Chronotropic incompetence—part i: Normal regulation of the heart rate

Fei, L

doi:10.1002/clc.4960190518

Cited by 35 publications

(6 citation statements)

References 43 publications

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“…It is, however, inefficient for the heart rate to increase such that LV filling is impaired. Thus, although the factors which determine maximal heart rate during exercise are incompletely understood, it is likely that cardiopulmonary baroreceptor activation contributes to maintaining an appropriate balance between LV preload and heart rate during exercise [51]. …”

Section: Cardiac Output Augmentation During Exercise In the Normalmentioning

confidence: 99%

What Limits Cardiac Performance during Exercise in Normal Subjects and in Healthy Fontan Patients?

Gerche

Gewillig

2010

International Journal of Pediatrics

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Exercise is an important determinant of health but is significantly reduced in the patient with a univentricular circulation. Normal exercise physiology mandates an increase in pulmonary artery pressures which places an increased work demand on the right ventricle (RV). In a biventricular circulation with pathological increases in pulmonary vascular resistance and/or reductions in RV function, exercise-induced augmentation of cardiac output is limited. Left ventricular preload reserve is dependent upon flow through the pulmonary circulation and this requires adequate RV performance. In the Fontan patient, the reasons for exercise intolerance are complex. In those patients with myocardial dysfunction or other pathologies of the circulatory components, it is likely that these abnormalities serve as a limitation to cardiac performance during exercise. However, in the healthy Fontan patient, it may be the absence of a sub-pulmonary pump which limits normal increases in pulmonary pressures, trans-pulmonary flow requirements and cardiac output. If so, performance will be exquisitely dependent on pulmonary vascular resistance. This provides a potential explanation as to why pulmonary vasodilators may improve exercise tolerance. As has recently been demonstrated, these agents may offer an important new treatment strategy which directly addresses the physiological limitations in the Fontan patient.

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Section: Cardiac Output Augmentation During Exercise In the Normalmentioning

confidence: 99%

What Limits Cardiac Performance during Exercise in Normal Subjects and in Healthy Fontan Patients?

Gerche

Gewillig

2010

International Journal of Pediatrics

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“…Other specific circumstances of this study include an exercise protocol applying slow increments of workload (30 W every 2 min) in order to simulate changes in physical load during everyday life [32]. Exercise was performed in a supine position, which is associated with a smaller heart rate increase than a sitting position [33]. In accordance, the cutoff point for chronotropic competence was lowered from 85 to 80% of the predicted age-related peak heart rate [34].…”

Section: Discussionmentioning

confidence: 99%

The Heart Rate Response to Exercise Is Blunted in Patients with Sleep-Related Breathing Disorder

2004

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Background: This study addressed the hypothesis that cardiovascular reactivity during graded bicycle exercise is influenced by a coexisting sleep-related breathing disorder (SRBD). Methods: Blood pressure and heart rate were assessed at rest and during graded exercise (110 W and maximal load) in 1,149 patients of a Sleep Disorders Center. The degree of SRBD, and potential confounders, including blood gases and pulmonary function, were determined. Results: Maximal exercise capacity tended to decrease with SRBD activity (p = 0.07). The heart rate reactivity was blunted and reduced by –0.07 and –0.09 beats/min for every SRBD unit at 110 W (p < 0.001) and at maximal load (p < 0.001), respectively. Systolic and diastolic blood pressure reactivity at maximal load were positively associated with SRBD severity. These associations were independent of possible confounders. Conclusion: SRBD is associated with reduced physical working capacity and a modified hemodynamic response to exercise.

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“…These disturbances are termed chronotropic incompetence referring to the inability of the heart to increase its rate commensurate with increased activity or demand as required with physical exertion [14]. It produces exercise intolerance which impairs quality-of-life [15].…”

Section: Introductionmentioning

confidence: 99%

Physiological Adaptation in Women Presenting Fibromyalgia: Comparison with Healthy Controls

Lange¹,

Mannerkorpi²,

Cider³

et al. 2017

Clin Exp Psychol

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Objective: To compare the heart rate variability (HRV) before and after a sub-maximal exercise test in women with fibromyalgia (FM) and to compare the result to matched controls. Additionally, to compare heart rate (HR) before, during and after the sub-maximal exercise test.Methods: Twenty-four women with FM and 26 controls performed a sub-maximal exercise test. HRV was registered for 5 minutes at rest before and after the exercise test. HR was registered at baseline, during the exercise test and at recovery. Results:The HRV of the healthy group was statistically different from the exercise test but the women with FM showed no such difference. HR was significantly higher among the women with FM than in the healthy group at baseline and up to 75W but lower at peak (138/152 bpm, p<0.008). In women with FM HR during exercise (HR2) was predicted by heart rate recovery (HRR20) and physical exertion (RPE2). HRR20 and RPE2 accounted for 0.465 of the variance (p=0.006) in HR2. In healthy women HR2 correlated with HRR20 and negatively with physical activity (PhA). In the reference group HRR20 and PhA accounted for 0.448 (p=0.002) of the variance HR. Conclusion:The HRV in women with FM show less adjustment of the ANS while not being significantly affected by submaximal exercise as healthy women. In healthy women heart rate during the test was negatively related to PhA. In women with FM exertion seems to replace an effect from exercise on physiological adaptation. FM may entail imperceptible extraction of power from PhA while under load. Links to FM pain will be discussed.Women with FM seem to rate exertion "Very hard" on lower workload and HR than healthy women. The physiotherapeutic methodology for measuring HRV with basic HR monitors should be improved before it can be recommended for clinical use.

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Chronotropic incompetence—part i: Normal regulation of the heart rate

Cited by 35 publications

References 43 publications

What Limits Cardiac Performance during Exercise in Normal Subjects and in Healthy Fontan Patients?

What Limits Cardiac Performance during Exercise in Normal Subjects and in Healthy Fontan Patients?

The Heart Rate Response to Exercise Is Blunted in Patients with Sleep-Related Breathing Disorder

Physiological Adaptation in Women Presenting Fibromyalgia: Comparison with Healthy Controls

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