Heart rate variability in health and disease

Abstract

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...

The Roles of Marriage and Anger Dysregulation in Biobehavioral Stress Responses

“…This model is consistent with a body of research that finds anger dysregulation to be associated with weaker vagal control (Fukudo et al, 1992;Muranaka et al, 1988). It is also consistent with a growing research literature that links weaker parasympathetic control mechanisms with CVD and adverse cardiovascular events (e.g., Kleiger, Miller, Bigger, & Moss, 1987;Kristal-Boneh, Raifel, Froom, & Ribak, 1995;Singh, Kartik, Otsuka, Pella, & Pella, 2002;Tsuji et al, 1996;VanRavenswaaij-Arts, Kollee, Hopman, Stoelinga, & van Geijn, 1993).…”

“…It is often difficult in the time-limited environment of health care to assess contextual factors in patients' lives. However, given the growing body of research that indicates an association between lower levels of heart period variability and cardiac events (e.g., Kleiger et al, 1987;Kristal-Boneh et al, 1995;Singh et al, 2002;Tsuji et al, 1996;VanRavenswaaijArts et al, 1993), recognizing the presence of a distressed marriage could be an important first step (particularly with female patients) in identifying those individuals who may be at future risk for cardiac and other problematic physical health outcomes. NOTE: HF-HPV = high-frequency heart period variability; IBI = interbeat interval.…”

Risky families: Family social environments and the mental and physical health of offspring.

“…5 Alterations in SAM reactivity in children exposed to risky family environments may also reflect contributions from the counterregulatory parasympathetic nervous system. Negative emotions such as anxiety and hostility have been associated with lower heart rate variability, a marker of reduced parasympathetic response (Kawachi, Sparrow, Vokonas, & Weiss, 1994;Sloan et al, 1994), and lower heart rate variability has in turn been linked to increased health risks (Kristal-Boneh, Raifel, Froom, & Rivak, 1995). These findings suggest that children in risky families may experience reductions in PNS activity, an important counterregulatory "brake" on SAM activity, thereby contributing to dysregulation of the SAM system.…”

Physiological Reaction to Work in Cold Microclimate

“…The method has become commonly used in the diagnosis of diabetic neuropathy and risk assessment of sudden cardiac death in post-infarction patients as well as in screening other cardiovascular and neurological disorders [6][7][8][9][10][11]. It is also used in experimental physiological studies [12,13], but rarely in examinations of workers exposed to various occupational hazards [14]. Ambulatory blood pressure monitoring (ABPM) makes it possible to identify people with high risk of developing arterial hypertension [15][16][17].…”