Heart Rate Recordings Research Articles

Usability of Wearable Multiparameter Technology to Continuously Monitor Free-Living Vital Signs in People Living With Chronic Obstructive Pulmonary Disease: Prospective Observational Study.

BackgroundVital signs monitoring (VSM) is routine for inpatients, but monitoring during free-living conditions is largely untested in chronic obstructive pulmonary disease (COPD).ObjectiveThis study investigated the usability and acceptability of continuous VSM for people with COPD using wearable multiparameter technology.MethodsIn total, 50 people following hospitalization for an acute exacerbation of COPD (AECOPD) and 50 people with stable COPD symptoms were asked to wear an Equivital LifeMonitor during waking hours for 6 weeks (42 days). The device recorded heart rate (HR), respiratory rate (RR), skin temperature, and physical activity. Adherence was defined by the number of days the vest was worn and daily wear time. Signal quality was examined, with thresholds of ≥85% for HR and ≥80% for RR, based on the device’s proprietary confidence algorithm. Data quality was calculated as the percentage of wear time with acceptable signal quality. Participant feedback was assessed during follow-up phone calls.ResultsIn total, 84% of participants provided data, with average daily wear time of 11.8 (SD 2.2) hours for 32 (SD 11) days (average of study duration 76%, SD 26%). There was greater adherence in the stable group than in the post-AECOPD group (≥5 weeks wear: 71.4% vs 45.7%; P=.02). For all 84 participants, the median HR signal quality was 90% (IQR 80%-94%) and the median RR signal quality was 93% (IQR 92%-95%). The median HR data quality was 81% (IQR 58%-91%), and the median RR data quality was 85% (IQR 77%-91%). Stable group BMI was associated with HR signal quality (rs=0.45, P=.008) and HR data quality (rs=0.44, P=.008). For the AECOPD group, RR data quality was associated with waist circumference and BMI (rs=–0.49, P=.009; rs=–0.44, P=.02). In total, 36 (74%) participants in the Stable group and 21 (60%) participants in the AECOPD group accepted the technology, but 10 participants (12%) expressed concerns with wearing a device around their chest.ConclusionsThis wearable multiparametric technology showed good user acceptance and was able to measure vital signs in a COPD population. Data quality was generally high but was influenced by body composition. Overall, it was feasible to continuously measure vital signs during free-living conditions in people with COPD symptoms but with additional challenges in the post-AECOPD context.

Heart rate and heart rate variability in school dogs

The aim of this study was to examine whether the canine stress level was elevated during animal-assisted education by means of the Polar monitor V800 (Polar Electro Oy, Kempele, Finland), which recorded heart rate (HR) and heart rate variability (HRV). At 54 Bavarian schools with one working dog each, we attended one class for a single or double session. The dog was videotaped for subsequent behavior analysis, and real-time measurements of the RR intervals were transmitted by the Polar device to the data logger attached to the dog's collar.On average, the mean HR per dog was 87 ± standard deviation 19 beats per minute (bpm). When the dogs were grouped according to the behavior analysis, i.e., scores based on the occurrence of specified displacement behavior / appeasement behavior / signs of stress, inter alia, the "problematic" dogs (n = 25) showed significantly increased mean HR values compared to the "innocuous" dogs (n = 22). The highest mean HR values were recorded in the subgroup of "problematic" dogs during the first 10 min of the classes (107 ± 29 bpm, vs. "innocuous" dogs: 90 ± 22 bpm, p < 0.05). Moreover, HR and HRV were to be measured at rest for 5 min. The mean HR at rest was significantly reduced. With respect to HRV data, it turned out that only 18 dogs showed an artifact rate ≤ 5% and were thus suitable for analysis. Consequently, we performed a range of exploratory analyses - on the one hand to examine this subgroup of dogs, on the other hand to quantify the differences in HRV parameters and to compare certain canine features among the various rates of artifacts.The HR values were in line with the behavior analysis. This was also supported by the exploration of the subgroup with an artifact rate ≤ 5%. In conclusion, cardiac monitoring confirmed that the dogs classified as "problematic" were more stressed than the "innocuous" dogs. This study additionally provided insights into outliers in HRV data, so-called artifacts, underlining the need for standardized conditions.

