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Human ventilatory efficiency and respiratory sinus arrhythmia during head-up tilt

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Cardiac vagal withdrawal when moving from supine to an upright posture may be independent of respiratory sinus arrhythmia. Further, ventilatory efficiency of an upright lung may improve with clustering of heart beats during inhalation. We studied healthy human subjects (n=8, 6 male) during supine rest (SUP) and 80° head-up tilt (HUT). ECG and expired breath were sampled continuously to determine heart rate, mean and end-tidal (ET) fractional content (F) of O2 and CO2, tidal volume (VT) and breathing frequency (Bf). HUT increased heart rate (47±3 vs. 59±9 beats min-1, p<0.01), decreased the high frequency component of heart rate variability (8.76± vs. 7.07±1.12, p<0.05), and increased the ratio of low to high frequency components in the heart rate (0.62±0.6 vs. 1.79±2.07, p<0.05). HUT did not change VT, Bf, or minute ventilation (V'E), but decreased FCO2 (4.90±0.48 vs. 4.56±0.42 %, p<0.05) and FETCO2 (6.64±0.24 vs. 6.30±0.27 %, p<0.01). HUT increased the CO2 ventilatory equivalent (24.88±2.50 vs. 26.74±2.61, p<0.01). Mean heart rate during inhalation increased with HUT (26±3 vs. 34±6 beats min-1), with no change during exhalation. Increased clustering of heart beats during inhalation independent of a decrease in HF cardiac variability may partly offset decreases in ventilatory efficiency of an upright lung.
Introduction and objective. As the autonomic nervous system (ANS) dysfunction is present in course of many disorders, an objective assessment of the ANS function is very important. In practice, the assessment is difficult, and based rather on indirect analysis of autonomically-controlled cardiovascular reflexes, than on direct recording of activity of central or peripheral autonomic structures. The aim of our paper was to discuss briefly current, clinical and scientific ANS investigations, as well as possible future methods of autonomic activity evaluation. A brief description of the state of knowledge. The review presents a short outline of autonomic function assessments based on clinical autonomic tests (e.g. “Ewing’s battery”) and discusses the heart rate variability (HRV) study, as currently popular and widespread option of analysis of the ANS activity. Other, complementary methods, including the baroreceptor sensitivity testing, microneurography or plasma norepinephrine measurement were also mentioned. The article also provides premises related to the determination of selected neuropeptides in plasma or saliva as an innovative concept of autonomic activity assessment. Summary. The available, clinical, non-invasive methods used for assessment of the ANS function are still relatively sparse and, in fact, a surrogate for direct ANS assessment. New methods of autonomic tension determination are still needed that would allow a more complete and reliable assessment. Reports of potential new laboratory markers of the ANS activity (NPY and VIP assay) bring some hope.
This study was aimed to demonstrate the efficacy of interval hypoxic training (IHT) in complex treatment of Helicobacter pylori-associated duodenal peptic ulcer disease (DPUD) by parameters of aerobic metabolism and indexes of heart rate variability (HRV). Eighty patients with H. pylori-associated DPUD were included into the study, mean age 32±1.8 yrs, duration of the disease up to 10 years (66.3 %). IHT was modulated using Frolov's hypoxicator (TDI-01) for 30 days after standard eradication therapy. Daily hypoxic sessions consisted of three one-minute sessions, one two-minute, and one three-minute sessions separated by one-minute intervals of room-air breathing. Use of IHT resulted in more efficient elimination of clinical symptoms, histological hallmarks of inflammation and signs of oxidative stress in glandulocytes of the gastric mucosa as determined by 4-hydroxynonenal accumulation. Moderate prooxidant activity of IHT was demonstrated by the increased level of TBARS and oxidatively modified products, normalization of hydroperoxides, middle mass molecules and atherogenic beta-lipoproteins with simultaneous increase in catalase activity and mild decline of SOD activity. Therefore, IHT appeared to be accompanied by higher intensity of redox reactions and enhanced regeneratory processes in cells and tissues. Significant increase in HRV was also noted. Such changes were associated with reduction of inflammation signs and modulation of the autonomic homeostasis in DPUD patients. In general, use of IHT in complex treatment of H. pylori in DPUD patients can be recommended to increase resistance to oxidative stress and to modulate autonomic balance and oxidative homeostasis
Gastro-esophageal reflux disease (GERD) is the result of the acid contents regurgitation back from the stomach into the esophagus. According to the endoscopic findings, GERD can be divided into two main forms: non-erosive (NERD) and erosive reflux esophagitis. The pathogenesis of GERD is associated with the impaired function of the antireflux barrier. Disturbances of the autonomic nervous system (ANS), especially parasympathetic part of the ANS, may be also involved in the pathogenesis of this disease. The aim of our study was to establish the parasympathetic activity in patients with reflux esophagitis and in patients with symptomatic endoscopically negative reflux. Working hypothesis was the question, whether the possible parasympathetic activity disturbances, which are observed in all GERD patients, may be regarded as the primary or secondary to the esophagitis. All the participants (20 pts. with NERD, 20 pts. with reflux esophagitis and 20 healthy controls) underwent esophageal manometry, 24-hour ambulatory pH-monitoring, resting heart rate variability (HRV) recording and the deep breathing (DB) test with the continuous HRV recording. The results of the spectral analysis both of the short-term, resting HRV recordings and DB-evoked revealed the disturbances of the main power spectra components - LF and HF in both groups of patients in comparison with the control group. In our opinion, the observed HRV spectra changes in both groups of patients support the hypothesis that not only is the parasympathetic activity impairment associated with the pathogenesis of GERD but it is also the primary factor contributing to the pathophysiological mechanism of reflux.
