Key result
Patients with severe tetanus and autonomic nervous system dysfunction had significantly reduced heart rate variability, including lower SDNN (11.23 vs 28.4 ms), compared to those without.
Why the study?
Autonomic nervous system dysfunction is a major cause of mortality in tetanus, but current diagnosis relies on nonspecific clinical signs, making heart rate variability a potential noninvasive diagnostic tool.
Does heart rate variability measurement indicate autonomic nervous system disturbance in patients with severe tetanus?
Cohort (n=9)
No
Does heart rate variability measurement indicate autonomic nervous system disturbance in patients with severe tetanus?
Absolute Event Rate: 11.23% vs 28.4%
p-value: p=0.008
Heart rate variability is significantly reduced in severe tetanus patients with autonomic nervous system dysfunction, suggesting it may serve as a valuable noninvasive diagnostic tool.
Reduced HRV may mark ANS dysfunction in severe tetanus; leaves open diagnostic utility pending prospective validation.
Autonomic nervous system dysfunction (ANSD) is a significant cause of mortality in tetanus. Currently, diagnosis relies on nonspecific clinical signs. Heart rate variability (HRV) may indicate underlying autonomic nervous system activity and represents a potentially valuable noninvasive tool for ANSD diagnosis in tetanus. HRV was measured from three 5-minute electrocardiogram recordings during a 24-hour period in a cohort of patients with severe tetanus, all receiving mechanical ventilation. HRV measurements from all subjects-five with ANSD (Ablett Grade 4) and four patients without ANSD (Ablett Grade 3)-showed HRV was lower than reported ranges for healthy individuals. Comparing different severities of tetanus, raw data for both time and frequency measurements of HRV were reduced in those with ANSD compared with those without. Differences were statistically significant in all except root mean square SD, indicating HRV may be a valuable tool in ANSD diagnosis.
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Duong et al. (2019) conducted a cohort in Severe tetanus (n=9). Autonomic nervous system dysfunction (Ablett Grade 4) vs. Ablett Grade 3 tetanus (without ANSD) was evaluated on SD of all normal-to-normal intervals (SDNN) (p=0.008). Patients with severe tetanus and autonomic nervous system dysfunction had significantly reduced heart rate variability, including lower SDNN (11.23 vs 28.4 ms), compared to those without.
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