JYOTI KATARIA, READER, COLLEGE OF NURSING

300 gram muscle which pumps over 70 litres of blood per minute without interruption for 70 to 80 years. It beats 100,000 times per day and approximately 40 million beats per year, which equates to around 3 billion pulses per lifetime.

Jyoti_Kath, Reader @ college Of Nursing

The heart is, in fact, a complex, sensory organ with its own functional "heart brain" that communicates with and influences the brain via the nervous system, hormonal system and other pathways long time - anger, anxiety and worry significantly increase the risk of heart disease, including sudden cardiac death
Jyoti_Kath, Reader @ college Of Nursing

Heart activity correlates to our emotions, stress, motivational levels, personality and social factors and at every living moment, there is implicit conditioning and interaction between the heart and the brain.

Jyoti_Kath, Reader @ college Of Nursing

The heart produces an electric field 60 times stronger than that produced by the brain it's electromagnetic field is 5000, stronger than the field generated by the brain This is why the quality of the variation of the heart beat can also subtly influence people who are in our proximity (under 1.5 m distance).
Jyoti_Kath, Reader @ college Of Nursing

Neurophysiologists have discovered a neural pathway and mechanism whereby input from the heart to the brain can "inhibit" or "facilitate" the brains electrical activity

Jyoti_Kath, Reader @ college Of Nursing

HEART BRAIN
Dr. J. Andrew Armour, introduced the concept of a functional "heart brain" in 1991. the heart is considered a single entity
The 'brain in the heart' is a network of neurons, neurotransmitters and proteins that send messages between neurons.Like the brain, the heart also has support cells and a complex circuitry that enables it to act independently, learn, remember, and produce the "feelings of the heart.

DEFINITION

Heart rate variability (HRV) refers to the beat-tobeat alterations in heart rate.

Jyoti_Kath, Reader @ college Of Nursing

Heart rate variability (HRV) is a physiological phenomenon where the time interval between heart beats varies. It is measured by the variation in the beat-to-beat interval. Other terms used include: "cycle length variability", "RR variability" (where R is a point corresponding to the peak of the QRS complex of the ECG wave; and RR is the interval between successive Rs), and "heart period variability".

Jyoti_Kath, Reader @ college Of Nursing

Does HRV predict disease?

HRV stems from its ability to predict survival after heart attack reduced HRV predicts sudden death in patients with MI, independent of other prognostic indicators such as ejection fraction Reduced HRV appears to be a marker of fatal ventricular arrhythmia. reduced HRV may predict risk of survival even among individuals free of CHD.

Jyoti_Kath, Reader @ college Of Nursing

CLINICAL SIGNIFICANCE

Reduced HRV has been shown to be a predictor of mortality after myocardial infarction[1][ usually lower HRV, indicates congestive heart failure, diabetic neuropathy, depression postcardiac transplant, susceptibility to SIDS and poor survival in premature babies.

Jyoti_Kath, Reader @ college Of Nursing

CLINICAL SIGNIFICANCE

HRV studies have also been used to examine autonomic function in the context of bodily pain. Studies of patients with Fybromyalgic Syndrome (FMS) demonstrate reduced general Autonomic Nervous System (ANS) activity and markedly reduced nocturnal ANS activity,[4] increased baseline Sympathetic Nervous System (SNS) activity,[5] and impaired SNS reactivity to stimuli including orthostatic and mental stress.[5][6]

Jyoti_Kath, Reader @ college Of Nursing

HEART RATE VARIABILITY PHENOMENA

There are two primary fluctuations: Respiratory arrhythmia (or Respiratory sinus arrhythmia). This heart rate variation is associated with respiration and faithfully tracks the respiratory rate across a range of frequencies. Low-frequency oscillations. This heart rate variation is associated with Mayer waves (TraubeHeringMayer waves) of blood pressure and is usually at a frequency of 0.1 Hz or a 6-second period. Breathing-frequency bias. This is the finding that the periodical properties of respiratory sinus arrhythmia produce a change of the correlation exponent in heart rate variability at a scale corresponding to the breathing period. The short-term detrended fluctuation analysis exponent is significantly reduced when breathing frequency rises from 0.1 Hz to 0.2 Hz

Heart Rate Variability

HRV was assessed manually, earlier from calculation of the mean R-R interval and its standard deviation measured on short-term (e.g., 5 minute) electrocardiograms. The smaller the standard deviation in R-R intervals, the lower is the HRV Recent Advances: over 26 different types of arithmetic manipulations of R-R intervals have been used in the literature to represent HRV.

Jyoti_Kath, Reader @ college Of Nursing

Heart Rate Variability Analysis

Timedomain methods

Geometric methods

Frequencydomain methods

Non-linear methods

Analysis software

Jyoti_Kath Reader @college Of Nursing

Time-domain methods
based on the beat-to-beat or NN intervals SDNN, the standard deviation of NN intervals. Often calculated over a 24-hour period.
SDANN, the standard deviation of the average NN intervals calculated over short periods, usually 5 minutes. SDANN is therefore a measure of changes in heart rate due to cycles longer than 5 minutes.

RMSSD, the square root of the mean squared difference of successive NNs.
NN50, the number of pairs of successive NNs that differ by more than 50 ms. pNN50, the proportion of NN50 divided by total number of NNs.

Jyoti_Kath, Reader @ college Of Nursing

Normal values of standard measures of HRV

SDNN ms 141 39 SDANN ms 127 35 RMSSD ms 27 12 HRV triangular index 37 15 Spectral analysis of stationary supine 5-min recording Total power ms2 3466 1018 LF ms2 1170 416 HF ms2 975 203 LF nu 54 4 HF nu 29 3 LF/HF ratio 1.52.0

Time Domain Analysis of Nominal 24 hours

Jyoti_Kath, Reader @ college Of Nursing

Physiological correlation of HRV components

Autonomic influences of heart rate
The sympathetic influence on heart rate is mediated by release of epinephrine and norepinephrine

vagal tone prevails and variations in heart period are largely dependent on vagal modulation

Jyoti_Kath, Reader @ college Of Nursing

AGE RELATED HEART RATE VARIABILITY

Fetal HR is about 140 beats per minute (bpm), During labor, HR rises to around 160 bpm. The newborn HR is around 140 bpm drops within the first year to around 120 bpm. At the age of ten, HR comes down to some 90 bpm. Newborns and young infants show HR decelerations ranging from 2-4 beats per minute when auditory or visual stimulation is terminated. (Berg, 1974; Porges, Stamps &Walter, 1974).

Jyoti_Kath, Reader @ college Of Nursing

Changes of HRV related to specific pathologies

Myocardial infarction

Diabetic neuropathy

Cardiac transplantation

Myocardial dysfunction

Tetraplegia

Jyoti_Kath, Reader @ college Of Nursing

Modifications of HRV by specific interventions

-Adrenergic blockade and HRV Antiarrhythmic drugs and HRV
Scopolamine and HRV Thrombolysis and HRV Exercise training and HRV

Jyoti_Kath, Reader @ college Of Nursing

Jyoti_Kath, Reader @ college Of Nursing