IMMEDIATE HEART RATE RESPONSE TO STANDING: A SIMPLE TEST FOR DIAGNOSIS OF AUTONOMIC NEUROPATHY IN DIABETES
AbstractBackground: This work was done to study the usefulness of heart rate response to standing from a lying posture as asimple bedside/outpatient maneuver in patients with diabetic autonomic neuropathy. Methods: It was a prospectiverandomized study of 43 patients suffering from diabetes mellitus conducted at Diabetic outpatient clinic, JinnahPostgraduate Medical Centre. Karachi. Results: The heart rate response, expressed as RR30/RR1 5 ratio in normalsubjects was 1.20±0.01, in diabetics without autonomic neuropathy 1.18±0.01 and in diabetic with autonomicneuropathy 0.98±0.01. Resting heart rate per minute in normal subjects was 72.68±1.39, in diabetics withoutautonomic neuropathy 76.66±1.43 and in diabetics with neuropathy 87.54 ± 1.53. Both RR30/ RR15 ratio and restingheart rate in diabetic with autonomic neuropathy were highly significant (p<0.001) when compared with thecorresponding values of normal subjects and diabetics without autonomic neuropathy. Conclusion: Heart rateresponse to change in posture is a useful and simple test that can be employed as a bedside or outpatient maneuver todiagnose autonomic neuropathy in diabetes by a conventional electrocardiogram
Orclard TJ. Lloyd CE, Maser RE. Kuller LH. Why does
diabetic autonomic neuropathy period IDDM mortality? An
analysis from the Pittsburgh Epidemiology of diabetes
complications study. Diabetic Res. Clin. Pract. 1996 Oct. 34
Ewing DJ. Clarke BF. Autonomic neuropathy: its diagnosis
and prognosis. Clin Endocrinol Med. 1986 Nov, 15(4):855-88.
Janka HU. Increased cardiovascular morbidity and mortality
in diabetics mellitus: identification of the high risk patient.
Diabetes Res. Clin Pract. 1996 Feb, 30 suppl: 85-8.
Ewing DJ, Campbell IW, Clarke BF. Assessment of
cardiovascular effects in diabetic autonomic neuropathy and
prognostic implications. Ann. Intern Med. 1980, 92(2):308-
Levitt NS, Stansberry KB, Wynchank S, Vinik Al. The natural
progression of autonomic neuropathy and autonomic function
tests in a cohort of people with IDDM. Diabetes Care: 1996
Johnson RH, Splading JMK. Disorders of autonomic nervous
system. Oxford, Blackwell, pp .33, 1974.
Ewing DJ. Campbell IW, Muray. A Neilson JMM, Clarke BF.
Immediate heart rate response to standing: simple test for
autonomic neuropathy in diabetics. Br. Med. J. 1978. 1:145-
Braune HJ, Geisendorfer L Measurement of heart rate
variations: influencing factors, normal values and diagnostic
impact on diabetic autonomic neuropathy. Diabetes Res. Clin.
Pract. 1995 Sept, 29:179-87.
Borst C. Wei ling W. Van Brederode JFM. Houd A, DeRijik
LG. Dunning Aj. Mechanisms of initial heart rate response to
postural change. Am. J. Physiol. 1982, 243: H 676-81.
Weiling W, Van Brederode JFM, DeRijik LG, Borste,
Dunning AJ. Reflex control of heart rate in normal subjects in
relation to age. A data base for cardiac vagal neuropathy.
Murray A Ewing DJ, Campbell IW. Neilson JMM. Clark BF.
R-R interval variations in young male diabetics. Br. Heart J.
Mackay JD. Page MM. Cambridge J, Walkins PJ. Diabetic
autonomic neuropathy. The diagnostic value of heart rate
monitoring. Diabetologia. 1980. 18:471-7
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