Heart Rate in Patients with SARS-CoV-2 Infection: Prevalence of High Values at Discharge and Relationship with Disease Severity

The most common arrhythmia associated with COronaVIrus-related Disease (COVID) infection is sinus tachycardia. It is not known if high Heart Rate (HR) in COVID is simply a marker of higher systemic response to sepsis or if its persistence could be related to a long-term autonomic dysfunction. The aim of our work is to assess the prevalence of elevated HR at discharge in patients hospitalized for COVID-19 and to evaluate the variables associated with it. We enrolled 697 cases of SARS-CoV2 infection admitted in our hospital after February 21 and discharged within 23 July 2020. We collected data on clinical history, vital signs, laboratory tests and pharmacological treatment. Severe disease was defined as the need for Intensive Care Unit (ICU) admission and/or mechanical ventilation. Median age was 59 years (first-third quartile 49, 74), and male was the prevalent gender (60.1%). 84.6% of the subjects showed a SARS-CoV-2 related pneumonia, and 13.2% resulted in a severe disease. Mean HR at admission was 90 ± 18 bpm with a mean decrease of 10 bpm to discharge. Only 5.5% of subjects presented HR > 100 bpm at discharge. Significant predictors of discharge HR at multiple linear model were admission HR (mean increase = β = 0.17 per bpm, 95% CI 0.11; 0.22, p < 0.001), haemoglobin (β = −0.64 per g/dL, 95% CI −1.19; −0.09, p = 0.023) and severe disease (β = 8.42, 95% CI 5.39; 11.45, p < 0.001). High HR at discharge in COVID-19 patients is not such a frequent consequence, but when it occurs it seems strongly related to a severe course of the disease.

Football society players over the age of 55: how stressful can a match be?

This study aimed at assessing the physical activity level, heart rate and the salivary cortisol level of football society players. The sample consisted of 19 male masters football players with an average age of 56.7 ± 3.9 years. The long form of the International Physical Activity Questionnaire (IPAQ) and Polar® heart rate monitors were used as instruments, in addition to Salivette® tubes to measure salivary cortisol. Data analysis was performed by using the repeated measures Analysis of Variance (ANOVA) with Bonferroni post hoc test, and Spearman’s Rank Correlation Coefficient. The results showed that the salivary cortisol concentration indicated an index of 1.97 ng/ml at the beginning of the match; 40 minutes after that these values increased to 8.00 ng/ml, and 60 minutes after the match had started they reached 8.40 ng/ml. Considering the post-match moment, a moderate and positive correlation between the salivary cortisol concentration and heart rate (average and maximum) was seen. In conclusion, the physical effort expended during football Society practice needs to be monitored due to the high heart rate and high increase in the salivary cortisol concentration of this age group.

Enhancing the brain's emotion regulation capacity with a randomised trial of a 5-week heart rate variability biofeedback intervention

Heart rate variability is a robust biomarker of emotional well-being, consistent with the shared brain networks regulating emotion regulation and heart rate. While high heart rate oscillatory activity clearly indicates healthy regulatory brain systems, can increasing this oscillatory activity also enhance brain function? To test this possibility, we randomly assigned 106 young adult participants to one of two 5-week interventions involving daily biofeedback that either increased heart rate oscillations (Osc+ condition) or had little effect on heart rate oscillations (Osc- condition) and examined effects on brain activity during rest and during regulating emotion. In this healthy cohort, the two conditions did not differentially affect anxiety, depression or mood. However, the Osc+ intervention increased low-frequency heart rate variability and increased brain oscillatory dynamics and functional connectivity in emotion-related resting-state networks. It also increased down-regulation of activity in somatosensory brain regions during an emotion regulation task. The Osc- intervention did not have these effects. These findings indicate that heart rate oscillatory activity not only reflects the current state of regulatory brain systems but also changes how the brain operates beyond the moments of high oscillatory activity.

