Traditional Chinese medicine wrist pulse-taking is associated with pulse waveform analysis and hemodynamics in hypertension.

BACKGROUND: Pulse wave analysis (PWA) quantifies the phenomenon of pulse waveform propagation in patients with cardiovascular diseases, whereas pulse image analysis (PIA) is a subjective examination in traditional Chinese medicine. OBJECTIVE: This study evaluated the association of PIA with PWA and hemodynamics in patients with hypertension. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This observational, cross-sectional study enrolled 45 patients (26 men, (55.2 ± 10.3) years, systolic blood pressure (155 ± 28) mmHg, diastolic blood pressure (93 ± 17) mmHg) for assessment of clinical and laboratorial data. MAIN OUTCOME MEASURES: Primary outcomes comprised: pattern differentiation based on an automated method; PIA at the radial artery using the 'simultaneous pressing' method for identification of factors such as strength (strong/weak), depth (superficial/deep), and speed (fast/moderate/slow); and PWA at the same artery using a noninvasive system. RESULTS: Significant multivariate main effects were observed for depth (λ=0.648, F5,29 =3.149, P=0.022, η(2) =0.352), strength (λ=0.608, F5,29 =3.736, P=0.010, η(2) =0.392), and speed (λ=0.535, F5,29 =5.302, P=0.002, η(2) =0.465). General effects comprised high values of PWA and blood pressure for superficial, strong, and fast pulse images. A strong pulse was found for pulse pressure ≥ 62.5 mmHg and systolic blood pressure ≥ 149.5 mmHg, whereas a superficial pulse was found for heart rate ≥ 58.25 beats/min; a fast pulse was found for heart rate ≥ 69.6 beats/min and pulse wave velocity ≥ 9.185 m/s. CONCLUSION: Associations were explained by LaPlace's law, arterial remodeling in hypertension, alongside the traditional criterion for classifying speed in pulse images. PIA is associated with PWA and hemodynamics in patients with hypertension. Systolic and pulse pressures, heart rate, and pulse wave velocity are quantitative variables that have information to describe the qualitative pulse images such as strength, depth and speed.

The six-minute walk distance is a marker of hemodynamic-related functional capacity in hypertension: a case-control study.

This study investigated the association between hemodynamic variables and the 6-minute walk distance (6MWD) in adults with and without hypertension and explored the role of hemodynamic variables as predictors of 6MWD. Patients undergoing antihypertensive medication therapy (n=41) and sex-matched healthy subjects (n=41) were evaluated for their clinical status and cardiovascular risk factors. Two 6-minute walk tests were performed along an 18-m corridor with a 30-minute rest interval. The intraclass correlation (ICC) was high among patients (ICC=0.984 (0.965; 0.992), P<0.001) and controls (ICC=0.987 (0.832; 0.996), P<0.001). The patients presented 6MWD values that were significantly lower than those of healthy controls (338.8±112.8 vs. 388.0±66.7 m, P=0.010). In patients, the 6MWD was significantly and positively correlated with sex (0.737; P<0.001), height (0.502; P<0.001) and weight (0.303; P=0.027). In addition, negative and significant correlations were observed between 6MWD and the mean (-0.577; P<0.001), systolic (-0.521; P<0.001), diastolic (-0.505; P=0.001) and pulse (-0.353; P=0.015) pressures after simultaneous adjustment for age, body height and weight. The same behavior was observed in healthy controls (except for pulse pressure), albeit with lower correlation values. A regression model with sex, age, height and weight explained 52.2% (P<0.001) of the variance. The highest explained variance in patients (64.8%; P<0.001) and controls (56.5%; P<0.001) was observed after replacing the body weight with mean pressure in the model. The 6MWD is inversely associated with hemodynamic variables in both groups and is lower in patients with hypertension compared with healthy controls. Hemodynamic variables, particularly the mean pressure, should be included in prediction equations for 6MWD.

Non-surgical periodontal treatment reduces cardiovascular risk in refractory hypertensive patients: a pilot study.

