heart rate is it a missing link heart
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9 789390 709038
ISBN: 978-93-90709-03-8
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Heart Rate Is it a Missing Link
Heart Rate Is
it a M
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Is it a Missing Link
HeartRate
J C MohanMonotosh Panja
I SathyamurthyRajeev Agarwala
Brian PintoC K Ponde
A Sreenivas KumarBijay Kumar Mahala
Dr. J C Mohan MBBS, MD, DM (Cardiology), MNAMS, FACC, FASE, FESC
Chairman and Head, Department of Cardiology, Jaipur Golden Hospital, New Delhi.
Dr. Monotosh Panja MBBS, MD, DM (Cardiology), FACC, FICP, FCSI
Director of Interventional Cardiologist, Belle Vue Clinic and AMRI Hospital, Kolkata.
Dr. I Sathyamurthy MD, DM, FACC, FRCP (Edin), FRCP (Glas), Dsc (Honoris Causa)
Recipient of Padmashri (2000), Recipient of Dr BC Roy National Award (2001), Senior Interventional Cardiologist, Apollo Main Hospital, Chennai.
Dr. Rajeev Agarwala MBBS, MD, DM (Cardiology)
Consultant Cardiologist, Jaswant Rai Specialty Hospital, Meerut.
Dr. Brian Pinto MBBS, MD, DM (Cardiology), FACC, FESC, FSCAI
Head, Department of Cardiology, and Interventional Cardiologist, Holy Family Hospital, Mumbai.
Dr. C K Ponde MD (Gen Med), DM (Card), DNB (Card) FACC, FESC, FCSI, FIAE, FISE, FICC
Consultant Interventional Cardiologist, Head, Department of Cardiology, PD Hinduja National Hospital, Mumbai.
Dr. A Sreenivas Kumar MBBS, MD, DM (Cardiology), FACC
Director of Cardiology and Clinical Research, Apollo Hospitals, Apollo Health City, Jubilee Hills, Hyderabad, Professor of Medicine, Apollo ISMR, Chairman, Facts Foundation and FPS.
Dr. Bijay Kumar Mahala MBBS, MD, DM
Senior Consultant Cardiologist, Narayana Institute of Cardiac Sciences, Bengaluru, India.
Heart RateIs it a Missing Link
Dr. JC MohanDr. Monotosh Panja
Dr. I SathyamurthyDr. Rajeev Agarwala
Dr. Brian PintoDr. CK Ponde
Dr. A Sreenivas KumarDr. Bijay Kumar Mahala
Heart Rate
CBS Publishers & Distributors Pvt LtdNew Delhi • Bengaluru • Chennai • Kochi • Kolkata • Mumbai
Hyderabad • Jharkhand • Nagpur • Patna • Pune • Uttarakhand
Is it a Missing Link
Editor
Dr. R Gulshan
Contributors
Dr. JC MohanDr. Monotosh Panja
Dr. I SathyamurthyDr. Rajeev Agarwala
Dr. Brian PintoDr. CK Ponde
Dr. A Sreenivas KumarDr. Bijay Kumar Mahala
Disclaimer
Science and technology are constantly changing fields.New research and experience broaden the scope ofinformation and knowledge. The editor/contributors havetried their best in giving information available to themwhile preparing the material for this book. Although, allefforts have been made to ensure optimum accuracy ofthe material, yet it is quite possible some errors mighthave been left uncorrected. The publisher, the printerand the editor/contributors will not be held responsiblefor any inadvertent errors, or inaccuracies.
ISBN: 978-93-90709-03-8
Copyright © Editor/Contributors and Publisher
First Edition: 2021
All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic ormechanical, including photocopying, recording, or any information storage and retrieval system without permission,
in writing, from the editor/contributors and the publisher.
