Clinical autonomic research : official journal of the Clinical Autonomic Research Society
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Heart rate recovery (HRR) after exercise and spectral decomposition of heart rate variability (HRV), measures of autonomic nervous system function, are predictors of cardiovascular morbidity/mortality. QT interval, an index of ventricular depolarization and repolarization attained from surface ECG, is also associated with morbidity/mortality and is strongly influenced by autonomic tone. The purpose of this study was to assess the association between HRR after exercise, resting HRV and resting rate corrected QT interval in young healthy men. ⋯ There was no correlation between high frequency power of HRV (a marker of parasympathetic modulation) and QTc interval. There was a negative relationship between absolute LF power (a marker of both sympathetic and parasympathetic modulation) and QTc interval for Karjalainen, Framingham, and Bazett correction methods (r = -0.33 to -0.47, P < 0.05). Resting LF power of HRV and HRR after exercise are inversely associated with resting QTc interval in young healthy men, supporting a relationship between cardiac autonomic nervous system function and ventricular depolarization and repolarization.
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Placement in the Trendelenburg position has successfully reverted two patients with supraventricular tachycardia back into sinus rhythm. This technique may provide a safe, non-invasive method for terminating supraventricular tachycardias without the need for drugs.
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The occurrence of asystole during an epileptic seizure is the most dramatic manifestation of ictal bradycardia. Recognition of ictal asystole is important as treatment with both antiepileptic drugs and cardiac pacing may be necessary. The purpose of this study was to identify clinical cues to aid in the detection of ictal asystole. ⋯ The presence of loss of muscle tone or bilateral asymmetric jerky limb movements during a seizure suggests the possibility of ictal asystole. Video-EEG/ECG monitoring should be considered in patients with epilepsy demonstrating these clinical features to determine if ictal asystole is present.
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The ganglionic blocking agent trimethaphan (TMP) is no longer produced. Therefore, a need exists for alternative pharmacological approaches to investigate baroreflex control of the circulation. The aim of the present study was to examine baroreflex-mediated cardiovascular responses during the administration of a muscarinic receptor antagonist (glycopyrrolate; GLY: ) and a selective alpha-2 receptor agonist (dexmedetomidine; DEX: ) and to compare responses to ganglionic blockade with TMP. ⋯ Phenylephrine increased systolic pressure 34 +/- 4 mmHg under GLY: -DEX: and 23 +/- 3 mmHg with TMP (P < 0.05). Heart rate only decreased 1 +/- 2 bpm during GLY: -DEX: and 1 +/- 1 bpm with TMP. Taken together, our results suggest that GLY: -DEX: is a reasonable alternative to TMP for baroreflex inhibition.
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Endoscopic thoracic sympathectomy is routinely used to treat severe hyperhidrosis. It is usually performed at the T2-T3 level of the nerve, but may produce less severe compensatory hidrosis if performed at a lower level. This study evaluates the outcome of 1,274 patients who underwent endoscopic thoracic sympathectomy for plamar, plantar, axillary or facial hyperhidrosis/blushing. ⋯ Endoscopic thoracic sympathectomy is a safe and effective treatment for hyperhidrosis. Clamping at the T3-T4 level has a more successful outcome. In particular, it appears to reduce the incidence of severe compensatory hidrosis.