Analysis of twenty-four hour heart rate variability in patients with panic disorder.

Growing evidence suggests that alterations in autonomic function contribute to the pathophysiology of panic disorder (PD). This retrospective study employed 24-h heart rate variability (HRV) analysis of Holter records to compare autonomic function in PD patients (n = 38) with healthy, age- and gender-matched controls. Both time and frequency domain measures were calculated, and a circadian rhythm analysis was performed. The SDNN index, 5-min total power, very low frequency (VLF) and low frequency (LF) power were significantly lower in panic patients relative to controls over the 24-h period. Hourly means were significantly lower during some of the waking hours as well as the latter part of the sleep cycle. In contrast, the mean RR interval, RMSSD and high frequency (HF) power were comparable in patients and controls. Results suggest that sympathetic activity is depressed in PD patients under usual life conditions, leading to a relative predominance of vagal tone. Findings of low HRV in PD patients are consistent with the high rate of cardiovascular morbidity and mortality in this population, as well as with the emerging view of panic as a disorder involving reduced flexibility and adaptability across biological, affective and behavioral dimensions.

The heart reinnervates after transplantation.

BACKGROUND: Whether cardiac reinnervation occurs after transplantation remains controversial. If reinnervation does occur, how sympathetic and parasympathetic efferent neurons do this remains unknown. METHODS: Power spectral analysis of heart rate variability was assessed for 1 year after cardiac autotransplantation in 9 dogs. After induction of anesthesia 13 months after transplantation, cardiac and intrinsic cardiac neuronal responses elicited by both electrical stimulation of parasympathetic or sympathetic efferent neurons and systemic or local coronary artery administration of nicotine (5 microg/kg), angiotensin II (0.75 microg/kg), and tyramine (1.2 microg/kg) were studied. The transmembrane electrical properties of intrinsic cardiac neurons were studied in vitro. Ventricular tissue catecholamine content, alpha-tubulin expression, and beta-adrenergic receptor density and affinity were studied. The presence of axons crossing suture lines was sought histologically. RESULTS: Nerves were identified crossing suture lines. Electrical or chemical (ie, nicotine or angiotensin II) activation of sympathetic efferent neurons enhanced cardiodynamics, as did tyramine. Stimulating vagal efferent preganglionic axons induced bradycardia in half of the dogs. Functional reinnervation did not correlate with specific power spectra derived from rate variability in the conscious state. Responding to nicotine and angiotensin II in situ, transplanted intrinsic cardiac neurons generated spontaneous activity. These neurons displayed nicotine-dependent synaptic inputs in vitro. Ventricular tissue had normal beta-adrenergic receptor affinity and density but reduced catecholamine and alpha-tubulin contents. CONCLUSIONS: The intrinsic cardiac nervous system receives reduced input from extracardiac sympathetic efferent neurons after transplantation and inconsistent input from parasympathetic efferent preganglionic neurons. These heterogeneous neuronal inputs are not reflected in heart rate variability or ventricular beta-adrenergic receptor function. Transplanted angiotensin II-sensitive intrinsic cardiac neurons exert greater cardiac control than do nicotine-sensitive ones. The intrinsic cardiac nervous system remodels itself after cardiac transplantation, and this indicates that direct assessment of extracardiac and intrinsic cardiac neuronal behavior is required to fully understand cardiac control after transplantation.

The impact of an emotional self-management skills course on psychosocial functioning and autonomic recovery to stress in middle school children.

