Respuesta autonómica cardiovascular al estrés mental inducido por la prueba de cálculo aritmético / Autonomic cardiovascular response to mental stress induced by the arithmetic computation test

Introducción: El estrés mental agudo, así como los estados de ansiedad inducidos para influenciar la reactividad psicofisiológica en jóvenes sanos, aportan cambios en los patrones nerviosos que pueden ser medidos mediante la variabilidad de la frecuencia cardiaca. Objetivo: Determinar las diferencias en los parámetros lineales del balance autonómico cardiovascular en individuos jóvenes en estado basal y durante la prueba de cálculo aritmético. Métodos: Se realizó un estudio cuasi-experimental, sin grupo control de tipo antes y después, en el Laboratorio de Ciencias Básicas Biomédicas de la Universidad de Ciencias Médicas de Santiago de Cuba. Población y muestra de 10 sujetos. Se registró el trazado electrocardiográfico (5 min) durante el reposo y luego durante la prueba de cálculo aritmético. Resultados: Existieron diferencias significativas entre ambos estados en las variables frecuencia cardiaca (p = 0,005); mínima (p = 0,007); máxima (p = 0,005); intervalo RR (p = 0,005); stress index (p = 0,028); índice simpático (p = 0,005); bajas frecuencias (p = 0,005); relación LF/HF (p = 0,005); RMSSD (p = 0,007); NN50 (p = 0,008); pNN50 (p = 0,005); índice parasimpático (p = 0,005) y altas frecuencias (p = 0,005). El estrés mental provocó una disminución parasimpática y un predominio simpático uniforme en todos los sujetos participantes en el estudio. Conclusiones: Durante el estrés mental inducido por la prueba de cálculo aritmético la dinámica lineal de la respuesta autonómica cardiovascular experimenta un aumento en la actividad simpática y una disminución del tono parasimpático, traduciendo una respuesta adaptativa en la regulación de la función cardiovascular por el sistema nervioso autónomo(AU)

Introduction: Acute mental stress and states of anxiety induced to influence psychophysiological reactivity in healthy young people, result in changes in nervous patterns which may be measured in terms of heart rate variability. Objective: Determine the differences in linear parameters for autonomic cardiovascular balance in young individuals at baseline and during the arithmetic computation test. Methods: A non-observational quasi-experimental before-after study without a control group was conducted at the Basic Biomedical Sciences Laboratory of the University of Medical Sciences of Santiago de Cuba. The study population and sample was 10 subjects. The electrocardiographic tracing (5 min) was recorded at rest and then during the arithmetic computation test. Results: Significant differences were found between the two states as to the variables heart rate (p = 0.005), minimum (p = 0.007), maximum (p = 0.005), RR interval (p = 0.005), stress index (p = 0.028), sympathetic index (p = 0.005), low frequencies (p = 0.005), LF/HF ratio (p = 0.005), RMSSD (p = 0.007), NN50 (p = 0.008), pNN50 (p = 0.005), parasympathetic index (p = 0.005) and high frequencies (p = 0.005). Mental stress caused a parasympathetic reduction and uniform sympathetic predominance in all the subjects participating in the study. Conclusions: During the mental stress induced by the arithmetic computation test, the linear dynamic of the autonomic cardiovascular response experiences an increase in sympathetic activity and a reduction in parasympathetic tone, displaying an adaptive response in cardiovascular function regulation by the autonomous nervous system(AU)

Variabilidad de la frecuencia cardiaca como factor predictor de las enfermedades cardiovasculares / Heart rate variability as a predictive factor of cardiovascular diseases

Resumen La variabilidad de la frecuencia cardiaca se conoce como la variación en el tiempo que transcurre entre los intervalos RR del electrocardiograma y refleja la actividad del sistema nervioso autónomo sobre la función cardiaca. Su aumento se considera un factor protector para el corazón y su medición podría ser una herramienta predictiva temprana o diagnóstica en enfermedades cardiovasculares. El sistema nervioso autónomo genera efectos inotrópicos y cronotrópicos en la función cardiaca, que pueden aumentar o disminuir esta variabilidad. Existen diversos métodos de medición de la variabilidad de la frecuencia cardiaca; el más común es el Holter seguido por el sistema POLAR, además se han desarrollado programas de software clínico (Kubios®, Sinus Core®) que han demostrado validez en estas mediciones. La variabilidad de la frecuencia cardiaca puede emplearse como factor predictor en la aparición de eventos coronarios, accidentes cerebrovasculares y muerte súbita, entre otros.

