An International Journal for Biomedical Sciences - Biomedicine

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22 Biomedicine; 2011; 31 (1): 22 - 26 Heart rate reserve – A useful tool for evaluation of chest pain in middle aged *C.P. Ganashree, S M Nataraj, R. Rajalakshmi,Vijaya Y Vageesh Department of Physiology, JSS Medical College, Mysore - 570015, Karnataka. * PGIBMS awardee at 31st Annual conference of IABMS (Received 12th November, 2010; Revised 20th December, 2010; Accepted 10th January, 2011) Corresponding author Ganashree C P E-mail: ganaraghu@yahoo.com Abstract Background: Chronotropic incompetence (CI) is the inability of heart rate response to meet metabolic demand. It is an attenuated heart rate response to exercise and is a predictor of all- cause mortality in healthy populations. Objectives: To study heart rate reserve and CI in middle aged with non specific chest pain to isotonic exercise. Methods: This is a retrospective cross sectional study carried out in the department of Medicine, JSS hospital. Study group comprised of 43 patients(Males-30 and Females-13) in the age group 40-50 years with history of nonspecific chest pain but normotensive, nondiabetic and normal resting ECG. Standard Bruce protocol was followed. Two groups were made-Group A(6 patients with typical angina) and Group B(37 patients with non typical angina). Chronotropic incompetence was concluded if derived value is less than 85% of the patient’s heart rate reserve. Results: Mean Heart rate reserve was significantly lowered in Group A when compared to Group B (60.4750 vs78.8978, p value
Heart rate reserve in the evaluation of chest pain events in the next five years than was ST segment depression(1). Many further studies have confirmed that chronotropic incompetence is an independent predictor of risk in patients with coronary artery disease; although inferior to myocardial perfusion scanning in the prediction of cardiac death, it does add incremental prognostic value to this test(2). Chronotropic incompetence is also predictive of adverse cardiac events and total mortality in apparently healthy individuals even after adjustment for factors such as age, ST segment shift, physical activity, and traditional coronary disease risk factors(3). Further confirmation of the prognostic value of the heart rate response to exercise has been demonstrated in a study of about 6000 healthy male Parisian civil servants who underwent exercise testing between 1967 and 1972(4). A low heart rate response to exercise proved to be a powerful predictor of both sudden death and total mortality though not of death from ‘‘non-sudden myocardial infarction’’. This finding was particularly striking as the lack of heart rate response in these individuals was relative; subjects who achieved less than 85% of their predicted maximum peak heart rate were excluded from the study. Chronotropic incompetence (CI) is the inability to proportionally increase heart rate (HR) to meet the increase in metabolic demand (4). It can refer to the inadequacy of the sinus node or of the escape pacemaker in the case of heart block. It can also refer to the inadequacy of AV nodal regulation of the supraventricular pacemaker as in atrial fibrillation. The clinical manifestations of CI are protean and include the inability to achieve maximal HR, a delay in achieving maximal HR, inadequate submaximal or recovering HR or rate instability with exertion (5,6). It is not known whether chronotropic incompetence is independently predictive of all-cause mortality among patients referred for stress testing after 23 accounting for myocardial perfusion defects. The purpose of this study was to examine the association of chronotropic incompetence with myocardial perfusion defects and to determine the ability of chronotropic incompetence to predict all-cause mortality in a low-risk cohort of patients referred for exercise treadmill test. Materials and methods: This is a retrospective cross sectional study conducted in Treadmill Unit, Department of Medicine, JSS Hospital, JSS Medical College, Mysore. Approval from the Ethical committee was obtained prior to the commencement of the study. Subjects: Study group included Forty three patients comprising 30 males and 13 females belonging to the age group of 40-50 years. They came with a history of non-specific chest pain. They were normotensive, nondiabetic and had normal Electrocardiogram (ECG) at rest. Simple random selection was made. Patients with evidence of recent myocardial infarction, angina pectoris of recent onset or with a pronounced change in the severity or frequency of angina were excluded from the study. Standard Bruce Protocol was followed. Subjects were divided into two groups-Group A (6 patients with typical angina) and Group B (37patients with non typical angina). Clinical data Before exercise testing, a structured interview and chart review yielded data on symptoms, medications, coronary risk factors, prior cardiac events and a number of cardiac and noncardiac diagnosis. Resting hypertension was defined as a resting systolic blood pressure ≥140 mm Hg, a resting diastolic blood pressure of ≥90 www.biomedicineonline.org Biomedicine - Vol 31; No.1: 2011
Page 1 and 2: TRUTH CURES CLING TO TRUTH An Inter
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Page 5 and 6: Editorial Biomedicine; 2011; 31 ( 1
Page 7 and 8: REVIEW ARTICLE Biomedicine; 2011; 3
Page 9 and 10: Beneficial effects of black tea ben
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Page 15 and 16: Modification of life style: Hyperte
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Clinico - Biochemical Profile of Hy
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appearance of undesirable effect of
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6. Jain P, Khanna NK, Trehan T, Pen
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Enterobacteriaceae in Clinical spec
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Anti-inflammatory effects of Allium
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ROS during hypoxia-reperfusion inju
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properties of L.fermentum and L.reu
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Perinatal androgen levels, digit ra
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Perinatal androgen levels, digit ra
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Bio Chemical profile in Acute MI In
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Bio Chemical profile in Acute MI VL
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serum ferritin in rheumatoid obese
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serum ferritin in rheumatoid obese
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Case Reports Biomedicine; 2011; 31
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asymptomatic pancreatico biliary du
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Unusual complication at Feeding Jej
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References: 1. Teh E, Edwards J, Du
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systolic pressure in the luteal pha
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Scope of the Journal BIOMEDICINE (T
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Indian Association of Biomedical Sc
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