin Pratter, source=Web Response

Adaptação cardiovascular no Teste de Caminhada dos Seis Minutos em pacientes com DPOC: estudo transversal

OBJETIVO: Avaliar o comportamento da adaptação cardiovascular e da saturação periférica de oxigênio em indivíduos com DPOC submetidos no teste de caminhada dos seis minutos (TC6). MATERIAL E MÉTODOS: Trata-se de um estudo de corte transversal, que foram incluídas pessoas com diagnóstico de DPOC, confirmado pela espirometria e de ambos os sexos. A magnitude de sintomas foi avaliada pela escala de dispneia Medical Research Council (MRC) e questionário COPD Assessment Test (CAT). Aplicou-se o TC6 para avaliar a tolerância ao esforço. Para mensurar a frequência cardíaca máxima (FC máx) prevista para a idade foram utilizadas equações específicas para população brasileira. RESULTADOS: Avaliou-se 34 indivíduos com DPOC, 20 (58,8%) homens; relação VEF1/CVF foi 56,7% ± 10,2% pós broncodilatador (BD). Quatorze 14 (41,2%) indivíduos apresentaram impacto clínico moderado; 16 (47,2%) dos avaliados apresentou grau 2 na escala do MRC. As médias das distâncias percorridas no primeiro e segundo TC6 foram 383,5 ± 13,6; 408,6 ± 85,7 metros, correspondendo a 70, 75%; 75,10% em relação ao valor previsto (p=0,001). As médias da FC máx ao final do primeiro e segundo TC6, foram 94,1 ± 21,9; 92,3 ± 17,9 bpm e a FC pós percentual da FC máx prevista pré e pós TC6 foram 61,1% ± 17,7%; 59,7% ± 21,5% e 14 (41,2%) pacientes apresentaram dessaturação de O2 no primeiro TC6; 9 (26,5%) no segundo teste. CONCLUSÕES: Pacientes com DPOC, apresentam aumento da FC identificado pelo esforço submáximo, por meio do percentual da FC max. Indivíduos com maior comprometimento da função pulmonar apresentaram dessaturação de O2.

Contribution of Holter ECG to the diagnosis of palpitations in Brazzaville (Congo)

To determine the prevalence and the nature of the rhythmic disorders during palpitations. It was about a cross-sectional study, descriptive, conducted to Brazzaville between January 2012 and December 2016. The study related to a consecutive series of 530 patients having carried out 24 h Holter ECG for assessment of palpitations. The sociodemographic parameters of the patients were collected, and the principal indexed rhythmic anomalies. The Lown classification made it possible to evaluate the degree of gravity of the ventricular ectopic beats (VEB) into benign and complex or malignant. There were 225 men (42.5%) and 305 women (57.5%), old on average of 48.7 ± 13.2 years, without difference between the two sexes (49.7 ± 14.6 vs 50.9 ± 13.7 years; P = 0.311). The Holter ECG, prescribed by a cardiologist in 476 cases (89.8%) and by a general practitioner in 54 cases (10.2%), was normal in 360 cases (68%) and pathological in 170 cases (32%). The mean average heart rate (HR) was 76.8 ± 10.7 bpm, the mean minimum HR was 56.5 ± 9.4 bpm, and the mean maximum HR was 116.3 ± 13.1 bpm. The principal recorded anomalies consisted into VEB ( n = 136), supraventricular ectopic beats ( n = 27), paroxysmal atrial fibrillation ( n = 9), non-sustained ventricular tachycardia ( n = 4), sustained ventricular tachycardia and nodal tachycardia in two cases each one. The VEB were isolated ( n = 125), couplets ( n = 38), triplets ( n = 14), and bigeminy ( n = 65). One noted salvos of VEB in 11 cases (8.1%). The VEB were benign in 125 cases (92%), and complex or malignant in 11 cases (8%). This study underlines the interest of 24 h Holter ECG in the diagnosis of palpitations. If the anomalies frequently in question seem benign, others more serious are to be feared in spite of their relative scarcity. Such is the case of atrial fibrillation and the malignant ventricular arrhythmias.

Influence of the Varied Pitch Shape on Soccer Players Physiological Responses and Time-Motion Characteristics During Small-Sided Games.

The aim of this study was to investigate the effect of pitch shape modifications on heart rate responses and time-motion characteristics in soccer players during 5-a-side small-sided games (SSGs). Players completed four different SSG dimensions: (1) short narrow pitch (SN; 40 × 25 m), (2) short wide pitch (SW; 66 × 25 m), (3) long narrow pitch (LN; 40 × 50 m), and (4) long wide pitch (LW; 66 × 50 m). Twenty amateur soccer players (age: 21 ± 5 yr; stature: 176.8 ± 1.9 cm; body mass: 72.7 ± 3.7 kg) were monitored using a heart rate monitor and a 10 Hz GPS device. Mean maximum heart rate (%HRmax), rating of perceived exertion (RPE), peak running speed, total distance covered (TD), distance covered in four speed categories, number of moderate and high accelerations (Ac), decelerations (Dc), changes of direction (COD) and player load were recorded. Increasing the pitch length had a greater effect compared to increasing the pitch width especially on RPE (3.8, 6.3, 4.9 and 6.6 AU to SN, LN, SW and LW, respectively) and time-motion characteristics such as TD (101, 127, 108 and 131 m·min-1 to SN, LN, SW and LW, respectively), peak speed (4.8, 6.1, 5.2 and 6.2 m·s-1 to SN, LN, SW and LW, respectively), and the number of accelerations, decelerations, and changes of direction. The data demonstrates that increasing the length rather than the width of 5-a-side SSG has a greater impact on players’ responses in terms of increasing workloads.

The Value of Holter Monitoring in the Assessment of Non-Specific Symptoms

Background: To assess the importance of Holter monitoring in evaluation of non-specific symptoms (like presyncope, dizziness, palpitations, syncope, etc.).&#x0D; Patients and Methods: This is an observational , prospective descriptive study which was conducted at Shaheed Al-Mihrab cardiac centre at Babylon City - Iraq in which 100 patients referred from the consultation department for the assessment of non-specific compliants were included in this study . Holter monitoring was done for all patients after initial evaluation. Holter monitoring was accomplished using GE Holter system with two channels and five leads, attached to the anterior chest wall. The recorder was attached to a strap, which was attached to the patient shoulder. The recording was started in the morning at hospital working hours and the patient was allowed to go home and to resume his normal activities. He was advised to maintain his activity and asked to return back at the same time next day.&#x0D; Results: 87% of patients have less than 10% premature ventricular ectopics as an isolated event while 90% of the patients have Supraventricular arrythmias less than 10% as isolated events. The mean minimum heart rate was 47 , mean maximum heart rate was 117 and mean average heart rate was 65 . 18 % of patients have ST segment Shift in which 4% were ST-segment elevation and 14% were ST segment depressions.&#x0D; Conclusion: Holter monitoring was found to have no important role for the early diagnosis of arrhythmias or ischaemia as a cause of compliant in patients with non-specific symptoms