Abstract Heart rate variability is defined as the variation in time between the RR intervals of the electrocardiogram, and reflects the activity of the autonomous nervous system over cardiac function. Its increase is considered as a protective factor for the heart, and its measurement could be used as a tool for the early prediction or diagnosis of cardiovascular diseases. The autonomous nervous system generates inotropic and chronotropic effects on cardiac function, which can increase or decrease this variability. There are several methods for measuring heart rate variability. The most common is the Holter device, followed by the Polar system. Clinical computer programs have also been developed (Kubios®, Sinus Core®) that have shown to be valid in the measurements. Heart rate variability may be used as a predictive factor for the appearance of coronary events, including among others, cerebrovascular accidents and sudden death.

Variabilidade da frequência cardíaca em diferentes posições corporais e durante MASR em amputado unilateral de membro inferior / Variability of heart beat frequency in different body positions and during MASR in a person with lower member unilateral amputation

A amputação leva a redução da mobilidade e atividade física afetando os sistemas musculoesquelético, respiratório e cardiovascular. Nosso objetivo foi analisar a variabilidade da frequência cardíaca (VFC) em diferentes posições corporais e durante a Manobra de Arritmia Sinusal Respiratória (MASR) em amputados unilaterais de membros inferiores (MMII) protetizados. Estudo transversal, amostra de conveniência, avaliou 07 amputados homens de origem traumática e registradas as variáveis clínicas e VFC nas posições supino, ortostase, sedestação (10 minutos) e durante a MASR (4 minutos). Em repouso os sujeitos apresentam predominância da modulação simpática que se acentua quando assume a posição de ortostase (p = <0.01) e atenuação da complexidade autonômica (p = 0,04). Os amputados não responderam de modo adequado à MASR e observou-se alteração na complexidade da VFC (0,04). Amputados unilaterais de MMII protetizados demonstraram comportamento esperado durante a mudança ativa de postura e respostas adversas à MASR

Amputation causes decrease of mobility and physical activities, affecting the muscle-skeleton, respiratory and cardiovascular systems. Variability of heart frequency (VFC) at different body positions and during Respiratory Sinus Arrhythmia (RSA) was analyzed in people with amputation of unilateral lower members with prosthesis (MMII). Current transversal study, with convenience sample, evaluated seven males with trauma-caused amputations. Clinical variations and VFC were registered with regard to supine position, orthostasis, sedestation (10 min) and during RSA (4 min). The subjects at rest showed a predominance in increasing sympathetic modulation as the orthostatic position is achieved (p = <0.01) and attenuation of autonomic complexity (p = 0.04). People with amputation failed to respond adequately to RSA and alterations were detected in VFC complex (0.04). Unilateral amputated people with prosthesis showed expected behavior during active changes in posture and adverse responses to RSA

Avaliação da modulação autonômica em indivíduos com síndrome de Down na equoterapia / Autonomic modulation of assessment in individuals with Down syndrome in hippotherapy

Introdução: A equoterapia é uma modalidade terapêutica que atende em grande parte os indivíduos com síndrome de Down, por apresentarem alterações motoras, cognitivas e sócio-afetivas. Sabe-se que as alterações na frequência cardíaca são moduladas pelo Sistema Nervoso Autônomo, entretanto, na literatura não há descrições sobre a Variabilidade de Frequência Cardíaca nestes praticantes, sobretudo na atividade relacionada à equoterapia. Objetivos: Avaliar a Variabilidade da Frequência Cardíaca de pacientes com Síndrome de Down antes, durante e após sessões de equoterapia. Métodos: Foram recrutadas 6 crianças com Síndrome de Down, idade média 12 ± 1,6 anos. A Frequência Cardíaca foi avaliada com um cardiofrequencímetro - Polar (RS800CX), antes, durante e após 5 sessões semanais. Resultados: Houve tendência a diminuição da atividade parassimpática no repouso inicial entre primeira e quinta sessão; e diminuição significativa da atividade parassimpática observada pelo índice pNN50 ao comparar a Frequência Cardíaca durante a primeira e quinta sessões. Conclusão: O tratamento equoterapêutico apresentou uma tendência à diminuição da Variabilidade da Frequência Cardíaca nas crianças estudadas.

Introduction: The hippotherapy is a therapeutic modality that serves largely individuals with Down syndrome, because they have motor, cognitive and socioemotional changes. It is known that changes in heart rate are modulated by the autonomic nervous system, however, in the literature there are no descriptions of the variability of heart rate in these practitioners, especially in the activity related to hippotherapy. Objectives: To evaluate Heart Rate Variability in practitioners of hippotherapy with Down Syndrome. Methods: Six children with Down Syndrome were recruited, age rate of 12 ± 1.6 years. The Heart Rate were evaluate using a cardiofrequencimetre ­ Polar (RS800CX), before, during and after 5 sessions of hippotherapy once weekly. Results: There were tendency of decrease in the parasympathetic activity during initial rest between first and fifth sessions, and significant decrease of the parasympathetic activity observed by the value of pNN50 compared to the Heart Rate during the first and fifth sessions. Conclusions: This study has shown that children treated with hippotherapy had tendency to have their Heart Rate Variability decreased.

