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We just presented the Heart Rate Variability
(HRV) work of Dr Michael Kessler at Homecoming. He has tried to get me
to understand the importance of Heart Rate Variability for years. It
wasn't until Clark Tilly of the 3rive company (who also presented at
Homecoming 2015), recently showed me the statistics of doctors that used
his testing and reporting system doubled their retention, results and
income that I caught the vision. The 3rive system of evaluating every
part of the practice and constantly educating the doctors and the
patients proved to me the effectiveness of both HRV and the 3rive
system. Dr Brett Brimhall has added both systems to his office to great
success.
Part 1
The reason why is that heart rate variability
(HRV) is a reflection of the autonomic nervous system that controls 90%
of the body's functions. The two branches of the autonomic nervous
system (ANS) consist of the sympathetic and the parasympathetic. These
two branches regulate the slowing and speeding up of the heart rate
through their influence on the SA node of the heart. This is why we can
look at an ECG and be able to look at the beat to beat changes between
one heart contraction to the next to give an indication of how well the
ANS is able to adapt to internal and external stressors. Ultimately,
increased HRV means that the time domain between each successive
heartbeat shows a variable time between one R wave to the next. This
means good autonomic balance and adaptability. Low heart rate
variability means that the time domain between each R wave to the next
is constant and lacks variability as far as time goes. These are the
people that are stuck in either sympathetic or parasympathetic tone and
have lost their ability to adapt. When we talk about time domain, it is
visualized as something called a rhythmogram that we construct from the
ECG. What's interesting is that the heart appears to beat very evenly.
This is not the case. Usually the difference between the shortest and
the longest cardiac cycles of a healthy person is 250 milliseconds. This
is called the variational range. Research shows those that lack this
variation or what we call low HRV are the ones that are more prone to
having a Myocardial Infarction (MI) on Monday morning at work.
If we turn the R to R waves vertically we
make a diagram called the rhythmogram that allows us to get a good
visual on the adaptive capabilities of the autonomic nervous system.
With the diagram below you can see a quickening of the heart rate, the
curve of the rhythmogram goes down and with a deceleration of the heart
rate it goes up. This is a consequence of the regulatory systems of the
body influencing these changes. This way you can see the body responding
to the needs of the organs and systems and the heart changing to meet
those needs.
The other key components of heart rate
variability are Low frequency, High frequency, Very Low Frequency,
Stress Index, Vital force and Standard Deviation of Normal to Normal
beats (SDNN). Once we explain these concepts you will be a connoisseur
of HRV. There are three regulatory systems that can be decoded from a
technique called Fast Fourier Transform which reflects how often waves
of a definite length appear on the ECG. The graph obtained from this
procedure is called a spectrogram. Basically we break down the ECG into
its frequency component band widths that correspond to specific
regulatory systems. A good analogy for Fast Fourier Transform is a prism
that separates the complete light spectrum into its individual color
frequency bands. LF or low frequency corresponds to sympathetic nervous
system regulation and HF or high frequency is about parasympathetic
regulation. VLF is about the central nervous system (CNS) and its
regulation through its downstream hormones.
Before we discuss the clinical implications
of LF, HF, and VLF we need to discuss the stress index. The stress index
is a common mathematical value found in some HRV systems and tells us
how hard the autonomic nervous system has to work to maintain balance.
If it is out of the normal range and high, it is like driving your car
without a thermostat and eventually the engine is going to heat up and
seize. Another standard HRV value is the SDNN. This stands for Standard
Deviation of Normal to Normal beats. This is the most common index of
overall HRV. This reflects the ability to respond quickly, dynamically
and effectively to a stressor. The last index is vital force and tells
us how much fuel that patient has in their engine. If it is low, it is a
good indication to use gentle therapies or detoxification so the
patient isn't pushed over their capacity to tolerate the treatment.
In the next installment we will discuss all
the other important information derived from heart rate variability such
as cardiovascular adaption, autonomic nervous system regulation,
neurohormonal regulation, psychoemotional state3 and show how it all
ties together. In the research coming out of Russia there are very
provocative studies on using HRV to give indications of thyroid balance
or imbalance4, brain function indirectly from HRV as well as very
accurate information about the meridians from Chinese and more. Once you
understand the basics, I will show you cases that will tie all the
information together in a seamless fashion. In private practice an
advanced HRV model will allow you to know if the therapies you are using
are improving your patients health, or if their health is staying the
same or getting worse.
REFERENCES
1. Sandercock, Gavin
Richard H., Brodie, David, The Role of Heart Rate Variability in
Prognosis for Different Modes of Death in Chronic Heart
Failure, Buckinghamshire Chilterns University College, Chalfont St.
Giles, UK, 2006; 29: 893-904.
2. Bayevsky, R.M, Ivanov,
G.G, Chireykin, L.V, Gavrilushkin, A.P., et al, HRV Analysis Under the
Usage of Different Electrocardiography Systems
(Methodical Recommendations), Committee of New Medical Techniques of
Ministry of Health of Russia, 2002; 4: 2-67.
3. Tonhajzerova, Ingrid,
Ondrejka Igor, Turianikova, Zuzana, Javorka, Kamil, et al, Heart Rate
Variability: An Index of the Brain-Heart Interaction,
Tachycardia, 2012: 185-202.
4. Moldabek, Gulnar, Heart
Rate Variability Indicators in Patients with Hypothyroidism, Medical and
Health Science Journal, 2011; 6: 127-131.
You can find out more information through our
office by calling or e-mailing Jason at 866-338-4883 or [email protected]<mailto:[email protected]>. We will be doing webinars with Dr Kessler as well!
Click Below To View The HeartQuest Webinar
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