Efficacy of Myofascial Release Therapy on the Cardiorespiratory Functions in Patients With COVID-19

Introduction: The present study aimed to investigate the effects of Myofascial Release Therapy (MRT) on cardiorespiratory functions in patients with COVID-19. Materials and Methods: A total of 36 patients with COVID-19 (intervention group=20, controls=16) were included in the present study. The patients in the intervention group participated in a single session of suboccipital, anterior thoracic and sternal, anterior cervical, and diaphragm myofascial release techniques, plus respiratory physiotherapy. The controls just received respiratory physiotherapy. Before-after assessments included recording heart rate, systolic and diastolic blood pressure, respiratory rate, blood oxygen saturation, chest expansion, and breathing comfort. Results: There was a significant reduction in the heart rate and ease of breathing in the intervention group (P=0.04, P=0.02; respectively); also, the diastolic blood pressure increased significantly in the control group (P=0.02). Compared to the controls, the ease of breathing decreased significantly in the intervention group (P=0.03). Conclusion: Myofascial release techniques of the neck, thoracic, and diaphragm, along with respiratory physiotherapy, could immediately affect heart rate and ease of breathing and prevent increasing diastolic blood pressure. If a patient with COVID-19 is stable, pulmonary physiotherapists may consider using these techniques while monitoring cardiopulmonary function.

Weekly Training Load in Elite Male Ice Hockey: Practice Versus Competition Demands.

The aim of this study was to compare training load (TL) between practice and games across in-season microcycles in elite Danish male ice hockey. Practice sessions and game data were collected using a wearable 200-Hz accelerometer, heart rate (HR) recording, and rating of perceived exertion (RPE) throughout 23 practice sessions and 8 competitive games (n = 427 files) and examined in relation to the number of days before the game (game day minus). Total accelerations, accelerations >2m·s-2 (Acc2), total decelerations, decelerations less than -2m·s-2 (Dec2), time >85% maximum heart rate (t85HRmax), Edwards TL, modified training impulse (TRIMPMOD), session-RPE, peak HR (HRpeak), and RPE were greater during competition than during practice (r = .19-.91; P < .05), whereas total accelerations per minute and total decelerations per minute were lower (r = .27-.36; P < .001). Acc2, t85HRmax, Edwards TL and TRIMPMOD, % t85HRmax, mean HR (HRmean), and RPE progressively decreased toward game day (r = .13-.63; P < .001). Positive correlations were found between Acc2, Dec2, Acc2 per minute, and Dec2 per minute during practice and during competition (r = .66-.84; P < .001). Evident within-week decreases in internal TL but not external TL were observed as the game day approached. Day-to-day variations were more pronounced in HR- and RPE-based parameters than accelerations and decelerations. Finally, the amount of intense accelerations and decelerations performed during practice was associated to the amount performed during competition, whereas physiological and perceptual demands showed no such relationship.

Reconstruction of Pulse Wave and Respiration From Wrist Accelerometer During Sleep.

Nocturnal recordings of heart rate and respiratory rate usually require several separate sensors or electrodes attached to different body parts - a disadvantage for at-home screening tests and for large cohort studies. In this paper, we demonstrate that a state-of-the-art accelerometer placed at subjects' wrists can be used to derive reliable signal reconstructions of heartbeat (pulse wave intervals) and respiration during sleep. Based on 226 full-night recordings, we evaluate the performance of our signal reconstruction methodology with respect to polysomnography. We use a phase synchronization analysis metrics that considers individual heartbeats or breaths. The quantitative comparison reveals that pulse-wave signal reconstructions are generally better than respiratory signal reconstructions. The best quality is achieved during deep sleep, followed by light sleep N2 and REM sleep. In addition, a suggested internal evaluation of multiple derived reconstructions can be used to identify time periods with highly reliable signals, particularly for pulse waves. Furthermore, we find that pulse-wave reconstructions are hardly affected by apnea and hypopnea events. During sleep, pulse wave and respiration signals can simultaneously be reconstructed from the same accelerometer recording at the wrist without the need for additional sensors. Reliability can be increased by internal evaluation if the reconstructed signals are not needed for the whole sleep duration. The presented methodology can help to determine sleep characteristics and improve diagnostics and treatment of sleep disorders in the subjects' normal sleep environment.