AIM: To evaluate the effects of non-surgical periodontal treatment on left ventricular mass (LVM), arterial stiffness, systolic and diastolic blood pressure and plasma levels of inflammatory markers (C-reactive protein (CRP), fibrinogen and interleukin-6) in refractory hypertension patients. MATERIAL AND METHODS: This interventional prospective cohort pilot study included 26 patients (53.6 ± 8.0 years old) diagnosed with refractory hypertension and generalized chronic periodontitis. Subjects received non-surgical periodontal treatment according to their needs. Plasma levels of systemic inflammation (CRP; fibrinogen and interleukin-6) and established cardiovascular risk factors [systolic and diastolic blood pressure (SBP and DBP), left ventricular mass (LVM) and arterial stiffness] were assessed at three time points (baseline, 3 months after baseline and 6 months after periodontal therapy). RESULTS: Periodontal therapy significantly reduced all cardiovascular risk markers evaluated. Median values of SBP and DBP were reduced by 12.5 mmHg and 10.0 mmHg, respectively, whereas left ventricular mass (LVM) reduced by 12.9 g and pulse wave velocity reduced by 0.9 m/s (p < 0.01). Levels of CRP, IL-6 and fibrinogen lowered by 0.5 mg/dl, 1.4 pg/dl and 37.5 mg/dl (p < 0.01), respectively, 6 months after periodontal therapy. CONCLUSIONS: Periodontal therapy significantly reduced levels of CRP, IL-6, fibrinogen, blood pressure, LVM and arterial stiffness, lowering cardiovascular risk in refractory hypertensive patients.

O valor do Doppler tecidual no diagnóstico diferencial da hipertrofia do atleta e da cardiomiopatia hipertrófica / The value of tissue Doppler in the differential diagnosis of athlete's heart and hypertrophic cardiomyopathy

Introdução: A cardiomiopatia hipertrófica é a responsável pelo maior número de mortes súbitas ou inesperadas por problemas cardíacos, em atletas jovens, e, quando tentamos esclarecer o diagnóstico pela ecocardiografia tradicional, a simples presença de hipertrofia, muitas vezes, não permite distinguir a sua etiologia, como a hipertrofia dos atletas e a hipertrofia secundária à hipertensão arterial. O Doppler tecidual (DTI) pode auxiliar na diferenciação das referidas hipertrofias. Objetivo: Avaliar os valores do Doppler tecidual (TDI) no anel mitral, em pacientes com cardiomiopatia hipertrófica, hipertrofia hipertensiva e hipertrofia, induzida pelo exercício, em atletas saudáveis de alta performance. Métodos: Foram estudados 147 pacientes: 30 voluntários saudáveis (grupo controle); 49 atletas de alta performance, jogadores de futebol profissionais do fluminense Futebol Clube , da cidade do rio de Janeiro-RJ (grupo dos atletas), avaliados na classe 1 de weber pela ergoespirometria; 40 portadores de hipertensão arterial sistêmica moderada controlada, com hipertrofia ventricular esquerda e função ventricular preservada (grupo dos hipertensos)...

Evaluation of systemic microvascular endothelial function using laser speckle contrast imaging.

OBJECTIVE: The aim of this study was to compare cutaneous microvascular function in young healthy subjects (n=50) with that of cardiometabolic diseased patients (n=50) using laser speckle contrast imaging (LSCI) coupled with transdermal iontophoretic delivery of acetylcholine (ACh) and post-occlusive reactive hyperemia (PORH). METHODS: Cutaneous blood flow was assessed in the forearm using LSCI at rest, during PORH and during iontophoresis of ACh with increasing anodal currents of 30, 60, 90, 120, 150 and 180 µA during 10-second intervals spaced 1 min apart. RESULTS: Endothelium-dependent skin microvascular vasodilator responses induced by both ACh and PORH were significantly reduced in cardiometabolic diseased patients compared to healthy subjects. Vasodilator responses induced by ACh were significantly higher in young women than in young men. Iontophoresis charges up to 1.5 mC do not induce nonspecific effects on skin microvascular flux. CONCLUSION: LSCI appears to be a promising noninvasive technique for evaluating systemic microvascular endothelial function.