Unmanaged emotional reactions to stress not only lead to behavior problems in young people but also create physiological conditions that inhibit learning and potentially increase the risk of disease later in life. For these reasons, the integration of emotional self-management skills training programs has become an increased priority in some schools. In this study, middle school students enrolled in a course in emotional competence skills learned techniques designed to intercept stressful responses during emotionally challenging situations. Behavioral outcomes were assessed using the Achievement Inventory Measure and autonomic function was measured by heart rate variability (HRV) analysis during and after a stressful interview. Following the program, students exhibited significant improvements in areas including stress and anger management, risky behavior, work management and focus, and relationships with family, peers and teachers. These improvements were sustained over the following six months. Students using the skills taught in the course to recover from acute emotional stress were also able to positively modulate their physiological stress responses. As compared to a control group, trained students demonstrated significantly increased HRV and more rhythmic, sine wave-like heart rhythm patterns during recovery. This response pattern reflects increased parasympathetic activity, heart rhythm coherence, and entrainment of other biological oscillatory systems to the primary heart rhythm frequency. Increased physiological coherence is associated with improved cognitive performance, emotional balance, mental clarity and health outcomes. These physiological shifts could promote the sustained psychological and behavioral improvements associated with the use of emotional management skills. It is suggested that learning emotional competence skills in childhood establishes healthier physiological response patterns which can benefit learning and long-term health. Results provide support for the integration in school curricula of courses designed to teach effective self-management skills to children.

The impact of a new emotional self-management program on stress, emotions, heart rate variability, DHEA and cortisol.

This study examined the effects on healthy adults of a new emotional self-management program, consisting of two key techniques, "Cut-Thru" and the "Heart Lock-In." These techniques are designed to eliminate negative thought loops and promote sustained positive emotional states. The hypotheses were that training and practice in these techniques would yield lowered levels of stress and negative emotion and cortisol, while resulting in increased positive emotion and DHEA levels over a one-month period. In addition, we hypothesized that increased coherence in heart rate variability patterns would be observed during the practice of the techniques. Forty-five healthy adults participated in the study, fifteen of whom acted as a comparison group for the psychological measures. Salivary DHEA/DHEAS and cortisol levels were measured, autonomic nervous system function was assessed by heart rate variability analysis, and emotions were measured using a psychological questionnaire. Individuals in the experimental group were assessed before and four weeks after receiving training in the self-management techniques. The experimental group experienced significant increases in the positive affect scales of Caring and Vigor and significant decreases in the negative affect scales of Guilt, Hostility, Burnout, Anxiety and Stress Effects, while no significant changes were seen in the comparison group. There was a mean 23 percent reduction in cortisol and a 100 percent increase in DHEA/DHEAS in the experimental group. DHEA was significantly and positively related to the affective state Warmheartedness, whereas cortisol was significantly and positively related to Stress Effects. Increased coherence in heart rate variability patterns was measured in 80 percent of the experimental group during the use of the techniques. The results suggest that techniques designed to eliminate negative thought loops can have important positive effects on stress, emotions and key physiological systems. The implications are that relatively inexpensive interventions may dramatically and positively impact individuals' health and well-being. Thus, individuals may have greater control over their minds, bodies and health than previously suspected.

Twenty-four hour time domain heart rate variability and heart rate: relations to age and gender over nine decades.