Efficacy of Breast Milk Olfactory and Gustatory Interventions on Neonates' Biobehavioral Responses to Pain during Heel Prick Procedures.

This study aimed to evaluate the efficacy of breast milk odor either alone or in combination with breast milk taste (via syringe-feeding) to alleviate neonates’ biobehavioral responses to pain during heel-prick procedures. This prospective randomized controlled trial recruited 114 neonates by convenience sampling from a newborn unit of a medical center in Taiwan. Neonates were randomly assigned to three groups: control (gentle touch + human voice), control + breast milk odor, and control + breast milk odor + breast milk taste. Heart rate, oxygen saturation, and voice recordings of crying were measured across heel-prick procedures: baseline, no stimuli (stage 0); during heel prick (Stages 1–4); and recovery (Stages 5–10). Generalized estimating equations and Kaplan–Meier survival analysis compared differences in changes between groups for heart rate, oxygen saturation, and time to crying cessation. Changes in mean heart rate and oxygen saturation in neonates receiving breast milk odor or breast milk odor + breast milk taste were significantly less than those at the corresponding stage for the control group. Among neonates receiving breast milk odor or breast milk odor + breast milk taste, hazard rate ratios for crying cessation were 3.016 and 6.466, respectively. Mother’s breast milk olfactory and gustatory interventions could stabilize the biobehavioral responses to pain during heel prick procedures in neonates.

Dexmedetomidine versus magnesium sulfate as adjunct to general anesthesia in patients undergoing video-assisted thoracoscopy

BackgroundThis study was designed to evaluate the effects of infusion of magnesium sulfate compared to dexmedetomidine on the postoperative analgesic consumption and pain control in patients scheduled for video-assisted thoracoscopic surgeries (VATS). The intraoperative hemodynamics, anesthesia requirements, and recovery profile were also evaluated.ResultsThe mean arterial pressure (MAP) and heart rate (HR) recordings were significantly lower in group D than in groups C and M. The MAP recordings were significantly lower in group M than in group C with no significant difference as regards the HR recordings between both groups. Intraoperative sevoflurane and fentanyl requirements were significantly lower in groups D and M than in group C and in group D than in group M. The atracurium consumption was significantly lower in group M than in groups C and D. The time to reach modified Aldrete score ≥ 9 was significantly longer in groups D and M than in group C and in group D than in group M. Postoperative Ramsay sedation scores were significantly higher in groups D and M than in group C throughout the PACU stay and in group D than in group M in the 1st h postoperatively. The VAS score recordings were significantly lower in groups D and M than in group C and in group D than in group M except at 24-h postoperative recordings. The postoperative nalbuphine and ketorolac requirements were significantly lower in groups D and M than in group C and in group D than in group M.ConclusionsDuring VATS, patients who received dexmedetomidine had better hemodynamic stability, less intraoperative anesthetic consumption with better quality of postoperative analgesia, and less postoperative analgesic consumption but longer postoperative anesthesia recovery and higher postoperative sedation scores compared with magnesium sulfate.