Exercícios em curto prazo de resistência no quadríceps em indivíduos hipertensos refratários / Quadriceps short-term resistance exercise in subjects with resistant hypertension

INTRODUCTION: Resistant arterial hypertension may lead to muscle disuse and reduced functional capacity due to arterial and target-organs lesions. The main objective of this work is to evaluate the quadriceps strength and fatigue tolerance after a program of resistance exercise in subjects with resistant primary hypertension. METHODS: Six patients under pharmacological treatment were submitted to a four-week resistance exercise training program for the quadriceps (8-14 repetitions, 3 sets, 3 days per week). Strength was evaluated by isometric dynamometry, as the percentage change in maximum voluntary contraction over the four week program. Fatigue was analyzed by surface electromyography, as the change in both root mean square value and intercept of median frequency slope of vastus medialis and vastus lateralis. RESULTS: Significant increase in the maximum voluntary contraction was observed (p = 0.04). Fatigue tolerance was not improved as seen by root mean square as well as in the intercept of median frequency (p > 0.05). Additionally, no significant changes were observed in resting arterial blood pressure and heart rate throughout the training period. CONCLUSION: The prescribed protocol seemed to successfully increase localized muscle strength without negatively affecting the monitored cardiovascular variables in patients with resistant hypertension under pharmacological treatment.

INTRODUÇÃO: A hipertensão arterial resistente pode levar ao desuso muscular e redução da capacidade funcional devido a lesões arteriais e de órgãos-alvo. O objetivo deste trabalho é avaliar a força muscular e resistência à fadiga do quadríceps em indivíduos com hipertensão primária resistente após um programa de exercícios de resistência. MÉTODOS: Seis pacientes sob tratamento farmacológico foram submetidos a um programa de treinamento muscular do quadríceps por 4 semanas (8-14 repetições, 3 séries, 3 dias por semana). Força foi avaliada por meio de dinamometria isométrica e apresentada como o percentual de alteração na contração voluntária máxima ao longo do programa de treinamento. Fadiga foi analisada por meio da eletromiografia de superfície como a alteração tanto na raiz quadrática média e no ponto de interceptação da inclinação da frequência mediana dos músculos vasto lateral e medial. RESULTADOS: Foi observado aumento significante na força isométrica máxima (p = 0,04). A tolerância à fadiga não foi alterada, como evidenciado pela raiz quadrática média ou interceptação da frequência mediana (p > 0,05). Adicionalmente, não foram observadas alterações significativas na pressão arterial de repouso e frequência cardíaca ao longo do programa. CONCLUSÃO: O protocolo prescrito aumentou a força muscular localizada sem alterar negativamente as variáveis cardiovasculares monitoradas nos pacientes com hipertensão resistente sob tratamento farmacológico.

Intervenção nos hábitos de vida em instituição pública / Life-habit intervention in a public institution

FUNDAMENTO: A doença coronariana é a maior causa mortis mundial, segundo a Organização Mundial de Saúde (OMS), e a segunda no Brasil. Morte súbita ocorre de 4 a 6 vezes mais nos que já sofreram um infarto agudo do miocárdio (IAM); em 6 anos, 18 por cento dos homens e 35 por cento das mulheres terão novo IAM. A prevenção secundária, cuja eficácia já foi demonstrada, é de fundamental importância. OBJETIVO: Testar a efetividade de um programa multiprofissional que visa a modificar fatores de risco para aterosclerose no sistema público. MÉTODOS: Dos 2.337 coronariopatas em tratamento ambulatorial, 513 com estudo coronariográfico concordaram em participar deste estudo, que utilizou como arma terapêutica palestras de como e por que controlar os fatores de risco. Análise estatística: variação significativa pré e pós-intervenção; teste t de Student emparelhado ou o teste de Wilcoxon; existência de diferença significativa entre dois grupos; teste t de Student para amostras independentes ou o teste de Mann-Whitney. Comparação entre três grupos: análise de variância (ANOVA) ou Kruskal-Wallis. RESULTADOS: Colesterol, LDL, triglicérides, índice de massa corpórea, índices de Castelli I e II e medida da cintura apresentaram diminuição significativa, mesmo nos pacientes sem hipolipemiante. Na avaliação do impacto em relação à dieta, verificou-se que 72 por cento dos que não faziam dieta passaram a fazê-la. Atividade física: dos 55 por cento sedentários, 71 por cento passaram a exercitar-se três ou mais vezes/semana. Tabagismo: dos fumantes, 60 por cento (9 por cento do total) interromperam este hábito e 32 por cento o diminuíram. CONCLUSÃO: Esses resultados demonstram a eficácia de programas para melhorar hábitos de vida, aplicados em unidades do sistema público de saúde.

