Evaluation of the heart rate during initial active standing in patients with vasovagal syncope
Keywords:
síncope vasovagal, frecuencia cardiaca, bipedestación activa, sistema nervioso autónomo.Abstract
Introduction: Vasovagal syncope is the most frequent cause of brief loss of consciousness, in its etiopathogenesis an autonomic dysfunction is reported that can be manifested in immediate active standing.Objective: To compare the dynamics of heart rate changes during immediate active standing of patients suffering from vasovagal syncope with control subjects.
Methods: 132 supposedly healthy subjects (group A) between 18 and 25 years old and 156 patients with vasovagal syncope were evaluated, which were divided by their response to prolonged standing, negative 111 (group B) and positive 45 (group C). Electrocardiographic activity was recorded in the supine position and at the beginning of active standing, the sequences of RR intervals were obtained. The heart rate was compared in the 3 groups, using 22 indicators (positional, temporal, ordinal and relational, average and of the speed of changes).
Results: Differences were not found in the average indicators in the analyzed period, however, some that evaluate the speed of the initial change were significantly lower in group A compared to B and C (p<0.05), while others that evaluate the speed recovery rates were significantly lower in group C compared to A and B. This allows to characterize, compare and differentiate the groups studied during the complex and rapid interactions that occur in the change of position.
Conclusion: The dynamic of frequency changes, allowed to find indicators, which can be considered as possible predictors of an inadequate cardiovascular response in patients with vasovagal syncope.
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References
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22. Kovalchuk T, Boyarchuk O, Pavlyshyn H, Balatska N, Luchyshyn N. Analysis of heart rate variability in paediatric patients with vasovagal syncope. Pediatr Pol. 2019 [acceso: 05/02/2021]; 94(6): 357-367. Disponible en: https://doi.org/10.5114/polp.2019.92965
23. Estévez M , Carricarte C , Denis Jas J, Rodríguez E, Machado C , Montes J, et al. Influence of Heart Rate, Age, and Gender on Heart Rate Variability in Adolescents and Young Adults. Adv Exp Med Biol - Clinical and Experimental Biomedicine. 2019 [acceso: 05/02/2021]; 4: 19-33. Disponible en: https://doi.org/10.1007/5584_2018_292
2. Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, et al. 2018 ESC Guidelines for the diagnosis and management of syncope . European Heart Journal. 2018 [acceso: 22/11/2019]; 39(21): 1883-48. Disponible en: https://doi.org/10.1093/eurheartj/ehy037
3. Ghariq M, Thijs RD, Bek LM, Van Zwet EW, Benditt DG, Van Dijk JG. A higher proportion of menthan of women fainted in the phase without nitroglycerin in tilt-induced vasovagal syncope. Clinical Autonomic Research. 2020 [acceso: 18/12/2020]; 30: 441-447. Disponible en: https://doi.org/10.1007/s10286-020-00666-5
4. Hall JE. Guyton y Hall: tratado de fisiología médica. 13 edición. Barcelona: Elsevier Health Sciences Spain; 2016.
5. Wieling W. Standing, orthostatic stress, and autonomic function. En: Bannister R, editor. Autonomic failure: a textbook of clinical disorders of the autonomic nervous system. Oxford: Oxford Medical Publications; 1988. p. 308-20.
6. Ewing DJ, Martyn CN, Young RJ, Clarke BF. The value of cardiovascular autonomic function tests: 10 years experience in diabetes. Diabetes Care. 1985 [acceso: 06/12/2019]; 8(5):491-8. Disponible en: https://doi.org/10.2337/diacare.8.5.491
7. Campbell IW, Ewing DJ, Clarke BF. Tests of cardiovascular reflex function in diabetic autonomic neuropathy. En: FA Gries, HJ Freund, F Rube, H Berger (eds). Aspects of autonomic neuropathy in diabetics. Stuttgart: Georg Thieme Verlag; 1979. p. 61-8.