Time and Effort by Labor Nurses to Achieve and Maintain a Continuous Recording of the Fetal Heart Rate via External Monitoring

ObjectiveTo describe the time and effort of labor and delivery (L&D) nurses working to achieve a continuous recording of the fetal heart rate via external fetal monitoring, as well as the types of aids involved in that process. DesignDescriptive study using a cross-sectional survey methodology. Setting/Local ProblemNurses on our L&D units were frequently repositioning laboring women and fetal monitors, and utilizing various aids to achieve continuous monitoring. No evidence to support a best practice for achieving continuous fetal monitoring was identified. ParticipantsL&D nurses practicing in New Jersey. Intervention/MeasurementsAn online survey was used to collect data from labor nurses to identify if they used aids and what types of aids they used in their practice to achieve and maintain a continuous recording of the fetal heart rate via external fetal monitoring, as well as the amount of time that they spent doing so at the bedside. ResultsOf the 134 nurses who participated in the survey, 50% reported spending 1 to 2 hours repositioning an individual, and 48.9% reported spending 1 to 2 hours per 12-hour shift manipulating the ultrasound transducer. Thus, up to one third of the shift was spent working to achieve a continuous recording of the fetal heart rate via external fetal monitoring. More than 99% (n = 133) of participants reported the use of aids. The most popular aids included supplemental monitoring equipment such as extra fetal monitor straps or improvised aids such as washcloths. ConclusionL&D nurses spend at least some time at the bedside manipulating the ultrasound transducer to achieve and maintain a continuous recording of the fetal heart rate via external fetal monitoring. Various aids are used to do so. Understanding the amount of time nurses spend at the bedside and the aids used for this purpose may provide a better understanding of the work of L&D nurses.

Physiological impacts on construction workers under extremely hot and humid weather.

Construction worker health and safety is a primary concern for construction companies and researchers. Arabian Gulf region, like Saudi Arabia, has been experiencing extremely hot and humid (EHH) weather, which directly affects construction workers' health and safety. This study aims to address the problem of EHH weather conditions and their impacts on construction workers' physiological status. This study assesses the impacts of EHH weather on construction workers' physiological status through the measurement of workers' physical body parameters (age, height, and weight); type of activities; and assigned tasks. Thirty-five multinational workers participated in the measurements, which were conducted in real construction site conditions A quantitative analysis was then applied to quantify the physiological impacts of the weather conditions. Several hypotheses were tested to identify the significant impacts of individual and working aspects on the workers' physiological responses. The results provide empirical evidence that the recorded Heart Rate (HR) exceeded the acceptable physiological zones for construction workers exposed to extremely hot and humid weather conditions. Physical body parameters, work activities, and worker status significantly influence construction workers' physiological responses. This study recommends adopting a continuous monitoring approach as an early warning system under extremely hot and humid weather conditions.

Blockade of vasopressin receptors reduces the threshold pressure of micturition reflex in female rats.

The mechanisms involved in urinary bladder control are not fully understood, but it is well accepted that a complex central network is involved in micturition control. The micturition reflex can be modulated by direct cortical influence through facilitatory and inhibitory mechanisms. In addition, humoral mechanisms are involved in the bladder control. Vasopressin increases bladder contraction and intravesical pressure. This study sought to investigate the effect of intravenous injections of vasopressin receptor antagonists on cystometric parameters in anesthetized female rats. Isoflurane anesthetized adult female Wistar rats underwent femoral artery and vein cannulation for arterial pressure (AP) and heart rate (HR) recordings, and infusion of drugs, respectively. The bladder was also cannulated for intravesical pressure (IP) recordings and infusion of saline (10 mL/h) for cystometric evaluation. After baseline AP, HR and IP recordings, saline (vehicle, 1 mL/kg), V1a (5 μg/kg) or V2 receptor antagonist (5 μg/kg) was injected i.v. and after 25 min the cystometry was carried out. Neither saline nor V1a or V2 receptor blockade evoked any change in AP, HR and IP. Nevertheless, during cystometry, the threshold pressure of the micturition reflex was significantly reduced in rats with V1a (to 19.30 ± 2.39 mmHg) and V2 receptor blockade (to 19.88 ± 2.49 mmHg) compared to the saline group (28.85 ± 2.06 mmHg, p = 0.014). No difference was observed in the other cystometric parameters. Therefore, the data suggest that blockade of V1a and V2 receptors reduces the threshold pressure of the micturition reflex and does not influence other cystometric parameters in anesthetized female Wistar rats.

