Heart disease, depression and reduced heart rate variability – includes editor note – adapted from the American Journal of Cardiology 1995;76:562-4 – Tips from Other Journals
The authors conclude that a whole blood PT-INR monitor for children receiving warfarin therapy can be used safely and effectively in a pediatric outpatient clinic and by parents at home. The generalizability of this conclusion requires parents to have easy access to clinicians who can interpret whole blood results and make appropriate therapeutic recommendations. (Massicotte P, et al. Home monitoring of warfarin therapy in children with a whole blood prothrombin time monitor J Pediatr 1995;127:389-94.)
Heart Disease, Depression and
Reduced Heart Rate Variability
Depression has been associated with increased morbidity and mortality in patients with coronary artery disease. Studies in depressed psychiatric patients have shown that altered autonomic tone in these patients reduces heart rate variability, which is a known predictor of increased rates of mortality after myocardial infarction and heart failure. This dysregulation of the autonomic nervous system may predispose to ventricular fibrillation. Depressed patients with coronary artery disease are more likely to be women and to have a smoking history. Carney and associates studied patients with coronary artery disease to determine the presence of decreased heart rate variability in depressed patients.
A total of 100 patients with angiographically proven coronary artery disease represented by a reduction of 50 percent or more in the luminal diameter of at least one coronary artery or branch were evaluated for depression using a modified version of the National Institute of Mental Health Diagnostic Interview Schedule. Diagnoses of major or minor depression were derived from the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. A 24-hour electrocardiogram was obtained for each patient during the day after catheterization.
Major depression was diagnosed in nine patients and minor depression in 10 patients. These patients were matched with 19 nondepressed patients according to age, sex and smoking status. Heart rate variability was significantly lower in the depressed patients than in the nondepressed patients.
The authors conclude that depression is associated with altered cardiac autonomic tone in patients with coronary artery disease. (Carney RM, et al. Association of depression with reduced heart rate variability in coronary artery disease. Am J Cardiol 1995;76:562-4).
EDITORS NOTE: The occurence of depression in patients with major medical diagnoses has been shown to be up to 50 percent. Depression can affect patient compliance with medical regimens and increase morbidity and mortality in several ways. The primary effect of depression on disease progression must be explored, and clinicians must make stronger efforts to diagnose depression in medical patients.
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