Published by Satish Kumar Jain and produced by Varun Jain for
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Science and technology by the way of intentions and innovations have made life easier for everybody in all spheres of life. The doctors in today’s world use complex
and sophisticated devices to diagnose and manage various diseases in their clinicalpractice. Palpation and auscultation have become less important over a period of time.One of the most important parameters that are not given due importance in suchinstances is the measurement of heart rate (HR). HR evaluation has been a prognosticmarker of health and disease for centuries. Evidence that RHR may be a marker or evena risk factor for CV morbidity and mortality has been growing since the last twodecades. It differs according to sex, age, weight/BMI, and rest. Our insights todetermine the importance of HR in health and disease are still evolving. Theseadvances are driving the application of new therapeutic strategies directed at recentlydiscovered molecular targets.
Heart rate variability (HRV) is becoming an increasingly important disease marker.It is the difference in time between the peaks of the heart in RR spans, which are theresult of continuous interaction between two arms of the autonomic nervous system(ANS). A high HRV is a sign that the heart is healthy as it shows greater adaptabilityto respond to any pressure. On the contrary, decreased HRV can be a result of medicalproblems and can influence immune capacities, self-regulation, and mental abilities.Understanding these key parameters are essential for progress beyond the currentstandard approaches of using HR as a marker or factor. It has been seen in severalepidemiological studies that elevations in RHR are related to increased risk of CVDand total mortality. Elevated RHR is related to diminished artery compliance,endothelial dysfunction and distensibility and subsequently increased arterial wallstress and increased PWV, which is further associated with increased after burden andultimately systemic HTN. Elevated HR also frequently coexist with CV risk factorssuch as dyslipidemia, glucose intolerance, obesity, and together they are associatedwith target organ damage such as chronic kidney disease (CKD), albuminuria, atrialfibrillation, and diabetic retinopathy.
Thus, the treatment of elevated HR may need to be individualized, employing acombination of pharmacological maneuvers. This book provides a “toolkit” in thecontext of an evidence-based cardiovascular practice in the midst of rapidly evolvingscientific knowledge and guidelines. This book fills an important niche for all involvedin elevated HR management to help ensure that we implement the variety of availabletreatments in the most effective and efficient manner and thereby help our patients livebetter and, ideally, longer lives.
Preface
Acknowledgements
We would like to thank the following doctors who provided their valuableopinions for the development of the book:
Dr. Mukul Kumar
Dr. Aijaz Hussain Mansoor
Dr. Rakesh Kumar Jaswal
Dr. Amar Singal
Dr. Parveen Chandra
Dr. Manish Bansal
Dr. Sumeet Sethi
Dr. Rishi Kumar Gupta
Dr. Aditya Batra
Dr. Jitendra Pal Singh Aawhney
Dr. Bharat Bhushan Chanana
Dr. Parneesh Arora
Dr. Randheer Pal
Dr. Pramod Joshi
Dr. Yogenra Singh
Dr. Praveen Kumar Jain
Dr. Vineet Jain
Dr. Deepesh Agarwal
Dr. Pankaj Rastogi
Dr. Anil Kumar Trivedi
Dr. Gaurav Narain Gupta
Dr. Hosdurg Ramdas Nayak
Dr. Somanathan C
Dr. SS Binu
Dr. Krishna Kumar B
