heart rate and the cardiovascular system: the role of...
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Heart Rate and the Cardiovascular
System: The Role of ExerciseSystem: The Role of Exercise
Harisios Boudoulas, Dr, Dr HonHarisios Boudoulas, Dr, Dr HonProfessor, Academician (an. mem.)
The Ohio State University, Columbus, Ohio, USA
Biomedical Research Foundation, Academy of Athens, GreeceBiomedical Research Foundation, Academy of Athens, Greece
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Semilogarithmic relation between rest heart rate and life expectancy in
mammals
Levine HJ, JACC 1997; 30: 1104$6
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Relation between life expectancy and total heart beats/lifetime among
mammalsThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
Levine HJ, JACC 1997; 30: 1104%6
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Effects of Heart Rate on the HeartEffects of Heart Rate on the Heart
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Circadian variations of heart rate in office workers (16�65 years)
Clarke et al. Lancet 1976; 2: 508
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Relationship between heart rate and
diastolic time
Cardiac Cycle: left ventricular (LV) work
and left coronary (L Cor) flow diastolic timeand left coronary (L Cor) flow
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QS2 (Duration
of systole)of systole)
Boudoulas H et al. Circulation 1979; 60: 164
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Collateral Flow is diastolic
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Boudoulas H, MMG 1979; 7: 405�417
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Effects of heart rate on the arteries
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Other abnormalities associated with high heart rate affecting the arterial system
• High adrenergic activity
• Inflammation
• Oxidative stress
• Endothelial dysfunction
• Proteinuria• Proteinuria
• High insulin (resistance)
Thorin E et al. Cardiovascular Research 2009; 84: 24(32
Vascular endothelial aging, heart beat after heart beat; stress and repair starts in utero.
Palatini P et al. Hypertension 1997; 30: 1267(1273
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Aortic function: storage capacity, pulse wave velocity,
arteriolar functionarteriolar function
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Aortic function: reflected wave, aortic pulse wave
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Relations between aortic pressure waves (central aortic pressure) and
heart rate
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Retarding effect of lowering heart rate on atherosclerosis
Maximum Stenosis (%)
55.9 ± 2355.9 ± 23
26.1 ± 18
High Heart Rate Low Heart Rate
Baere, Glagoc, Zarins. Science 1984; 226: 180
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Rate of developing sustained hypertension by age according to the
presence or absence of transient tachycardia and transient hypertension
Levy, White, Strand. JAMA 1945; 129: 585#588
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Heart rate and mortality in healthy men
Jouven X et al. N Engl J Med 2005;352: 1951�8
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Heart rate and mortality in coronary artery disease
Diaz A et al. Eur Heart J 2005; 26: 967�74
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Total mortality in patients with AMI from day 2 to 1 year for
patients on or not on β�blockerspatients on or not on β�blockers
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< 70 ≥ 9070�89
Hjalmarson A et al. Am J Cardiol 1990; 65: 547�553
Anton LM et al. Eur Heart J 2012; 33: 96�102
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Relation between changes in heart rate (decrease), diastolic time
(increase) and mortality in post�myocardial infarction patients(increase) and mortality in post�myocardial infarction patients
Kjekshus J. Eur Heart J 1985; 6 (Suppl A): 29�30 Boudoulas H. Acta Cardiologica 1991; 46: 61�71Kjekshus J. Eur Heart J 1985; 6 (Suppl A): 29�30 Boudoulas H. Acta Cardiologica 1991; 46: 61�71
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Patients with coronary artery disease, stable angina and
heart rate > 70 beats per minuteheart rate > 70 beats per minute
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Fox K et al. Lancet 2008; 372:807016
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Olympic Anthem
Effects of exercise on cardiovascular system
Olympic Anthem
“Αρχαίο πνεύ α αθάνατο,
αγνέ πατέρα, του εγάλου, του αγνέ πατέρα, του εγάλου, του
ωραίου και τ’ αληθινού…”
Κ.Παλα�άςΚ.Παλα�άς
“ Ancient immortal spirit,
father of everything that is
beautiful, great and true…”
K.Palamas
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ΝΕΝΙΚΗΚΑΜΕΝ(We have won)
ΦΕΙ∆ΙΠΠΙ∆ΗΣ 530 BC – 490 BCΦΕΙ∆ΙΠΠΙ∆ΗΣ 530 BC – 490 BC
Pheidippides
Cardiac arrest during long�distance running races. Kim JH. N Engl J Med 2012; 366: 130�140
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Effect of aerobic and strength (resistance) exercise on heart rate and blood pressure.
Aerobic: heart rate
Women
Strength: blood pressure (BP)
MenMen
Feldman M, Elettereades J. Triggers of Aortic Dissections.
In Boudoulas H, Stefanadis C eds.
The Aorta: Structure, Function, Dysfunction and Diseases.
Informa Healthcare USA, Inc., New York, NY, 2009
Körperlicher Belastung, Steinkopff, Darmstadt 1984,
p 62 Gleichmann V in Anlaut and Bock eds.