Hipertensión arterial resistente. Tratamiento con denervación renal percutánea / Resistant hypertension. Treatment with percutaneous renal denervation

Se presentan tres casos de hipertensión arterial resistente en mujeres, sin respuesta clínica adecuada al tratamiento médico farmacológico con más de cinco clases de antihipertensivos diferentes, en dosis y con esquemas de prescripción apropiados. Se descartaron las causas secundarias de hipertensión y posteriormente se les hizo terapia de denervación renal percutánea que fue exitosa y no tuvo complicaciones; el seguimiento clínico demostró mejoría significativa en el control de las cifras de tensión arterial.

We report the cases of three women with resistant hypertension who had no adequate response to pharmacological treatment with more than five classes of different anti-hypertensive drugs given in optimal doses and with appropriate schedules. Secondary causes of hypertension were ruled out. Percutaneous renal denervation therapy was successful and without complications. Clinical follow-up revealed significant improvement in the control of hypertension.

Frecuencia cardiaca en la bipedestacion activa inmediata en jóvenes sanos / Heart rate in the immediate active bipedal posture in healthy young people

OBJETIVO: caracterizar la dinámica de los cambios de la frecuencia cardíaca durante la bipedestación activa inmediata en sujetos jóvenes. MÉTODOS: se evaluaron 132 jóvenes supuestamente sanos, con edades entre 18 y 25 años. Se registró digital y continuamente la actividad electrocardiográfica en decúbito supino y al inicio de la bipedestación activa, se obtuvo las secuencias de intervalos RR de forma automática y verificada por un especialista, con el RITMOCARD v. 3.2. Se procesaron las series de cardiointervalos con el VFC32. Se estudió la frecuencia cardíaca usando 27 indicadores, agrupados en: posicionales y ordinales, de promedio, de la velocidad de los cambios, relacionales y temporales. RESULTADOS: se obtuvieron los valores medios y desviación estándar de los principales indicadores vitales en el grupo de sujetos sanos. Los indicadores usados permitieron caracterizar al grupo durante las complejas y rápidas interacciones que se producen en el cambio de posición. Los valores de estos indicadores pueden servir como referencia, para ser utilizados en la selección de personal y el control de salud en un grupo de edades de gran importancia medico-militar. CONCLUSIONES: la caracterización de la dinámica de la respuesta de la frecuencia cardíaca en la bipedestación activa inmediata de jóvenes del sexo masculino cubanos, puede ser útil para la selección de personal militar

OBJECTIVE: to characterize the dynamics of changes in heart rate during active and immediate bipedal posture in young people. METHODS: a total of 132 supposedly healthy young people aged between 18 and 25. The supine electrocardiography activity was digital and continuously registered and at onset of active bipedal posture obtaining the RR interval frequencies in automated way and verified by a specialist using the RITMOCARD version 3.2. The cardiac intervals series assisted by VFC32 were processed. The heart rate was studied using 27 indicators grouped in: positional and ordinate, of average, of change velocity, relational and temporary. RESULTS: median values and standard deviation from the main vital indicators in healthy subjects group. The used indicators allowed us to characterize the group during the complex and fast interactions producing in the position change. Values of these indicators may serve as reference to be used in the staff selection and in the health control in an age group of very medical-military significance. CONCLUSIONS: characterization of heart rate response dynamics in immediate active bipedal posture of Cuban young males may be useful for military staff selection

Caracterização da variabilidade de freqüência cardíaca e sensibilidade do barorreflexo em indivíduos sedentários e atletas do sexo masculino / Characterization of heart rate variability and baroreflex sensitivity in sedentary individuals and male athletes