Effects of severe anthropogenic disturbance on the heart rate and body temperature in free-living greylag geese (Anser anser).

Anthropogenic disturbances are a major concern for the welfare and conservation of wildlife. We recorded heart rate and body temperature of 20 free-living greylag geese in response to a major regularly re-occurring anthropogenic disturbance—New Year’s Eve fireworks. Heart rate and body temperature were significantly higher in the first and second hour of the new year, compared with the same hour on the 31st of December, the average during December and the average during January. Heart rate and body temperature was not significantly affected by sex or age. From 0200 to 0300 onwards, 1st of January heart rates did not significantly differ from the other periods; however, body temperatures were significantly increased until 0300–0400. From 0400 to 0500, heart rate was not affected by any of the investigated factors, whereas body temperature was significantly increased on the 1st of January compared with the 31st of December and the December average but not compared with the January average. To conclude, our results show that New Year’s Eve fireworks cause a substantial physiological response, indicative of a stress response in greylag geese, which is costly in terms of energy expenditure.

Intrapartum cardiotocographic monitoring and its correlation with neonatal outcome.

Despite the advancements in perinatal care in past decades, perinatal asphyxia remains a serious problem leading to significant perinatal morbidity and mortality. Therefore, foetal monitoring during the intrapartum period is of paramount importance. Among various methods of fetal monitoring, cardiotocography is a form of electronic foetal monitoring in which there is simultaneous recording of foetal heart rate and uterine contractions. This cross-sectional observational study was done in the labour room and neonatal intensive care unit (NICU) of a teaching Municipal Hospital in North India including 500 pregnant women of age group 18-45 years with singeleton fetus of gestation ≥36 weeks without any known congenital anomaly. Intrapartum cardiotocography (CTG) for 20 minutes was done within 12 hours prior to delivery and babies born to them were observed for birth asphyxia as Apgar score <7 at 1 minute as per using APGAR score less than 7 at 1 minute as per south east asia regional neonatal perinatal database (SEAR-NPD), world health organization (WHO) working definition. CTG tracing was normal/reassuring in 92% of pregnant women, nonreassuring in 7% and was abnormal in only 1%. In patients with abnormal and nonreassuring CTG, delivery by lower segment cesarian section (LSCS) was significantly high (P < .0001). APGAR scoring was done at 1 minute and 5 minutes of life, it was found that 4% babies were having score less than 7 at 1 minute with incidence of birth asphyxia 40 per 1,000 live births Neonatal seizure was significantly more in nonreassuring and abnormal CTG group (P value <.0001). Abnormal CTG tracings result in higher incidence of operative interventions for deliveries. Abnormal CTG pattern during intrapartum CTG has high specificity and negative predictive value but has low sensitivity and positive predictive value for detection of birth asphyxia and need for NICU admission.

Accuracy of Heart Rate and Respiratory Rate Measurements Using Two Types of Wearable Devices.

ABSTRACTObjectives:Wearable devices such as fitness trackers have become popular in the healthcare field. Tracking heart rate and respiratory rate, in addition to physical activity, may provide an accurate picture of daily health. We believe that a combination of two types of devices can simultaneously measure and record physical activity, heart rate, and respiratory rate. However, the measurement accuracies of these two types of devices are not clear. This study aimed to determine the measurement accuracies of two wearable devices for heart and respiratory rate measurements.Methods:Ten healthy men performed incremental load tests (ILTs) and constant load tests (CLTs) on a cycle ergometer. The heart and respiratory rates were measured using wrist-worn (Silmee W22, TDK, Japan, Tokyo) and respiratory tracking devices (Spire Stone, Spire Health, San Francisco, CA, USA), respectively. A 12-lead electrocardiograph and the breath-by-breath method were used as external standards for heart and respiratory rates, respectively.Results:Bland–Altman analysis showed that heart rate had a fixed bias at rest and during ILT and CLT and had a proportional bias during CLT. The standard error values of the regression at rest and during CLT were less than 10 bpm for heart rate and less than 5.0 /min for respiratory rate. During ILT, the standard error was greater than 10 bpm for heart rate and approximately 5.0 /min for respiratory rate.Conclusions:The heart and respiratory rate measurements obtained using wearable devices were accurate within the practical margin of error.