BACKGROUND: Coronary disease is the major worldwide cause of death, according to the World Health Organization (WHO) and the second in Brazil. Sudden death occurs 4 to 6 times more frequently in those who have suffered an acute myocardial infarction (AMI); within 6 years, 18 percent of the men and 35 percent of the women will have a new AMI. The secondary prevention, of which effectiveness has been previously demonstrated, is of utmost importance. OBJECTIVE: To test the effectiveness of a multiprofessional program that aims at modifying risk factors for atherosclerosis in the public health system. METHODS: Of the 2,337 patients with coronary artery disease undergoing outpatient treatment, 513 with a coronary angiography study agreed to participate in the present study, which used lectures on how and why to control risk factors as therapeutic tool. Statistical analysis: significant variation pre and post-intervention; paired Student's t test or Wilcoxon's test ; existence of a significant difference between the two groups; Student's t test for independent samples or Mann-Whitney test. Comparison among three groups: analysis of variance (ANOVA) or Kruskal-Wallis. RESULTS: Cholesterol, LDL, triglycerides, body mass index, Castelli indexes I and II and waist circumference showed a significant decrease, even in patients without hypolipemiant treatment. The assessment of the diet impact showed that 72 percent of the patients that did not follow a diet, started to do so. Physical activity: of the 55 percent sedentary patients, 71 percent started to exercise three or more times a week. Smoking: of the smokers, 60 percent (9 percent of the total) stopped smoking and 32 percent decreased the number of cigarettes. CONCLUSION: These results demonstrated the effectiveness of the programs to improve life habits when applied to the units of the public health system.

[Life-habit intervention in a public institution].

BACKGROUND: Coronary disease is the major worldwide cause of death, according to the World Health Organization (WHO) and the second in Brazil. Sudden death occurs 4 to 6 times more frequently in those who have suffered an acute myocardial infarction (AMI); within 6 years, 18% of the men and 35% of the women will have a new AMI. The secondary prevention, of which effectiveness has been previously demonstrated, is of utmost importance. OBJECTIVE: To test the effectiveness of a multiprofessional program that aims at modifying risk factors for atherosclerosis in the public health system. METHODS: Of the 2,337 patients with coronary artery disease undergoing outpatient treatment, 513 with a coronary angiography study agreed to participate in the present study, which used lectures on how and why to control risk factors as therapeutic tool. STATISTICAL ANALYSIS: significant variation pre and post-intervention; paired Student's t test or Wilcoxon's test ; existence of a significant difference between the two groups; Student's t test for independent samples or Mann-Whitney test. Comparison among three groups: analysis of variance (ANOVA) or Kruskal-Wallis. RESULTS: Cholesterol, LDL, triglycerides, body mass index, Castelli indexes I and II and waist circumference showed a significant decrease, even in patients without hypolipemiant treatment. The assessment of the diet impact showed that 72% of the patients that did not follow a diet, started to do so. Physical activity: of the 55% sedentary patients, 71% started to exercise three or more times a week. Smoking: of the smokers, 60% (9% of the total) stopped smoking and 32% decreased the number of cigarettes. CONCLUSION: These results demonstrated the effectiveness of the programs to improve life habits when applied to the units of the public health system. (Arq Bras Cardiol. 2010; [online]. ahead print, PP.0-0).

Periodontal therapy reduces plasma levels of interleukin-6, C-reactive protein, and fibrinogen in patients with severe periodontitis and refractory arterial hypertension.