INTRODUÇÃO: A capacidade de variar a freqüência cardíaca representa importante papel fisiológico na vida diária. As variações dos intervalos RR estão na dependência de moduladores biológicos, como o sistema nervoso autônomo. Essas variações constituem a variabilidade da freqüência cardíaca (VFC). MÉTODOS: 10 indivíduos atletas (Atl) e 10 sedentários (Sed) (20-35 anos) foram submetidos a eletrocardiografia digital, em repouso, antes, durante e após a manobra. Os valores de RR foram tratados (software Matlab 6.1), no domínio do tempo. RESULTADOS: Os grupos Sed e Atl apresentaram freqüência cardíaca média igual a 73,59bpm ± 2,5 e 51,01bpm ± 2,4, respectivamente. Quanto aos intervalos RR, o grupo de Sed apresentou média de 826,58ms ± 5,3 e o grupo Atl, 1.189,18 ± 6,9. O tempo de retorno simpático após a manobra 72 ± 12s (Sed) 37 ± 6s (Atl). O tempo de retorno parassimpático foi de 80 ± 11s (Sed) 40 ± 8s (Atl). O pNN50 foi de 10 ± 3,3 (Sed) e 42,10 ± 6,9 (Atl). O valor da variação dos RR acima da média de todo o sinal foi de 343 ± 40ms (Sed) e 175 ± 39ms (Atl). A variação abaixo da média de todo o sinal foi de 281 ± 27ms (Sed) e 425 ± 26ms (Atl). CONCLUSÕES: A análise da VFC associada à manobra de Valsalva pode representar uma ferramenta simples, mas importante, para possíveis inferências sobre aptidão física.

INTRODUCTION: The capacity to vary the heart rate represents important physiologic role in the daily life. The variations of the RR intervals is dependent of biological modulators as the autonomic nervous system. Those variations constitute the heart rate variability (HRV). METHODS: 10 athletes (Atl) and 10 sedentary (Sed) male individuals (20-35 age) were submitted to digital electrocardiography, in rest, before, during and after the maneuver. The values of RR were analyzed (software Matlab 6.1), in the time domain. RESULTS: Both Sed and Atl presented mean heart rate of 73.5 bpm ± 2,5 and 51 bpm ± 2,4, respectively. Related to the RR intervals, the group of Sed presented average of 826.58 bad ± 5.3 and the group Atl, 1189.18 ± 6.9. The return time of sympathetic system after the maneuver was 72 ± 12 s (Sed) 37 ± 6 s (Atl). The return time of parasympathetic system was 80 ± 11 s (Sed) and 40 ± 8 s (Atl). The pNN50 was of 10 ± 3,3 (Sed) and 42,10 ± 6,9 (Atl). The value of RR variation above the average of the whole sign was 343 ± 40 (Sed) and 175 ± 39 (Atl). The RR variation below the average of the whole sign was 281 ± 27 (Sed) and 425 ± 26 (Atl). CONCLUSIONS: The analysis of HRV associated to the Valsalva maneuver can represent a simple, but important tool, for possible inferences on physical aptitude.

Variabilidad de la frecuencia cardiaca en pacientes con infarto agudo del miocardio / Variability of heart rate in patients with acute myocardial infarction

Se analizó el efecto que tiene el infarto agudo del miocardio sobre el equilibrio neurovegetativo, tanto en el dominio del tiempo como de las frecuencias. Se escogió un grupo de pacientes con infarto a los que se les realizó un estudio de variación de intervalos RR . Se obtuvieron parámetros en el dominio del tiempo y de las frecuencias. La variabilidad de la frecuencias se encontró disminuida después de un infarto agudo del miocardio. Se puso de manifiesto un marcado incremento del tono simpático, factor predisponente importante en la aparición de complicaciones tardías en los pacientes, lo que constituye un marcador superior a la fracción de eyección del ventrículo izquierdo para pronosticar eventos arrítmicos, y su combinación con los otros marcadores de riesgo permite mejorar la exactitud predictiva positiva.

The effect of acute myocardial infarction on the neurovegetative balance was analyzed for the control of time and frequencies. A group of patients with infarction that underwent a study of variation of RR intervals was selected. Parameters in the control of time and frequencies were obtained. The variability of the frequencies was reduced after an acute myocardial infarction. It was observed a marked increase of the sympathetic tone, an important predisposing factor in the appearance of late complications in patients, that constitutes a better marker than the left ventricle ejection fraction for the prognosis of arrhythmic events. Its combination with other risk markers allows to improve the positive predictive accuracy.

Stanger-Bath "Ascending" or "Descending" / 日本温泉気候物理医学会雑誌

Since hydrogalvanic baths have been used for treatment various diseases have been claimed to be positively influenced by the so-called Stanger-bath. Its analgesic properties are generally accepted. It is also common practice to use “ascending” direct currents (cathode near the head, anode near the feet) for the stimulation and the reverse polarization (“descending”) for the relaxation of the patient, although there are hardly any controlled studies on this issue. In three test series “ascending” and “descending” Stanger-baths were compared. The effects on the autonomous nervous system, on the reaction time, on the concentration capability and on the subjective state of relaxation and well-being were evaluated in healthy volunteers. In none of the trials there was a significant difference between “ascending” and “descending” Stanger-baths.<br>The data do not confirm the common practice to use “ascending” Stanger-baths for stimulation and “descending” Stanger-baths for relaxation.