Kristal-Boneh E, Raifel M, Froom P, Ribak J. Heart rate variability in health and disease. Scand J Work Environ Heal th 199521 :85-95.Beat-to-beat fluctuations in heart rate (HR) or instantaneous HR is mainly determined by activity of the cardiac sympathetic and parasympathetic systems. Despite the need for standardization in methodology to facilitate the interpretation and coinparison of results, the data presented in this review clearly show that there are individual differences in heart rate variability (HRV) and that these differences partly reflect differences in the degree of parasympathetic and sympathetic stimulation of the heart. HRV and its spectral components can be easily and noninvasively assessed and call provide valuable information to the occupational physician. Measurements of HRV and the quantification of its spectral components are powerful predictors of cardiovascular morbidity and mortality. Therefore it may help assess the return to work of patients with ischemic heart disease. Studies in the workplace can also indicate the effects of various stresses of the work environment on such patients and even on asymptomatic workers. Key words occupation, review.For a long time the study of heart rate variability (HRV) was confined to the laboratory. However, thanks to recent advances in microprocessor technology, the analysis of beat-to-beat variation has become possible also to the clinician. The increasing number of HRV investigations in the clinical and physiological literature emphasizes the value of HRV measures as a prognostic tool for the rapid and noninvasive assessment of the autonomic nervous function of the heart. Provided herein is an update of the current knowledge on HRV, in health and disease. Hearf rate variability -definifion and causesHRV is defined as spontaneous fluctuations in sinus rate due to internal and external body processes. It is usually measured as the standard (or average) deviation from the mean R-R intervals of all cardiac cycle lengths (R-R intervals for normal sinus beats) over a given period, most commonly 5 min. Beat-to-beat fluctuations in heart rate are mainly determined by the activity of the cardiac sympathetic and parasympathetic systems. Physiological experiments have demonstrated a correlation between cardiac nervous activity and immediate R-R interval changes (1-4). These studies form the basis for the examination of autonomic cardiac activity by HRV. The rate and variation of heart beats are the result of a complex interaction between sympathetic and parasympathetic efferent impulse activity in addition to the influence of sinus node pacemaker properties (5-7). The sinoatrial (S-A) node is directly and richly innervated by both sympathetic and parasympathetic (vagus) nerve fibers, which are continually active; the atrioventricular (A-V) node is less affected. Parasympathetic stimulation hyperpolarizes the S-A node, decreasing the rate of spontaneous firing and the cardiac rate. Sympathetic nerve endings, on the other hand, release norepinephrine, and th...
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