BACKGROUND: Recent epidemiologic studies suggest that inflammation is the link between periodontal diseases and cardiovascular complications. This study aimed to evaluate the effects of non-surgical periodontal treatment on plasma levels of inflammatory markers (interleukin [IL]-6, C-reactive protein [CRP], and fibrinogen) in patients with severe periodontitis and refractory arterial hypertension. METHODS: Twenty-two patients were examined and randomly divided into two groups. The test group was composed of 11 patients (mean age, 48.9 +/- 3.9 years) who received periodontal treatment, whereas the control group had 11 patients (mean age, 49.7 +/- 6.0 years) whose treatment was delayed for 3 months. Demographic and clinical periodontal data were collected, and blood tests were performed to measure the levels of IL-6, CRP, and fibrinogen at baseline and 3 months later. RESULTS: The clinical results showed that the mean percentages of sites with bleeding on probing, probing depth (PD) 4 to 5 mm, PD > or =6 mm, clinical attachment loss (CAL) 4 to 5 mm, and CAL > or =6 mm were significantly reduced in the test group 3 months after periodontal treatment. There were no significant differences between the data at baseline and 3 months in the control group. Periodontal treatment significantly reduced the blood levels of fibrinogen, CRP, and IL-6 in the test group. CONCLUSION: Non-surgical periodontal therapy was effective in improving periodontal clinical data and in reducing the plasma levels of IL-6, CRP, and fibrinogen in hypertensive patients with severe periodontitis.

Diferentes significados da disfunção diastólica tipo I, conforme o grupo estudado - nova proposta de classificação da disfunção diastólica tipo I com Doppler ecocardiograma aliado ao Doppler tecidual / Diastolic dysfunction grade I associated with different implications according to the studied group - new proposal for diastolic dysfunction grade I classification using Doppler echocardiography and tissue Doppler imaging

Atualmente dispõe-se do Doppler pulsado e do Doppler tecidual paraclassificar a disfunção diastólica em quatro graus.Ainda assim, considera-se não ser adequado atribuir um mesmo grau dedisfunção diastólica a indivíduos tão distintos como normaise pacientes hipertensos, isquêmicos e outros. Neste trabalho, o objetivo édemonstrar que pacientes com patologias distintas e ummesmo grau de disfunção diastólica podem ter característicasecocardiográficas bastante distintas.Foram estudados 86 indivíduos, sendo 25 atletas profissionais, 27adultos normais, 17 hipertensos e 17 coronariopatas, pelo ecocardiograma Doppler e Doppler tecidual. Foram determinadas as funçõessistólica, diastólica, diâmetros cavitários e massa do VE.Os atletas não apresentavam disfunção diastólica. Entre indivíduos com disfunção diastólica grau I, hipertensos ecoronariopatas, apresentavam espessuras parietais, massa do VE e diâmetro do AE maiores (P

A gravidade da lesão do fundo de olho e o padrão de hipertrofia ventricular esquerda na hipertensão arterial sistêmica refratária ao tratamento / Severity of retinopathy and left ventricular hypertrophy pattern in treatment-resistant systemic arterial hypertension

Fundamentos:A avaliação dos órgãos-alvo na hipertensão arterial refratária ao tratamento(HRT) permite uma estratificação prognóstica. Objetivo:Relacionar a lesão no fundo de olho (FO) com o padrão de hipertrofia ventricular esquerda(HVE) e os níveis médios de pressão sistólica nas 24h, na HRT. Métodos:Estudo transversal com 194 sujeitos do ambulatório de hipertensão arterial(INC-MS), sendo 42(21,6 por cento) com HRT. A retinopatia foi classificada de acordo com keith-wagener-backer(KWB); as variáveis analisadas ecocardiograficamente foram: índice de massa do VE(IMVE), para o diagnóstico de HVE; e a espessura relativa de parede do VE(ERP), para avaliar o padrão, se concêntrica(C) ou excêntrica(E). Foi estudada a pressão sistólica média de 24 hs(PSM24H) obtida pela MAPA. A análise dos dados foi testada por t de student, oneway ANOVA e quiquadrado ou exato de fisher para tabelas de contingência(a<0,05). Resultados: Todos os pacientes com HRT apresentavam lesão no FO e HVE. Foram estratificados em quatro grupos, segundo o FO(KWBII e KWBIII) e o ecocardiograma(HVEC e HVE E). Não houve diferença nos parâmetros antropométricos entre os grupos (p=NS) e na distribuição de HVE C e E entre os sujeitos com KWB II e KWB III (x=1,84; p=0,17). Nos indivíduos com HVE E(p<0,001) o que não foi observado nos KWB II e KWB III(p=NS). Conclusão: Nos sujeitos com HRT, lesões de FO e HVE foram dominantes. Os níveis de PSM24H elevados estão associados ao HVE C, mas não ao FO.

