ABSTRACT
Antiplatelet therapy is the leading therapy for the primary and secondary prevention for the atherosclerotic arterial disease. The practical question of withdraw alavoiding or continuation of oral antiplatelet agents accurs currently before any invasive procedure. It is important to compare the relative thrombotic vs hemorrhagic risk. For most interventions, it is recommended to continue antiplatelet therapy. It is particularly important in patients who benefited from drug-eluting stents where the thrombotic risk is major.
Subject(s)
Platelet Aggregation Inhibitors/administration & dosage , Platelet Aggregation Inhibitors/adverse effects , Postoperative Hemorrhage/prevention & control , Thrombosis/prevention & control , Atherosclerosis/complications , Atherosclerosis/drug therapy , Humans , Postoperative Hemorrhage/etiology , Risk Assessment , Thrombosis/etiologyABSTRACT
Heart rate variability (HRV), a measure of cardiac autonomic control, was analyzed in infants to assess the hypothesis that early undernutrition may induce autonomic dysfunction that could play a role in the programming of later cardiovascular disease. HRV data were collected during a night session in 546 healthy infants at 5-12 weeks of adjusted age, and statistical associations with fetal and postnatal growth indices were established. A significant positive correlation between birth weight, the ratio of neonatal weight to head circumference and postnatal weight gain, and HRV indices mostly influenced by sympathetic activity was demonstrated in 11- and 12-week-old infants. A slight correlation (p > 0.05) was also found in younger infants. These data suggest the influence of fetal and postnatal growth on the programming of the autonomic nervous system beyond the neonatal period. This influence may be one of the important mechanisms that link impaired growth in fetal and infant life to high blood pressure and other cardiovascular disease during childhood and adulthood (the Barker hypothesis).
Subject(s)
Cardiovascular Diseases/etiology , Embryonic and Fetal Development/physiology , Growth/physiology , Heart Rate/physiology , Electrocardiography , Heart Rate, Fetal/physiology , Humans , Infant , Linear Models , Nutritional Status , Prospective StudiesABSTRACT
OBJECTIVE: Measurements of the variability in heart rate are increasingly used as markers of cardiac autonomic activity. We sought to establish the development this variability in healthy young infants while sleeping. PATIENTS: We carried out polygraphic studies with electrocardiographic recording in 587 healthy infants aged from 5 to 26 weeks. METHODS: We determined several variables over a period of 400 minutes sleeping: mean RR interval, 5 time-domain (SDNN, SDNNi, SDANNi, RMSSD, and pNN50) and 5 frequency-domain indexes (spectral power over 3 regions of interest, total power and low-to-high frequency ratio). Frequency-domain indexes were also assessed separately for the periods of quiet sleep and those of rapid eye movement sleep. RESULTS: Our data showed a significant correlation between the indexes of heart rate variability and the mean RR interval, the breathing rate, and the corrected age of the infants. We also demonstrated the importance of the maturation of the sleeping patterns. CONCLUSION: These data in a large cohort of healthy infants confirm a progressive maturation of the autonomic nervous system during sleep, and may be used to examine the influence of physiological and pathophysiological factors on autonomic control during polygraphic studies.
Subject(s)
Heart Rate/physiology , Sleep/physiology , Age Factors , Circadian Rhythm/physiology , Electrocardiography, Ambulatory , Electrophysiologic Techniques, Cardiac , Female , Humans , Infant , Infant Welfare , Infant, Newborn , Male , Observer Variation , Reference Values , Smoking , Statistics as TopicABSTRACT
Coarctation of the aorta presents with characteristic and distinctive physical findings. Because delayed detection of severe forms may be fatal and late detection of classic forms is associated with premature cardiovascular disease in adult life, early detection and treatment is important. However, in our survey a few patients in whom aortic coarctation was ultimately diagnosed had the correct diagnosis made by the referring physician. Our survey suggests that an incomplete physical examination explains the diagnostic failure. This survey reaffirms the need for palpation of pulses and proper measurement of blood pressure in all infants and children to facilitate early recognition of coarctation.
Subject(s)
Aortic Coarctation/diagnosis , Blood Pressure , Child , Child, Preschool , Diagnosis, Differential , Humans , Infant , Infant, Newborn , Physical Examination , PulseABSTRACT
The aim of the present study was to identify and quantify the rate dependence of premature ventricular contractions (PVC) during childhood. A 24-hour Holter recording was performed in 16 consecutive children, aged 22 days to 11 years (mean age 5.6 years), with frequent (>5,000/day), isolated monomorphic PVC. Those PVC were identified and the length of the preceding sinus cycle was measured. The values were ordered into 50-ms class intervals, and the percentage of PVC for each class was calculated and then analyzed by linear regression analysis. On the basis of the significance of the p value, and the positive or negative value of the slope, we identified a tachycardia-enhanced, a bradycardia-enhanced, and an indifferent pattern. Chronobiologic analysis was made by the cosinor method. All the patients had upper and lower limits of cycle length beyond which PVC disappeared. A tachycardia-enhanced pattern was present in 7 patients and an indifferent one in 9 patients. In the latter a second-degree polynomial correlation was systematically found. Children but not infants had a significant circadian variation in the frequency of PVC with a very variable time of highest incidence. In conclusion, it is possible to identify a circadian rhythm of PVC and a spontaneous trend between their incidence and the length of the preceding cardiac cycle in children.
Subject(s)
Circadian Rhythm/physiology , Heart Rate/physiology , Myocardial Contraction/physiology , Ventricular Premature Complexes/physiopathology , Child , Child, Preschool , Electrocardiography, Ambulatory , Exercise Test , Female , Humans , Infant , Infant, Newborn , MaleABSTRACT
BACKGROUND: Measurements of heart rate variability (HRV) are increasingly used as markers of cardiac autonomic activity. AIM: To examine circadian variation in heart rate and HRV in children. SUBJECTS: A total of 57 healthy infants and children, aged 2 months to 15 years, underwent ambulatory 24 hour Holter recording. Monitoring was also performed on five teenagers with diabetes mellitus and subclinical vagal neuropathy in order to identify the origin of the circadian variation in HRV. METHODS: The following variables were determined hourly: mean RR interval, four time domain (SDNN, SDNNi, rMSSD, and pNN50) and four frequency domain indices (very low, low and high frequency indices, low to high frequency ratio). A chronobiological analysis was made by cosinor method for each variable. RESULTS: A significant circadian variation in heart rate and HRV was present from late infancy or early childhood, characterised by a rise during sleep, except for the low to high frequency ratio that increased during daytime. The appearance of these circadian rhythms was associated with sleep maturation. Time of peak variability did not depend on age. Circadian variation was normal in patients with diabetes mellitus. CONCLUSION: We have identified a circadian rhythm of heart rate and HRV in infants and children. Our data confirm a progressive maturation of the autonomic nervous system and support the hypothesis that the organisation of sleep, associated with sympathetic withdrawal, is responsible for these rhythms.