An Analysis of Warm-Up Strategies at a Cross-Country Skiing National Championship.

To provide a descriptive analysis of the warm-up (WU) strategies employed by cross-country skiers prior to distance and sprint competitions at a national championship and to compare the skiers' planned and executed WUs prior to the respective competitions. Twenty-one national- and international-level skiers (11 women and 10 men) submitted WU plans prior to the distance and sprint competitions, and after the competitions, reported any deviations from the plans. Skiers used personal monitors to record heart rate (HR) during WU, races, and cooldown. Quantitative statistical analyses were conducted on WU durations, durations in HR-derived intensity zones, and WU loads. Qualitative analyses were conducted on skiers' WU plans and their reasons for deviating from the plans. Skiers' planned WUs were similar in content and planned time in HR-derived intensity zones for both the distance and sprint competitions. However, 45% of the women and 20% of the men reported that their WU was not carried out as planned, with reasons detailed as being due to incorrect intensities and running out of time. WU activities including skiing across variable terrain, muscle-potentiating exercises, and heat-maintenance strategies were missing from the skiers' planned routines. Skiers favored a long, traditional WU approach for both the sprint and distance events, performing less high-intensity and more moderate-intensity exercise during their WUs than planned. In addition, elements likely relevant to successful performance in cross-country skiing were missing from WU plans.

EVALUATION OF DEXMEDETOMIDINE ON HEMODYNAMIC STRESS RESPONSE DURING LARYNGOSCOPY AND INTUBATION

Objective: To compare the efficacy of Dexmedetomidine (Precedex) in addressing the mean haemodynamic stress response to laryngoscopy and endotracheal intubation (L&amp;I).&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Anesthesiology Department, Combined Military Hospital, Rawalpindi, from Jun 2019 Jun 2020.&#x0D; Methodology: The patients were divided into two groups. Group A was given Inj. Dexmedetomidine and group B (placebo). Operation theatre assistant randomly assigned the patients to either group A or group B each day. The second person administered the drug or placebo. The third person (researcher) recorded all the parameters mentioned in the proforma.&#x0D; Results: There were 100 patients with an age range of 18-60 years. The majority of the patients were ASA-I physical status. The main surgical procedure was laparoscopic cholecystectomy. Recording of heart rate and systolic blood pressure during laryngoscopy and intubation, after administration of drug or placebo, showed mean heart rate less than mean basal value in group-A and 22% above mean basal value in group-B, and it was statistically highly significant (p-value &lt;0.001). Whereas mean systolic blood pressure in group-A was 122.42 ± 14.91 (less than the mean basal value) as compared to group B, 155.00 ± 18.32/min (20% above mean basal value). This change was also statistically highly significant (p-value &lt;0.001).&#x0D; Conclusion: It is concluded that dexmedetomidine showed statistically significant stabilizing effects on the expected changes of the hemodynamic stress response.

Detection of Clenbuterol-Induced Changes in Heart Rate Using At-Home Recorded Smartwatch Data: Randomized Controlled Trial.