OBJECTIVES: This study sought to define the effects of age and gender effects on the normal range of time domain heart rate variability (HRV) over nine decades in healthy subjects. BACKGROUND: Low HRV is considered an independent marker of mortality risk. However, the age-related decline in HRV may limit its predictive value, particularly in the elderly. Delineation of the range of HRV in healthy subjects over the life span is needed. Gender-related differences in HRV also need clarification. METHODS: We determined, according to decade, 24-h heart rate (HR) and HRV of 260 healthy subjects (10 to 99 years old; 112 male, 148 female) by means of five standard time domain measures: standard deviation of all normal sinus RR intervals over 24 h (SDNN), standard deviation of the averaged normal sinus RR intervals for all 5-mm segments (SDANN), mean of the standard deviations of all normal sinus RR intervals for all 5-min segments (SDNN index), root-mean-square of successive normal sinus RR interval difference (rMSSD) and the percentage of successive normal sinus RR intervals >50 ms (pNN50). RESULTS: 1) HRV decreased with aging, the pattern of change being measure dependent. HRV (SDNN and SDANN) decreased only very gradually, reaching 60% of baseline (second-decade values) by the tenth decade. With the SDNN index, HRV decreased linearly with aging, reaching 46% of baseline by the tenth decade. Using pNN50 and rMSSD, HRV decreased most rapidly, reaching 24% and 47% of baseline, respectively, by the sixth decade and then stabilized. 2) Using the SDNN index, rMSSD and pNN50, HRV of subjects >65 years old fell below published cutpoints for increased risk of mortality in 25%, 12% and 4%, respectively. 3) At age <30 years, HRV for all measures was lower in female than male subjects. Gender differences decreased at age >30 years and disappeared at age >50 years. 4) HR also declined with aging but much more slowly. HR at age <50 years was faster in female than in male subjects. Gender differences disappeared thereafter. CONCLUSIONS: 1) Using all measures, HRV of healthy subjects declines with aging, with measure-dependent patterns. 2) Using the SDNN index, rMSSD and pNN50, HRV of healthy subjects, particularly those >65 years old, may decrease to below levels associated with increased risk of mortality. 3) Gender influences HRV. Gender differences in HRV are age and measure dependent. 4) Age and gender also affect heart rate.

The effects of different types of music on mood, tension, and mental clarity.

This study investigated the impact of different types of music on tension, mood, and mental clarity. A total of 144 subjects completed a psychological profile before and after listening for 15 minutes to four types of music (grunge rock, classical, New Age, and designer). With grunge rock music, significant increases were found in hostility, sadness, tension, and fatigue, and significant reductions were observed in caring, relaxation, mental clarity, and vigor. In contrast, after listening to the designer music (music designed to have specific effects on the listener), significant increases in caring, relaxation, mental clarity, and vigor were measured; significant decreases were found in hostility, fatigue, sadness, and tension. The results for New Age and classical music were mixed. Feeling shifts among subjects were observed with all types of music. Designer music was most effective in increasing positive feelings and decreasing negative feelings. Results suggest that designer music may be useful in the treatment of tension, mental distraction, and negative moods.

Cardiac coherence: a new, noninvasive measure of autonomic nervous system order.

Although cardiac sympathovagal regulation has been studied during stress using power spectral density analysis of heart rate variability, little is known about its regulation during emotional states. Using heart rate variability measurements, we studied autonomic balance in 20 subjects trained in a mental and emotional self-management technique called Freeze-Frame. The study was conducted in two environments: under controlled laboratory conditions, and under real-life stressful conditions in the workplace. Power spectral density plots of R-R intervals obtained from electrocardiogram recordings were divided into three regions: low frequency (predominantly sympathetic activity), midfrequency, and high frequency (parasympathetic activity). Measurements were taken for a 5-minute baseline period, followed by a 5-minute period of positive emotional expression. Three unique conditions of autonomic nervous system order can be clearly discriminated in the data: (1) normal heart function mode, (2) entrainment mode, and (3) internal coherence mode. The internal coherence mode is new to the electrophysiology literature. We provide supporting data for modes 2 and 3 and show that a group of 20 subjects trained in this technique can enter and maintain these states at will. We found that, when one is in the entrainment mode, other physiological systems lock to the entrainment frequency, which is approximately 0.1 Hz. The results suggest that emotional experiences play a role in determining sympathovagal balance independent of heart rate and respiration and further suggest that positive emotions lead to alterations in heart rate variability that may be beneficial in the treatment of hypertension and reduce the likelihood of sudden death in patients with congestive heart failure and coronary artery disease.

The effects of emotions on short-term power spectrum analysis of heart rate variability .

In summary, this work extends previous findings by demonstrating that anger produces a sympathetically dominated power spectrum, whereas appreciation produces a power spectral shift toward MF and HF activity. Results suggest that positive emotions lead to alterations in HRV, which may be beneficial in the treatment of hypertension and in reducing the likelihood of sudden death in patients with congestive heart failure and coronary artery disease.