Valsalva ratio: Assessment of autonomic modulation in patients of cervical spondylosis

Background: Cervical spondylosis is a common progressive degenerative disorder of the human spine often caused by the natural aging process. Osteophytic formations contribute to biomechanical changes that result in neural and vascular compression. The spinal compression of the obliquely passing cervical nerve roots can result in possible autonomic imbalance in the body. Valsalva maneuver is a simple, non-invasive and cost effective means to assess the autonomic activity. The results are appreciably reproducible if done properly under standardized conditions. Valsalva ratio is an important index of the baroreflex-mediated bradycardia and gives a fair idea about the parasympathetic tone. Aim: The aim of our study was to assess the level of autonomic activity by studying the valsalva ratio in patients with cervical spondylosis and to compare it with healthy controls. Materials and methods: This prospective random case control study was conducted at Pt. B. D. Sharma PGIMS, Rohtak. The study sample comprised of group I consisting of thirty randomly selected age and sex matched healthy controls and group II of thirty patients diagnosed with cervical spondylosis (age group 30-60 years of either sex). Results: In our study, valsalva ratio was found to be significantly low (p<0.01) in patients of cervical spondylosis as compared to healthy individuals. Conclusion: Altered parasympathetic tone can predispose the patients to hemodynamic instability leading to adverse cardiovascular implications in the long run.

Valsalva ratio: a measure of stress in first year medical students.

Background: The Valsalva manoeuvre is commonly used as a method of assessing normal or disordered Autonomic control of Blood pressure and Heart Rate. Continuous changes in sympathetic and parasympathetic neural inputs exhibits alteration in Heart Rate and blood pressure which causes oscillation of R-R interval. Acute and short term stress leads to rapid changes throughout the body. Almost all body system gear up to meet the perceived dangers (stress).When healthy subjects are acutely stressed Heart rate increases and R-R interval on ECG decreases transiently. The purpose of the study is to see the changes in VMM in prestress and stress conditions. Methods: 56 non-smoking apparently healthy first year medical students (26 males and 26 females) were selected for the present study. Data collected two month prior to the examination as prestress values and during examination as during stress values. Data analyzed using Wilxcon Rank signed 2 tailed test and the sub groups data analyzed paired t test. Results: 11.54% males and 19.23% females had mild stress in prestress condition. During stress 46.15% males and 19.23% females had mild stress while 34.62% males and 57% of females had severe stress. The female had more stress as compared to males both in prestress and during stress conditions. Conclusion: We conclude that VR is affected by the academic stress in the first year medical students and that among them females are more affected which may be due to the new environment and new protocol of the education system.

Evaluation of Arterial Pulse Amplitude Ratio and Valsalva Ratio in Different Age Groups.

Aims: To construct normal values of Valsalva ratio for heart rate responses during Valsalva maneuver (VM) and arterial pulse amplitude ratio as reference values for different age groups, and to investigate the effect of aging alone , without , the presence of risk factors, on autonomic nervous system. This is a case control study, performed in Marjan teaching hospital, in Hilla city, from February 2012 to June 2012. Methodology: 40 subjects were included in this study, all were healthy males, group 1 (G1) mean age 28.3±9.7 years, group 2 (G2) mean age 48.4±7.1 years. Strips of lead II of ECG were recorded during performance of VM for calculation R-R intervals and measurement of blood pressure during phase I and phase II by mercury sphygmomanometer. Calculation of Valsalva ratio for heart rate and arterial pulse amplitude ratio for both groups were done. Results: The systolic and diastolic blood pressures of G2 were significantly higher than values of systolic and diastolic blood pressures of G1 at phase I and phase II of VM (P=0.05). Pulse pressure for the two groups at phase I (G1:51±11, G2: 53±13mmHg) and phase II (G1:41±5, G2:41±3.99) of VM were not significant (P>0.05). Valsalva ratio for G1 was (1.5±0.3) and for G2 was (1.39±0.29), pulse amplitude ratio for G1 was (0.80±0.19) and for G2 was (0.77±0.19). There were no significant differences between the two groups (P>0.05). All values were expressed as mean±SD. Conclusions: The results showed that the autonomic nervous system is intact in the older group. The aging process, without the presence of risk factors, does not affect the autonomic nervous system.

Clinical assessment of the autonomic nervous system in diabetes mellitus and its correlation with glycemic control.

Aim: Clinical assessment of the autonomic nervous system in Diabetes mellitus (DM) and its correlation with glycemic control. STUDY DESIGN: Cross sectional study of 50 adult diabetes patients. Materials and Methods: Fifty patients with DM who were on regular treatment with either insulin and/or oral hypoglycemic agents were studied. Cardiovascular autonomic neuropathy (CAN) score was calculated using the clinical test variables. Results: Of the 50 patients 30 had no CAN, 10 had early CAN and 10 had severe CAN. The mean of CAN score increased with duration of diabetes. The mean HbA 1C was 7.73. The mean CAN score was higher in patients who had complication of diabetes as compared to patients without complications. The heart rate variability with respiration was found to be 15.84 ± 7.02/min. The mean valsalva ratio was 1.31 ± 0.23. The mean drop in BP on standing was 7.30 ± 7.24 mmHg. The mean 30:15 ratio was 1.06 ± 0.04. The mean rise in diastolic BP on sustained hand grip was 16.04 ± 4.11 mmHg. Conclusions: The prevalence of autonomic neuropathy in DM as assessed by CAN score was 40%. The CAN score did not correlate with the duration of DM. The HbA 1C had a significant correlation with the severity of autonomic neuropathy. Occurrence of CAN correlated with the presence of peripheral neuropathy but not with the presence of retinopathy or nephropathy. All individual tests in the battery of CAN score were significantly associated with the presence of autonomic neuropathy, except 30:15 ratio.