BackgroundAlthough electrocardiography is the gold standard for heart rate (HR) recording in clinical trials, the increasing availability of smartwatch-based HR monitors opens up possibilities for drug development studies. Smartwatches allow for inexpensive, unobtrusive, and continuous HR estimation for potential detection of treatment effects outside the clinic, during daily life.ObjectiveThe aim of this study is to evaluate the repeatability and sensitivity of smartwatch-based HR estimates collected during a randomized clinical trial.MethodsThe data were collected as part of a multiple-dose, investigator-blinded, randomized, placebo-controlled, parallel-group study of 12 patients with Parkinson disease. After a 6-day baseline period, 4 and 8 patients were treated for 7 days with an ascending dose of placebo and clenbuterol, respectively. Throughout the study, the smartwatch provided HR and sleep state estimates. The HR estimates were quantified as the 2.5th, 50th, and 97.5th percentiles within awake and asleep segments. Linear mixed models were used to calculate the following: (1) the intraclass correlation coefficient (ICC) of estimated sleep durations, (2) the ICC and minimum detectable effect (MDE) of the HR estimates, and (3) the effect sizes of the HR estimates.ResultsSleep duration was moderately repeatable (ICC=0.64) and was not significantly affected by study day (P=.83), clenbuterol (P=.43), and study day by clenbuterol (P=.73). Clenbuterol-induced changes were detected in the asleep HR as of the first night (+3.79 beats per minute [bpm], P=.04) and in the awake HR as of the third day (+8.79 bpm, P=.001). The median HR while asleep had the highest repeatability (ICC=0.70). The MDE (N=12) was found to be smaller when patients were asleep (6.8 bpm to 11.7 bpm) than while awake (10.7 bpm to 22.1 bpm). Overall, the effect sizes for clenbuterol-induced changes were higher while asleep (0.49 to 2.75) than while awake (0.08 to 1.94).ConclusionsWe demonstrated the feasibility of using smartwatch-based HR estimates to detect clenbuterol-induced changes during clinical trials. The asleep HR estimates were most repeatable and sensitive to treatment effects. We conclude that smartwatch-based HR estimates obtained during daily living in a clinical trial can be used to detect and track treatment effects.Trial RegistrationNetherlands Trials Register NL8002; https://www.trialregister.nl/trial/8002

346 Baroreflex sensitivity and autonomic function in Takotsubo syndrome long after the acute phase

Abstract Aims Takotsubo Syndrome (TS) occurs as an acute coronary syndrome (ACS) characterized by severe left ventricular (LV) dysfunction that typically recovers spontaneously within days or weeks and in the absence of obstructive coronary artery disease. Although during the acute phase it is well documented that an exaggerated sympathetic tone plays a central role in the development of TS, whether an impaired sympatho-vagal balance may persist long after the acute phase, despite the recovery of left ventricular function, is still an open issue. Interestingly, recent evidences suggest that an impairment in central autonomic network not only persist long after the acute event but also may be pre-existent before the acute onset of TS. The Aim of the study was to investigate whether an impairment of the autonomic function is still present long after a TS event. Methods and results We evaluated 67 patients (91% female, mean age 66 ± 8 years) divided into three groups: 24 with a history of TS (1 year after acute event), 21 subjects with a previous history of acute coronary syndrome (ACS) and complete LV ejection fraction recovery (1 year after acute event) and 22 age- and gender-matched healthy subjects. All patients underwent a non-invasive beat-to-beat arterial blood pressure and heart rate recording (short term: 5 min), after at least 3 days of β-blockers wash-out, to obtain heart rate variability (HRV) and spontaneous baroreflex sensitivity (sBRS) data. An overall autonomic dysfunction was found in both TS and ACS groups compared to controls. In particular, a lower heart rate variability, expressed as lower SDNN, has been found in TS and ACS groups compared to controls (31 ± 12 vs. 25 ± 11 vs. 41 ± 22; P = 0.006—Figure A) as a consequence of blunted vagal tone, expressed as lower RMSSD (20 ± 12 vs. 19 ± 11 vs. 40 ± 37; P = 0.007—Figure B) and higher sympathetic tone, expressed as higher LF/HF ratio (P = 0.007 Figure C) which was found to be higher in TS even when compared to ACS (TS: 3.5 ± 2.5 vs. ACS: 2.1 ± 1.7; P = 0.011). Moreover, fractal analysis of HRV showed higher complexity of heart rate regulation, expressed as higher fractal dimension (DFA 1.48 ± 0.06 vs. 1.53 ± 0.05 vs. 1.40 ± 0.10; P &amp;lt; 0.0001—Figure D), in both TS and ACS compared to controls. Interestingly, spontaneous BRS showed the lowest values in the TS group (sSBP: 5.6 ± 2.6 vs. 7.5 ± 3.0 vs. 12.1 ± 11.9; P = 0.027—Figure E), associated with highest levels of sympathetic peripheral control of systolic blood pressure (SBP), expressed as LF-BRS (13.7 ± 9.6 vs. 8.3 ± 5.2 ± 6.8 ± 5.8; P = 0.008—Figure F). Conclusions An autonomic dysfunction, characterized by a hyper-sympathetic tone, reduced baroreflex sensitivity and increased peripheral adrenergic control of blood pressure, persists in TS patients long after the acute phase.