Characteristics and Outcomes of Patients Activated by Rapid Response Team Who Transferred to the Intensive Care Unit

Background:The utilization of a Rapid response team (RRT) has influenced patient’s clinical outcomes in the general ward. However, characteristics of RRT-screened patients admitted in the ward or transferred to the intensive care unit (ICU) is unknown. Therefore, this study aimed to evaluate these factors.Methods:We conducted a retrospective study using patient’s data in a tertiary medical center in Korea between January 2016 and December 2017. Results: Total 1,096 patients were included; 389 patients were transferred to the ICU, and 707 patients stayed in the ward. The ICU group was more likely to be admitted for medical reasons, hepatobiliary disease, and high heart rate. More interventions were performed, hospital stays were longer, and 28-day and in-hospital mortality were higher in the ICU group. Multivariate logistic regression analyses showed that the risk factors affecting ICU admission were Sequential Organ Failure Assessment (SOFA) score, and National Early Warning Score (NEWS), platelet and lactate level. Transfer to the ICU was not associated with in-hospital mortality.Conclusions: Among RRT-activated patients, those with higher SOFA, NEWS scores, and lactate levels were more likely to transfer to the ICU. Therefore, these patients should be closely monitored and considered for ICU transfer.

Changes in health promoting behavior during COVID-19 physical distancing: Utilizing wearable technology to examine trends in sleep, activity, and cardiovascular indicators of health

The COVID-19 pandemic incited unprecedented restrictions on the behavior of society. The aims of this study were to quantify changes to sleep/wake behavior and exercise behavior, as well as changes in physiological markers of health during COVID-19 physical distancing. A retrospective analysis of 5,436 US-based subscribers to the WHOOP platform (mean age = 40.25 ± 11.33; 1,536 females, 3,900 males) was conducted covering the period from January 1st, 2020 through May 15th, 2020. This time period was separated into a 68-day baseline period and a 67-day physical distancing period. To provide context and allow for potential confounders (e.g., change of season), data were also extracted from the corresponding time periods in 2019. As compared to baseline, during physical distancing, all subjects fell asleep earlier (-0.15 hours), woke up later (0.29 hours), obtained more sleep (+0.21 hours) and reduced social jet lag (-0.13 hours). Contrasting sleep behavior was seen in 2019, with subjects falling asleep and waking up at a similar time (-0.01 hours; -0.03 hours), obtaining less sleep (-0.14 hours) and maintaining social jet lag (+0.06 hours) in corresponding periods. Individuals exercised more intensely during physical distancing by increasing the time spent in high heart rate zones. In 2020, resting heart rate decreased (-0.90 beats per minute) and heart rate variability increased (+0.98 milliseconds) during physical distancing when compared to baseline. However, similar changes were seen in 2019 for RHR (-0.51 beats per minute) and HRV (+2.97 milliseconds), suggesting the variation may not be related to the introduction of physical distancing mandates. The findings suggest that individuals improved health related behavior (i.e., increased exercise intensity and longer sleep duration) during physical distancing restrictions. While positive changes were seen to cardiovascular indicators of health, it is unclear whether these changes were a direct consequence of behavior change.

Bodily Information and Top-Down Affective Priming Jointly Affect the Processing of Fearful Faces

According to embodied theories, the processing of emotions such as happiness or fear is grounded in emotion-specific perceptual, bodily, and physiological processes. Under these views, perceiving an emotional stimulus (e.g., a fearful face) re-enacts interoceptive and bodily states congruent with that emotion (e.g., increases heart rate); and in turn, interoceptive and bodily changes (e.g., increases of heart rate) influence the processing of congruent emotional content. A previous study by Pezzulo et al. (2018) provided evidence for this embodied congruence, reporting that experimentally increasing heart rate with physical exercise facilitated the processing of facial expressions congruent with that interoception (fear), but not those conveying incongruent states (disgust or neutrality). Here, we investigated whether the above (bottom-up) interoceptive manipulation and the (top-down) priming of affective content may jointly influence the processing of happy and fearful faces. The fact that happiness and fear are both associated with high heart rate but have different (positive and negative) valence permits testing the hypothesis that their processing might be facilitated by the same interoceptive manipulation (the increase of heart rate) but two opposite (positive and negative) affective primes. To test this hypothesis, we asked participants to perform a gender-categorization task of happy, fearful, and neutral faces, which were preceded by positive, negative, and neutral primes. Participants performed the same task in two sessions (after rest, with normal heart rate, or exercise, with faster heart rate) and we recorded their response times and mouse movements during the choices. We replicated the finding that when participants were in the exercise condition, they processed fearful faces faster than when they were in the rest condition. However, we did not find the same reduction in response time for happy (or neutral) faces. Furthermore, we found that when participants were in the exercise condition, they processed fearful faces faster in the presence of negative compared to positive or neutral primes; but we found no equivalent facilitation of positive (or neutral) primes during the processing of happy (or neutral) faces. While the asymmetries between the processing of fearful and happy faces require further investigation, our findings promisingly indicate that the processing of fearful faces is jointly influenced by both bottom-up interoceptive states and top-down affective primes that are congruent with the emotion.

