ABSTRACT
Background: Sudden cardiac death in patients with Rheumatoid Arthritis has been attributed to the decreased vagal drive to the heart. Objective: To assess cardiac parasympathetic nerve function status in patients with Rheumatoid Arthritis (RA). Methods: This cross sectional study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from January to December 2010. Sixty female RA patients aged 18-50 years were included in the study group. They were enrolled from the Out Patient Department of Rheumatology Wing of the Department of Medicine, BSMMU, Dhaka. For comparison age matched thirty apparently healthy females were also studied as control. To assess parasympathetic nerve function status, all the subjects were examined by three noninvasive cardiovascular reflex tests such as heart rate response to valsalva maneuver (valsalva ratio), heart rate response to deep breathing and heart rate response to standing (30th :15th ratio). For statistical analysis independent sample t test was used. Results: Mean values of valsalva ratio, deep breathing test and 30th :15th ratio were significantly (p<0.001) lower in rheumatoid arthritis patients compared to those of healthy control. Conclusion: From this study it may be concluded that lower cardiac parasympathetic nerve activity characterized the autonomic nerve dysfunction in patients with Rheumatoid Arthritis.
ABSTRACT
Objective To observe autonomic nerve function damage in diabetic patients with gastrointestinal symptoms. Methods Twenty-four patients of diabetes mellitus (DM) with gastrointestinal symptoms, as well as 20 cases of DM without gastrointestinal symptoms and 17 health volunteers were recruited from the clinic of gastroenterology, Jishuitan Hospital, Beijing during December 2008 to May 2009, and standard cardiovascular reflex test was performed for all of them to determine their functions of the autonomic nerve. Results Respiratory rate (an indicator of parasympathetic nerve function) was ( 14 ± 5 ) times per minute in patients of DM without dyspepsia, obviously lower than that in healthy controls [(20±10) times per minute], and that in patients of DM with dyspepsia was (9 ±6) times per minute, obviously lower than that in healthy controls and asymptomatic ones ( P ＜ 0. 05 ). Scores of five indicators of the autonomic nerve functions, and the sympathetic, parasympathetic nerve and overall autonomic nerve functions were significantly higher in patients of DM with gastrointestinal symptoms than those in the patients without dyspepsia and healthy controls. Abnormality rate of autonomic nerve functions was 96 percent (23/24) in the patients with dyspepsia, 58 percent (14/24) in those definitely and seriously involved, and five percent (1/20) in those without dyspepsia. Conclusions Autonomic neuropathy exists in most diabetic patients with dyspepsia, both sympathetic and parasympathetic nerve involved. Impairment of parasympathetic nerve function occurs earlier than that of sympathetic nerve in patients of DM.
ABSTRACT
Background: In postmenopausal women, the risk of cardiovascular diseases gradually increases and alterations in autonomic nerve functions commonly affect cardiac vagal control. Objective: To observe some aspects of parasympathetic nerve function status in apparently healthy post menopausal women. Method: This cross sectional study was carried out in the Department of Physiology Bangabandhu Sheikh Mujib Medical University. In this study, 30 postmenopausal women with age 45 to 60 years were included in group B (study group) and 30 premenopausal women aged 20 to 30 years were taken in group A (control group). They were further divided into group A1(menstrual),A2(follicular), A3(luteal) according to phases of menstrual cycle during which they were studied. Serum estrogen and progesterone levels were measured in postmenopausal women and also during follicular and luteal phases in premenopausal women and were estimated by MEIA technique. To assess parasympathetic nerve function status, three noninvasive cardiovascular reflex tests such as heart rate response to valsalva maneuver, heart rate response to deep breathing and heart rate response to standing were performed in all the subjects. Data were collected by recording ECG in resting conditions. For statistical analysis, unpaired t test and multiple regression analysis was used. Results: In postmenopausal women, serum estrogen and progesterone levels were significantly (p<0.001) lower compared to those of follicular and luteal phases of premenopausal women except progesterone level during follicular phase which was though lower but not statistically significant. Heart rate response to valsalva maneuver were almost similar in all the groups.Heart rate response to deep breathing and heart rate response to standing were significantly lower in group B than those of group A1, A2 and A3 respectively. On regression analysis parasympathetic nerve function in post postmenopausal women showed significant association with estrogen level. Conclusion: From this study it may be concluded that parasympathetic nerve function was lower in postmenopausal women, which may be related to decreased level of estrogen.
ABSTRACT
Background: Autonomic control on cardiovascular activity is modified with age. Impaired autonomic nerve functions are common features of patients suffering from cardiovascular diseases particularly in old age. Objective: To observe the influence of aging process on parasympathetic nerve function. Study design: This observational study was conducted in the Department of Physiology, BSMMU, Dhaka during the period of July 2005 to June 2006. For this purpose, 60 apparently healthy elderly subjects of both sexes were selected as study group and divided into two groups-one group consisted of 30 elderly subjects with age ranged from 51-60 years and another group consisted of 30 elderly subjects with age ranged from 61-70 years. Thirty sex and BMI matched healthy adults with age ranged from 21-30 years were studied as control. Methods: Parasympathetic nerve function status of all the subjects were assessed by three simple non-invasive cardiovascular reflex tests. These were heart rate response to valsalva maneuver, heart rate response to deep breathing and heart rate response to standing (30th:15th ). For statistical analysis one way ANOVA (Post Hoc Test) and the Pearson’s correlation co-efficient tests were done. Results: Mean (± SD) of valsalva ratio were 1.50±0.23, 1.32±0.14 and 1.28±0.15; HR response to deep breathing test were 25.36±3.90, 18.82±3.35 and 15.96±3.54 beats/min; 30th:15th ratio in standing test were 1.100.06, 1.05±0.03 and 1.04±0.02 in 21- 30, 51-60 and 61-70 years age groups respectively. All the 3 parameters were significantly lower in both elderly groups compared to that of control adults (p<0.001) Again, HR response to deep breathing was significantly lower in 61-70 years age group compared to that of 51-60 years age group. Valsalva ratio and 30th:15th ratio were also lower in 61-70 years age group than that of 51-60 years group but the differences were not statistically significant. All the 3 parameters were negatively correlated with age which were statistically significant. Conclusion: From this study it may concluded that aging process substantially impaired cardiovascular parasympathetic nerve functions.