Prenatal Diagnosis of a Lethal Skeletal Dysplasia.

Prenatal Diagnosis of a Lethal Skeletal Dysplasia.

Evidence of an active Cushing reflex in a preterm neonate with hyaline membrane disease: a case report

BackgroundThe Cushing reflex does not appear to have been described in preterm neonates. This case report shows the presence of an active Cushing reflex in a 32-week preterm neonate with hyaline membrane disease.Case presentationThe 1.94 kg Caucasian infant was delivered by caesarean section following concerns about possible maternal infection and fetal compromise. Chest X-ray showed mild-to-moderate hyaline membrane disease and treatment was initiated with supplemental oxygen and nasal continuous positive airway pressure. It is probable that a pneumothorax occurred at 5–6 hours of age, with progression during the day. Interstitial air, pneumomediastinum, and tension pneumothorax were diagnosed on subsequent X-ray, and ultrasound of the brain showed a grade IV intraventricular hemorrhage. A review of the nurses’ recordings of heart rate, blood pressure, and respiratory rate showed a progressive increase in blood pressure accompanied by slowing of the heart rate and irregular respiration. These are features of the Cushing reflex that is elicited in response to raised intracranial pressure.ConclusionWhile well-described in older children and adults, in neonates the Cushing reflex has mainly been described in animal experiments and infants who have developed hydrocephalus. It is likely that in this case, the reflex was elicited as a result of a progressive increase in intracranial pressure due to the combination of elevated intrathoracic pressure, obstructed venous return from the brain, and concurrent intraventricular hemorrhage.

Comparison of Intravenous Dexmedetomidine versus Labetalol for Their Effectiveness in Suppression of Haemodynamic Response during Extubation

Background: Tracheal extubation causes autonomic nervous system disturbances which causes tachycardia, hypertension which are harmful in susceptible patients.so we conducted a study between iv Dexmedetomidine and iv Labetalol to assess their effectiveness in decreasing haemodynamic disturbances during extubation. Materials and Methods:we included 100 participants of age of 18-55 yrs with ASA grading I &amp; II and divided them into 2 groups. Group D was given injection Dexmedetomidine 0.6mcg/kg iv and Group L was given injection Labetalol 0.25mg/kg body weight. We recorded Heart rate, systolic and diastolic blood pressure at baseline, 2,5,8 minutes post drug injection, at extubation and 1,3,5,8,10 and 15 minutes after extubation. Results: Group D had better decreased heart rate, systolic and diastolic blood pressure at the time of extubation, and also 15 minutes post extubation in comparison to Group L. Conclusion: Injection Dexmedetomidine 0.6µg/kg has showed a better attenuating effect on sympathoadrenal system during extubation than injection Labetalol 0.25mg/kg Keywords: Dexmedetomidine, labetalol, extubation,hemodynamics.