Cardiac sarcoidosis: Case report and review of the literature

Sarcoidosis is a rare inflammatory multisystem disease, frequently underdiagnosed and often clinically silent, with a negative prognosis on patient’s survival should the cardiovascular system be involved. This occurs not only due to the direct involvement of the heart and blood vessels but also due to associated organ dysfunctions, most commonly pulmonary sarcoidosis. Cardiac sarcoidosis typically manifests as either conduction disturbances or, less commonly, as tachy- or bradyarrhythmia, sometimes even with signs and/or symptoms of heart failure. In this article, we present the case of a relatively young female patient with few significant comorbidities, who presented to the emergency department for palpitations with a high heart rate, which ultimately turned out to be caused by sustained ventricular tachycardia. The diagnostic steps undertaken thereafter reveal an underlying pulmonary sarcoidosis with cardiac involvement.

Post-COVID Syndrome and Tachycardia: Theoretical Base and Treatment Experience

The coronavirus pandemic showed not only an increase in levels of excess morbidity and mortality in the acute phase, but also persisting symptoms 4 weeks after the onset of the disease. A review of international studies on the prevalence and diversity of the manifestations of postcoid syndrome is presented. The data on such a manifestation of post-COVID syndrome as postural orthostatic tachycardia syndrome (POTS) are accumulating. Pathogenetic mechanisms, modern diagnostic criteria and research data on the prevalence of this syndrome are presented in the article. The Canadian Cardiovascular Society has proposed medications as a treatment for POTS, including the sinus node If channel inhibitor ivabradine. Data from several studies showing the effectiveness of this drug for POTS, including after suffering COVID-19, are presented in the article. Clinical data on the prevalence of tachycardia among patients admitted to the Sechenov University hospital are presented. About 18% of patients with hypertension and 21% of patients with normal blood pressure had a high heart rate. A clinical example of the use of ivabradine in a patient after a coronavirus infection is presented. Drug interactions and individual tolerance of ivabradine in patients after coronavirus infection are being discussed. The authors put forward the hypothesis about the further prospect of using ivabradine in the treatment of clinical manifestations of postcoid syndrome on the basis of literature data and their own experience.

Effect of heart rate on left ventricular longitudinal myocardial function in type 2 diabetes mellitus

Background Left ventricular (LV) longitudinal myocardial dysfunction is considered a marker of preclinical LV dysfunction in patients with type 2 diabetes mellitus (T2DM). High heart rate (HR) is associated with cardiovascular outcomes, but the effect of HR on LV longitudinal myocardial function in T2DM patients is uncertain. Methods We studied 192 T2DM patients with preserved LV ejection fraction (LVEF), and 81 age-, sex-, and LVEF-matched healthy volunteers. HR was measured as the average HR during echocardiography, and high HR was defined as resting HR ≥ 70 beats/minute. LV longitudinal myocardial function was assessed as global longitudinal strain (GLS). The predefined cutoff for subclinical LV dysfunction was set at GLS < 18%. Results GLS in T2DM patients with high HR was significantly lower than that in T2DM patients with low HR (16.3% ± 4.2% vs. 17.8% ± 2.8%; P = 0.03), whereas GLS in normal subjects with high and low HR was similar (20.3 ± 1.7% vs. 20.3 ± 2.0%; P = 0.99). Multivariable logistic regression analysis showed that high HR (odds ratio: 1.04; 95% confidence interval: 1.01–1.07; P = 0.01) was independently associated with GLS < 18% in T2DM patients as well as HbA1c, T2DM duration, LVEF, body mass index, and mitral inflow E and mitral e’ annular velocity ratio. One sequential logistic model evaluating the associations between GLS < 18% and clinical variables in T2DM patients showed an improvement with the addition of LVEF and E/e’ (P < 0.001) and a further improvement with the addition of high HR (P < 0.001). Conclusion Compared with normal subjects, resting HR was associated with LV longitudinal myocardial function in asymptomatic T2DM patients with preserved LVEF. Our findings provide new insights on the management of T2DM patients.