8. Sundkvist G, Lilja B, Almer LO. Deep breathing, Valsalva, and tilt table tests in diabetics with and without symptoms of autonomic neuropathy. Acta Med Scand. 1982 [acceso: 06/12/2019]; 211:369-73. Disponible en: https://doi.org/10.1111/j.0954-6820.1982.tb01964.x
9. Borst C, Wieling W, Van Brederode JFM, Hond A, de Rijk LG, Dunning AJ. Mechanisms of initial heart rate response to postural change. Am J Physiol. 1982 [acceso: 18/12/2020]; 243(6): H676-H81. Disponible en: https://doi.org/10.1152/ajpheart.1982.243.5.H676
10. Wieling W, Borst C, Van Brederode JFM, Van Dongen Torman MA, Van Montfrans GA, Dunning AJ. Testing for autonomic neuropathy: heart rate changes after orthostatic maneuvers and static muscle contractions. Clin Sci. 1983 [acceso: 06/12/2019]; 64:581-6. Disponible en: https://doi.org/10.1042/cs0640581
11. Cybulski G, Niewiadomski W. Influence of age on the immediate heart rate response to the active orthostatic test. J Physiol Pharmacol. 2003 [acceso: 18/12/2020]; 54(1): 65-80. Disponible en: http://www.jpp.krakow.pl/journal/archive/03_03/pdf/65_03_03_article.pdf
12. Iglesias Alfonso JC, Aldana Vilas L, García Gutiérrez E, Vázquez Díaz Granados G. Frecuencia cardiaca en la bipedestación activa inmediata en jóvenes sanos. Revista cubana de medicina militar. 2010 [acceso: 18/12/2020]; 39(2): 104-15. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0138-65572010000200005&lng=es
13. Machado A, Estévez M. Software to digitize electrocardiograms and quantify heart rate variability in humans. ManualZZ, The Universal Manual Library. 2008 [acceso: 18/12/2020]. Disponible en: https://manualzz.com/doc/6611880/software-to-digitize-electrocardiograms-and-quantify-hear
14. Iglesias JC, Reyes L, Delgado O, Sánchez K, Quevedo C. Manual del Usuario del Sistema de Registro y Procesamiento del Ritmo Cardiaco. Ritmocard. Ver 3.2. La Habana: HMC Dr. Carlos J. Finlay; 1997.
15. StatSoft, Inc. STATISTICS (data analysis software system), version 12. 2013. [acceso: 18/12/2014]. Disponible en: https://www.scientific-computing.com/press-releases/statistica-12?product_id=1543
16. Grubb BP. Neurocardiogenic syncope and related disorders of orthostatic intolerance. Circulation. 2005 [acceso: 18/12/2020]; 111(22): 2997-3006. Disponible en: https://doi.org/10.1161/CIRCULATIONAHA.104.482018
17. Purves D, Augustine GJ, Fitzpatrick D, Hall WC, Lamantia AS, Mc Namara JO, et al (Eds.). The Visceral Motor System. En: Neuroscience, 3rd ed., Sunderland, MA: Sinauer Associates, Inc.; 2004. p. 469-499. [acceso: 18/12/2020]. Disponible en: https://www.hse.ru/data/2011/06/22/1215686482/Neuroscience.pdf
18. Estévez M. Visión clásica del Sistema Nervioso Autónomo. Habana, Instituto Nacional de Neurología y Neurocirugía; 2007. [acceso: 18/12/2020]. Disponible en: http://infomed20.sld.cu/wiki/doku.php?id=librosabiertos:vision_clasica_del_sistema_-nervioso_autonomo&rev=1192374032
19. Pagani M, Lombardi F, Guzzetti S, Rimoldi O, Furlan R, Pizzinelli P, et al. Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympathovagal interaction in man and conscious dog. Circ Res. 1986 [acceso: 18/12/2020]; 59(2):178-193 Disponible en: https://doi.org/10.1161/01.res.59.2.178
20. Mallat Z, Vicaut E, Sangaré A, Verschueren J, Fontaine G, Frank R. Prediction of head-up tilt test result by analysis of early heart rate variations. Circulation. 1997 [acceso: 05/02/2021]; 96:581-584. Disponible en: https://doi.org/10.1161/01.CIR.96.2.581
21. García A, Lacunza J, Rojo JL, Sánchez JJ, Juan Martínez J, Jesús Requena J, et al. El incremento temprano de la frecuencia cardiaca no predice el resultado de la prueba de mesa basculante potenciada con nitroglicerina. Rev Esp Cardiol, 2005 [acceso: 05/02/2021]; 58: 499-503. Disponible en: https://doi.org/10.1157/13074859
22. Kovalchuk T, Boyarchuk O, Pavlyshyn H, Balatska N, Luchyshyn N. Analysis of heart rate variability in paediatric patients with vasovagal syncope. Pediatr Pol. 2019 [acceso: 05/02/2021]; 94(6): 357-367. Disponible en: https://doi.org/10.5114/polp.2019.92965
23. Estévez M , Carricarte C , Denis Jas J, Rodríguez E, Machado C , Montes J, et al. Influence of Heart Rate, Age, and Gender on Heart Rate Variability in Adolescents and Young Adults. Adv Exp Med Biol - Clinical and Experimental Biomedicine. 2019 [acceso: 05/02/2021]; 4: 19-33. Disponible en: https://doi.org/10.1007/5584_2018_292
Published
2021-09-14
How to Cite
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Iglesias Alfonso JDC, Socarras Hernandez BN. Evaluation of the heart rate during initial active standing in patients with vasovagal syncope. Rev Cubana Med Milit [Internet]. 2021 Sep. 14 [cited 2025 Apr. 8];50(3):e02101396. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/1396
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