Doppler tecidual em indivíduos normotensos e hipertensos e sua correlação com o peptídio natriurético B plasmático / Tissue doppler in normotensive and hypertensive individuals and its correlation with natriureic peptide (plasmatic B)

Objetivo:Verificar a correlação existente entre o peptídio natriurético B (BNP), marcador fidedigno da disfunção miocárdica e a velocidade Ea ao Doppler Tissular, associada à disfunção diastólica, em pacientes normotensos e hipertensos com a função sistólica preservada.Métodos:Foram estudaods 101 pacientes, 68 do sexo masculino e 33 do sexo feminino, assim distribuídos:Grupo I 40 pacientes normotensos; Grupo II 61 pacientes portadores de hipertensão arterial sitêmica;Grupo IIa 52 pacientes hipertensos, com BNP maior 100pg/ml;Grupo IIb 9 pacientes hipertensos, com BNP menor 100pg/ml.Resultados:Grupo I Pacientes normotensos: Idade média:38 anos;Média do AE:35mm.Fração de ejeção:65 por cento;Massa do VE:162;EPW 79cm/s: DT(Ea) 18,8cm/s

Effect of oscillatory breathing on the variability of the RR Intervals and its prognostic importance in individuals with left ventricular global systolic dysfunction.

OBJECTIVE: To assess the effect of the oscillatory breathing on the variability of RR intervals (VRR) and on prognostic significance after one year follow-up in subjects with left ventricular global systolic dysfunction. METHODS: We studied 76 subjects, whose age ranged from 40 to 80 years, paired for age and gender, divided into two groups: group I - 34 healthy subjects; group II - 42 subjects with left ventricular global systolic dysfunction (ejection fraction < or = 0.40). The ECG signals were acquired during 600s in supine position, and analyzed the variation of the thoracic amplitude and the VRR. Clinical and V-RR variables were applied into a logistic multivariate model to foretell survival after one year follow-up. RESULTS: Oscillatory breathing was detected in 35.7% of subjects in vigil state of group II, with a concentration of the spectral power in the very low frequency band, and was independent of the presence of diabetes, functional class, ejection fraction, cause of ventricular dysfunction and survival after one year follow-up. In the logistic regression model, ejection fraction was the only independent variable to predict survival. CONCLUSION: 1). Oscillatory breathing pattern is frequent during wakefulness in the left ventricular global systolic dysfunction and concentrates spectral power in the very low band of V-RR; 2). it does not relate to severity and cause of left ventricular dysfunction; 3). ejection fraction is the only independent predictive variable for survival in this group of subjects.

Efeito da respiração oscilatória sobre a variabilidade dos intervalos RR e sua importância prognóstica em indivíduos com disfunção sistólica global do ventrículo esquerdo / Effect of oscillatory breathing on the variability of the RR Intervals and its prognostic importance in individuals with left ventricular global systolic dysfunction

OBJECTIVE: To assess the effect of the oscillatory breathing on the variability of RR intervals (VRR) and on prognostic significance after one year follow-up in subjects with left ventricular global systolic dysfunction. METHODS: We studied 76 subjects, whose age ranged from 40 to 80 years, paired for age and gender, divided into two groups: group I - 34 healthy subjects; group II - 42 subjects with left ventricular global systolic dysfunction (ejection fraction < 0.40). The ECG signals were acquired during 600s in supine position, and analyzed the variation of the thoracic amplitude and the VRR. Clinical and V-RR variables were applied into a logistic multivariate model to foretell survival after one year follow-up. RESULTS: Oscillatory breathing was detected in 35.7 percent of subjects in vigil state of group II, with a concentration of the spectral power in the very low frequency band, and was independent of the presence of diabetes, functional class, ejection fraction, cause of ventricular dysfunction and survival after one year follow-up. In the logistic regression model, ejection fraction was the only independent variable to predict survival. CONCLUSION: 1) Oscillatory breathing pattern is frequent during wakefulness in the left ventricular global systolic dysfunction and concentrates spectral power in the very low band of V-RR; 2) it does not relate to severity and cause of left ventricular dysfunction; 3) ejection fraction is the only independent predictive variable for survival in this group of subjects

Nonrespiratory sinus arrhythmia.