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Leukotrienes are lipid mediators produced via 5-lipooxygenase pathway of arachidonic acid. At least two cysteinyl-leukotrienes receptors are highly expressed in the heart, including the conduction system. Coronary angiography or angioplasty is accompanied by release of cysteinyl leukotrienes into coronary circulation and into urine. We tested the hypothesis that inhibition of leukotrienes biosynthesis would affect the conductance system function. In a double-blind placebo controlled study, patients with stable angina undergoing elective coronary catheterization or angioplasty were randomly assigned to 48 hrs treatment with a 5-lipoxgenase inhibitor (n=54) or placebo (n=49). ECG Holter recording was carried out for 24 hrs before and after the procedure and urinary leukotriene E4 measurements were done. Inhibition of 5-lipoxygenase caused 26% reduction of urinary leukotriene E4, associated with: 1) decrease in heart rate by about 7%, 2) enhanced heart rate variability; 3) protection against depressions in atrioventricular conductance and ventricular repolarization induced by the procedure. No effects on either arrhythmias, or ECG patterns of ischemia were noted. We conclude that pharmacological inhibition of 5-lipoxygenase, shortly before percutaneous coronary intervention, reveals specific actions of leukotrienes on the heart rhythm. Inhibitors of 5-lipoxygenase might be of interest as a novel class of cardiac drugs affecting the conductive system.
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Why study sympathetic nervous system?

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Cardiovascular diseases are the most frequent causes of morbidity and mortality around the world. However, during last decades, an improvement was made in diagnosis and therapy of cardiovascular diseases, there was still a need for better understanding of their pathophysiology. Among neurohormonal systems, SNS plays a central role in cardiovascular regulation in both health and disease. Involvement of SNS in pathogenesis of hypertension, coronary artery disease or heart failure is well known and proved. Methods such as microneurography, direct catecholamine measurements, heart rate variability or baroreflex sensitivity assessment allowed studying sympathetic activity and its influence on cardiovascular disorders. Although introduced into scientific practice methods of SNS evaluation are not commonly used in the clinic. However, two of the methods: analysis of heart rate variability (HRV) and baroreflex sensitivity (BRS) were recommended as the diagnostic tools and can be found in clinical guidelines as basic assessment methods.
The aim of our study was to characterize the dynamics of heart rate variability (HRV) during sleep in healthy subjects and in patients with obstructive sleep apnea syndrome (OSAS). Present results were compared with earlier data obtained in healthy subjects (1) performing intermittent voluntary apneas. Power spectra in low (LF) and high (HF) frequency band and non linear indices: correlation dimension (CD) and recurrence plots were computed. New indices were applied: a beat-to beat control (BBC) for the assessment of cardiovascular regulatory mechanisms as cardiac, vascular or mixed type control and COT for quantification of relative contribution of cardiac and vascular component in blood pressure variability. During Wake stage in OSAS patients mean LF component was augmented (0.035 s2/Hz) comparing to healthy subjects (0.012 s2/Hz). Nonlinear indices suggest reduced HRV dynamics complexity in OSAS patients. Similar pattern could be observed when comparing LF component, CD and recurrence parameters during spontaneous breathing and in consecutive voluntary apneas. The results correlate with 20% increase in BBC vascular control type and COT inversion form +0.08 to - 0.12. Changes in BBC and COT along with power spectra and nonlinear dynamics indices appear to signal risk and/or initiation of arterial hypertension in OSAS patients.
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