Dr. Pathiyil Balagopalan Jayagopal
Dr. Arun Gopi
Dr. Saji Jose
Dr. Subramanian R
Dr. Aravindakumar
Dr. Sivakumar
Dr. R Sundar
Dr. AL Narayanan
Dr. Sivaramakrishnan Manoj
Dr. Sanjiv Agarwal
Dr. Janakiraman Ezhilan
Dr. Prasant KR Sahoo
Dr. Hrudananda Mishra
Dr. Satyanarayan Routray
Dr. Soumyajit Ghosh
Dr. Prabhat Kumar
Dr. Rajiv Krishana
Dr. Ritesh Kumar
Dr. Chinmoy Mazumder
Dr. Kashi Nath Ghosh Hazra
Dr. Arindam Pande
Dr. Kanak Kumar Mitra
Dr. Suvro Banerjee
Dr. Khawer Naveed Siddiqui
Dr. Subhendu Bikash Bhattacharyya
Dr. Anjan Lal Dutta
Dr. Manotosh Panja
Dr. Kuntal Bhattacharya
Dr. TR Raghu
Dr. KH Srinivasa
Dr. Shreekanth B Shetty
Dr. Prabhakar C Koregol
Dr. Tom Devasia
Dr. Anand R Shenoy
Dr. Pradeep Haranahalli
Dr. Srikanth KV
Dr. Sadanand KS
viii Heart Rate
Dr. Dhiren Shah
Dr. G P Ratnaparkhi
Dr. Vivek Mehan
Dr. Pravin Kahale
Dr. Anand Rao
Dr. Nitin Gokhale
Dr. Sharukh Golwalla
Dr. Rahul Gupta
Dr. Bhaskar Shah
Dr. Hasmukh Ravat
Dr. Vidhut Kumar Jain
Dr. Girish Kawthekar
Dr. Anand Mohan Tiwari
Dr. Smit Shrivastava
Dr. Prashant Advani
Dr. Prashant Manohar Jagtap
Dr. Rajiv Sethi
Dr. Hiralal Pawar
Dr. Prashant Pawar
Dr. Dharmesh Ramakant Solanki
Dr. Sumit Sinha
Dr. Nirmal Kumar
Dr. Gokul Reddy Mandala
Dr. Yerra Shiva Kumar
Dr. PA Jiwani
Dr. Rajendra Kumar Premchand
Dr. Rama Kumari Nuthalapati
Dr. Ravinder Reddy Kasturi
Dr. K Purnachandra Rao
Dr. Battina Venkateswara Rao
Dr. C Sesha Srinivasa Raju
Dr. Eric Borges
Dr. Anil Damle
Dr. Sadanand Shetty
Dr. VT Shah
Dr. Chetan Shah
Dr. Rajiv Karnik
Dr. Bharat Shivdasani
Dr. Bhupen Desai
Dr. Ajit Desai
Dr. Sharad Jain
Dr. Ajit Mehta
Dr. Rajdatt Deore
Dr. Kishor Pabitwar
Dr. M Viswanathan
Scientific Support:
Dr. V V KolapkarDr. Lokesh Kumar
Editor
Dr. R Gulshan
ixHeart Rate and other Clinical Scenarios
Contents
Preface v
1. Importance of Heart Rate in Health and Disease 1Dr. BK Mahala
Heart Rate and its Epidemiology 1Regulation of HR and Significance of If Channel 3Factors Affecting HR and HRV 9Genetic Influences on HR and Longevity 16High RHR and its Association with Adverse Clinical and CV Outcomes 19
2. Heart Rate—a Risk Marker or a Risk Factor 29Dr. CK Ponde
Resting Heart Rate (RHR) for Cardiovascular (CV) Risk Evaluation 29High RHR and its Association with CV Risk Factors 35High HR and its Impact on Established CVD 40Evaluation of RHR as a CV Risk Factor 43
3. Heart Rate and Hypertension 50Prof. (Dr.) JC Mohan
Hypertension (HTN) and its Epidemiology 50Heart Rate and its Relationship with BP 53High RHR and its Significance in HTN 56Management of High RHR in Patients with HTN 64
4. Heart Rate and Coronary Artery Disease (CAD) 77Prof. (Dr.) Monotosh Panja, Dr A Sreenivas Kumar
Epidemiology of CVD 77Clinical Implications of Coronary Artery Disease (CAD) and Angina 79High Resting Heart Rate and its Impact on CAD and Angina 82Management of High RHR—Angina Perspective 87Spectrum of Clinical Evidence with Ivabradine in CAD and Angina 96Take Home Summary 103
5. Heart Rate and Heart Failure 108Dr. I Sathyamurthy, Dr. Rajeev Agrawala
Epidemiology of Heart Failure 108Heart Failure (HR) Types and Clinical Course 113High RHR and its Impact on HFrEF 118Management of High RHR–HFrEF Perspective 122Take Home Summary 137
x Heart Rate
6. Heart Rate and other Clinical Scenarios 143Dr. Brian Pinto
Heart Rate (HR) in other Cardiovascular (CV) and Non-CV Scenarios 143HR Modulation in CVD Beyond CAD and HF with Reduced Ejection Fraction (HFrEF) 145HR Modulation in Non-CV Conditions 161Take Home Summary 168
Index 173