We report here 2 cases of sinus arrhythmia considered to be a form of nonrespiratory sinus arrhythmia because they did not have variances in the RR interval sequence within the oscillations modulated by respiration. Because the patients had pulsus alternans similar that observed in bigeminy, and because they did not have signs or symptoms of heart failure, we believe the arrhythmias represent intrinsic alterations of the electric activity of the sinus node

Arritmia sinusal não respiratória / Nonrespiratory sinus arrhythmia

We report here 2 cases of sinus arrhythmia considered to be a form of nonrespiratory sinus arrhythmia because they did not have variances in the RR interval sequence within the oscillations modulated by respiration. Because the patients had pulsus alternans similar that observed in bigeminy, and because they did not have signs or symptoms of heart failure, we believe the arrhythmias represent intrinsic alterations of the electric activity of the sinus node.

Autonomic modulation of the heart in systemic arterial hypertension.

OBJECTIVE: To analyze the heart rate variability in patients with mild to moderate systemic arterial hypertension. METHODS: Thirty-two healthy (group I) and 70 systemic arterial hypertensive (group II) individuals, divided according to age (40 to 59 and 60 to 80 years old, respectively) and with a similar distribution by sex were studied. Thirty-one had left ventricular hypertrophy (LVH), 22 were overweight, and 16 had Type II diabetes mellitus. Smoking, alcohol ingestion, and sedentary habits were the same between groups. Variability in heart rate was analyzed in the time domain, using standard deviations of normal RR intervals (SDNN) and the differences between maximal brady- and tachycardia (D-BTmax) during sustained inspiration. Analysis of the frequency band of the power spectrum between 0.05 and 0.40 Hz at rest and during controlled respiration was chosen for analysis of the frequency domain. RESULTS: In both time and frequency domains, variables were lower in group II than in group I. Within groups, statistically significant variables were only found for individuals in the 40 to 59 year old group. The presence of LVH, overweight, or diabetes mellitus did not influence the variability in heart rate to a significant extent. CONCLUSION: Variability in heart rate was a valuable instrument for analyzing autonomic modulation of the heart in arterial hypertension. The autonomic system undergoes significant losses in cardio-modulatory capacity, more evident in subjects between 40 and 59 years old. In those over 60 years old, reduced variability in heart rate imposed by aging was not significantly influenced by the presence of systemic arterial hypertension.

Modulação autonômica do coração na hipertensão arterial sistêmica / Autonomic modulation of the heart in systemic arterial hypertension

OBJECTIVE: To analyze the heart rate variability in patients with mild to moderate systemic arterial hypertension. METHODS: Thirty-two healthy (group I) and 70 systemic arterial hypertensive (group II) individuals, divided according to age (40 to 59 and 60 to 80 years old, respectively) and with a similar distribution by sex were studied. Thirty-one had left ventricular hypertrophy (LVH), 22 were overweight, and 16 had Type II diabetes mellitus. Smoking, alcohol ingestion, and sedentary habits were the same between groups. Variability in heart rate was analyzed in the time domain, using standard deviations of normal RR intervals (SDNN) and the differences between maximal brady- and tachycardia (D-BTmax) during sustained inspiration. Analysis of the frequency band of the power spectrum between 0.05 and 0.40 Hz at rest and during controlled respiration was chosen for analysis of the frequency domain. RESULTS: In both time and frequency domains, variables were lower in group II than in group I. Within groups, statistically significant variables were only found for individuals in the 40 to 59 year old group. The presence of LVH, overweight, or diabetes mellitus did not influence the variability in heart rate to a significant extent. CONCLUSION: Variability in heart rate was a valuable instrument for analyzing autonomic modulation of the heart in arterial hypertension. The autonomic system undergoes significant losses in cardio-modulatory capacity, more evident in subjects between 40 and 59 years old. In those over 60 years old, reduced variability in heart rate imposed by aging was not significantly influenced by the presence of systemic arterial hypertension