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Relative risk of myocardial infarction (MI) according to the usual frequency
of heavy exercise
Mittleman et al. N Engl J Med 1993; 324: 1677&83
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Role of exercise or emotional stress in precipitating acute aortic dissection
Feldman M, Elettereades J. Triggers of Aortic Dissections. In Boudoulas H, Stefanadis C eds.
The Aorta: Structure, Function, Dysfunction and Diseases. Informa Healthcare USA, Inc., New York, NY, 2009
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Pressure wave recordings during running
The rhythm of running: Can the heart join in?
• Heart Rate (HR) and
Step Rate Synchronized
The rhythm of running: Can the heart join in?
Step Rate Synchronized
• HR and Body Wave in Phase
• HR and Step Rate
SynchronizedSynchronized
• HR and Body Wave Out of
Phase
• Rest Alter Exercise
O’Rourke M et al. Aust NZ J Med 1993; 23: 708
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Compliance in the ascending aorta displayed on a logarithmic scale and
plotted against age
Mohiaddin RH. Br Heart J 1989; 62: 90�6
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Effects of chronic aerobic exercise on
cardiovascular systemcardiovascular system
• ↓ Heart rate• ↓ Heart rate
• ↓ Adrenergic activity
• Improves endothelial function• Improves endothelial function
• ↓ Insulin (insulin resistance)
• ↓ Pulse wave velocity
• ↓ Reflected wave velocity (central aortic pressure)• ↓ Reflected wave velocity (central aortic pressure)
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Why heart rate is increased ?Why heart rate is increased ?
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Relation between body weight and total heart beats/lifetime
among mammalsamong mammals
Levine HJ. JACC 1997; 30: 1104"6
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Body surface area (BSA) / body weight (BWt) in different
size animals
100 –
size animals
• The ratio of heat loss (a function
of body surface area) to heat
production (a function of body
mass) increases as body weight is 100 –
#
80 –
#
mass) increases as body weight is
reduced.
• Mammals with large body surface
area in relation to body weight #
60 –
#BSA/BWt
Infant3.5 Kg
area in relation to body weight
(small) need to increase the
metabolic rate in order to maintain
constant body temperature.
40 –
#
20 –
Adult75 Kg
• Higher metabolic needs in
animals with large body surface
area in relation to weight result in
fast heart rate.20 –
#
0 –
1 10 100 1000
fast heart rate.
1
Body Weight (Kg)
10 100 1000
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RR interval association results for ~ 2.5 million imputed autosomal SNPs in
38,991 individuals from 15 cohorts38,991 individuals from 15 cohorts
Other abnormalities associated with fast heart rate
• High adrenergic activity
• Inflammation
• Oxidative stress
Eijgelsheim M et al. Hum Mol Genet 2010; 19: 3885/94
• Oxidative stress
• Endothelial dysfunction
• Proteinuria
• High insulin (resistance)
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High heart rate: Therapeutic considerationsHigh heart rate: Therapeutic considerations
• Apparently healthy individuals:• Apparently healthy individuals:
– Regular aerobic exercise “ΜΗ∆ΕΝ ΑΓΑΝ”
– Avoid stimulants (caffeine, alcohol, other)
– Maintain normal body weight
• Patients with underlying disease:• Patients with underlying disease:
– Management of the disease using current knowledge
and common senseand common sense
– Regular exercise when appropriate
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Effect of heart rate on cardiovascular system:
Concluding remarksConcluding remarks
• Fast heart rate may reflect high metabolic needs in • Fast heart rate may reflect high metabolic needs in
different species and in certain conditions and diseases
in humans
• Fast heart rate:• Fast heart rate:
– Decreases coronary flow and increases LV work
– Is associated with high adrenergic tone, proteinuria,
inflammation and endothelial dysfunction
– Is associated with faster PWV– Is associated with faster PWV
– Is associated with higher cardiovascular and all cause
mortalitymortality
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Effect of heart rate on cardiovascular system:
Concluding remarksConcluding remarks
• Reduction in heart rate:• Reduction in heart rate:
– May slow the progression of atherosclerosis
– Is associated with decrease cardiovascular mortality – Is associated with decrease cardiovascular mortality
– May result in an increase in central aortic pressure
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Effects of heart rate on cardiovascular system –
the role of exercise: Concluding remarksthe role of exercise: Concluding remarks
Chronic aerobic exerciseChronic aerobic exercise
• ↓ Heart rate
• ↓ Adrenergic activity• ↓ Adrenergic activity
• ↓ Insulin (insulin resistance)
• Improves endothelial function
• ↓ Pulse wave velocity• ↓ Pulse wave velocity
• ↓ Reflected wave velocity (central aortic pressure)
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Genetics, body area/weight, adrenergic activity/insulin, other
Heart rate and the cardiovascular system
Genetics, body area/weight, adrenergic activity/insulin, other
Metabolic needs
↑ Heart rate
↑ LV work↑ LV work
LVH/failure
• Oxidative stress
• Inflammation
• Endothelial damage
↓ Diastolic time
↑ Systolic time
Myocardial
ischemiaAging
Stiff vessels
↑ LV work
↓ Myocardial perfusion
• Atherosclerosis
• Hypertension
• Organ damage
(brain, kidney)
Stiff vessels
↑ Pulse wave/reflected
wave velocity
Stiff aorta
(brain, kidney)