A characterization of HRV's nonlinear hidden dynamics by means of Markov models.

A study of the 24-h heart rate variability's (HRV) hidden dynamic is performed hour by hour, in order to investigate the evolution of the nonlinear structure of the underlying nervous system. A hierarchy of null hypotheses of nonlinear Markov models with increasing order n is tested against the hidden dynamic of the HRV time series. The minimum accepted Markov order supplies information about the nonlinearity of the HRV's hidden dynamic and consequently of the underlying nervous system. The Markov model with minimum order is detected for each hour of the RR time series extracted from seven 24-h electrocardiogram records of patients in different pathophysiological conditions, some including ventricular tachycardia episodes. Heart rate, pNN30, and LF/HF index plots are reported to serve as a reference for the description of the patient's cardiovascular frame during each examined hour. The minimum Markov order shows to be a promising index for quantifying the average nonlinearity of the autonomic nervous system's activity.

Bioavailability of digoxin and beta-methyl-digoxin.

In a randomized crossover study the bioavailability of a single dose of digoxin and of beta-methyl-digoxin tablets was tested in four normal volunteers. No difference was found between the two products in the rate and extent of drug absorption using 6 day cumulative urinary excretion and serial serum concentration measurements.

Signal-averaged ECG abnormalities in haemodialysis patients. Role of dialysis.

BACKGROUND: Late potentials (LP) on the signal-averaged electrocardiogram (SAECG) are predictive of malignant ventricular arrhythmias and sudden cardiac death in patients with ischaemic and non-ischaemic cardiomyopathy. Cardiac dysfunction, both regional and global, as well as supraventricular and ventricular arrhythmias are reported in a high percentage of patients with end-stage renal failure (ESRF). The aim of the study was to assess the prevalence of LP and the effects of haemodialysis on the SAECG of ESRF patients. METHODS: SAECG was recorded immediately before and within 30 min after the end of dialysis in 48 patients in sinus rhythm, free of conduction disturbances on ECG and of signs of congestive heart failure. Serum electrolytes were sampled together with the SAECG recordings. An echo-Doppler exam was performed within 2 weeks of the study. SAECGs were adequate for analysis in 45/48 patients. LP were present when at least two of the following criteria were fulfilled: QRS duration < or = 115 ms, LAS40 < or = 38 ms, RMS40 > or = 38 microV at 40 Hz high pass bidirectional filter, and noise <0.7 microV. RESULTS: LP were detected in 12/45 patients (25%) on the SAECG before dialysis; of these 12 patients, seven had a history of a previous myocardial infarction and two had documented coronary artery disease (CAD). A significant greater wall motion score index--calculated on a 16 segment model--was reported in patients with LP (1.20+/-0.20 vs 1.01+/-0.03, P<0.01), while left ventricular mass was comparable in the two groups of patients. At the end of dialysis, a significant prolongation of fQRS duration was found both at 25 and 40 Hz filters (from 98+/-11 to 106+/-16 ms and from 97+/-12 s to 102+/-13 ms, respectively, P<0.001). A significant inverse relationship was seen between the percentage of dialysis-induced serum potassium reduction and fQRS changes at 40 Hz (r=-0.68, P<0.001). CONCLUSIONS: LP were detected in a significant proportion of dialysis patients, probably related to underlying CAD with left ventricular dysfunction. Prolongation of fQRS after dialysis could be explained by the acute reduction in serum potassium levels.

[Circadian and ultradian rhythms of the heart rate in the neonate]. / Ritmi circadiani ed ultradiani della frequenza cardiaca nel neonato.

Few papers deal with the chronobiologic characteristics of heart rate in neonates. A better knowledge of this topic could be useful under both clinical and therapeutical point of view. We studied the circadian and ultradian rhythms of heart rate in 10 healthy neonates (5 males and 5 females). Six of them (60%) show a well defined circadian rhythm of heart rate such as adult subjects even if with an obviously higher mesor and with acrophases dispersed throughout the 24 hours. We also demonstrated one or more ultradian rhythms of heart rate for each neonate. The most frequent have a period between 4 hours and 6 minutes and 4 hours and 36 minutes. These rhythms are out of phase with the world outside which is the best evidence that they are not imposed by some undetected external factors.