Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-20T21:05:50.941Z Has data issue: false hasContentIssue false
  • English
  • Français

Heartbeat and arrhythmia perception in diabetic autonomic neuropathy

Published online by Cambridge University Press:  09 July 2009

Paul Pauli ,
Lydia Hartl ,
Christian Marquardt ,
Henrica Stalmann  and
Friedrich Strian
Paul Pauli*
Affiliation:
Clinical Department, Max Planck Institute for Psychiatry, Munich, Germany
Lydia Hartl
Affiliation:
Clinical Department, Max Planck Institute for Psychiatry, Munich, Germany
Christian Marquardt
Affiliation:
Clinical Department, Max Planck Institute for Psychiatry, Munich, Germany
Henrica Stalmann
Affiliation:
Clinical Department, Max Planck Institute for Psychiatry, Munich, Germany
Friedrich Strian
Affiliation:
Clinical Department, Max Planck Institute for Psychiatry, Munich, Germany
*
1Address for correspondence: Dr Paul Pauli, Max-Planck-Institut für Psychiatrie, Neurologische Poliklinik, Kraepelinstr. 10, 8000 München 40, Germany.
Get access Rights & Permissions [Opens in a new window]

Synopsis

A comparative study of diabetics with autonomic neuropathy (N = 13) as against non-neuropathic diabetics (N = 16) and healthy control persons (N = 20) was carried out with respect to heart rate both at rest and under stress, frequency of cardiac arrhythmias in a 24-h ECG and accuracy of heartbeat and arrhythmia perception. In the subjects with diabetic autonomic neuropathy, the spontaneous variability and stress-induced reactivity of the heart rate as well as the number of tachycardic episodes were reduced, whereas the frequency of ventricular extrasystoles was somewhat increased. Impaired heartbeat perception and a complete loss of perception of arrhythmias as a consequence of neuropathic deafferentation could be demonstrated. Cardiac perception disorders also play a vital role in other clinical problems, e.g. silent myocardial infarction and lack of awareness of hypoglycaemia in diabetes mellitus.

Type
Original Articles
Information
Psychological Medicine , Volume 21 , Issue 2 , May 1991 , pp. 413 - 421
Copyright
Copyright © Cambridge University Press 1991

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Airaksinen, K. E. J., Niaemen, P. J., Pirttiaho, H. I. & Takkunen, J. T. (1986). Standard EKG: a useful screening method for diabetic autonomic neuropathy. Diabetes Care 9, 103–104.CrossRefGoogle Scholar
American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders (DSM-III), 3rd ed. APA: Washington, DC.Google Scholar
Bestler, M., Schandry, R., Weitkunat, R. & Alt, E. (1990). Kardiodynamische Determinanten der Herzwahrnchmung. Zeitschrift für Experimentelle und Angewandte Psychologic 37, 361–377.Google Scholar
Brener, J. (1974). A general model of voluntary control applied to the phenomena of learned cardiovascular change. In Cardiovascular Psychophysiology (ed. Obrist, P. A., Black, A. H., Brener, J. and DiCara, L. V.), pp. 365–391. Aldine: Chicago.Google Scholar
Brener, J. & Jones, J. M. (1974). Interoceptive discrimination in intact humans: detection of cardiac activity. Physiology and Behavior 13, 763–767.CrossRefGoogle ScholarPubMed
Clarke, B. F. & Ewing, D. J. (1982). Resting heart rate and diabetic autonomic neuropathy. New York State Journal of Medicine 82, 908–913.Google ScholarPubMed
Clarke, B. F., Ewing, D. J. & Campbell, I. W. (1979). Diabetic autonomic neuropathy. Diabetologia 17, 195–212.CrossRefGoogle ScholarPubMed
Davis, M. R., Langer, A. W., Sutterer, J. R., Gelling, P. D. & Marlin, M. (1986). Relative discriminability of heartbeat-contingent stimuli under three procedures for assessing cardiac perception. Psychophysiology 23, 76–81.CrossRefGoogle ScholarPubMed
Ehlers, A., Margraf, J., Roth, W. T., Taylor, C. B. & Birbaumer, N. (1988 a). Anxiety induced by false heart rate feedback in patients with panic disorder. Behavior Research and Therapy 26, 1–11.CrossRefGoogle ScholarPubMed
Ehlers, A., Margraf, J. & Roth, W. T. (1988 b). Selective information processing, interoception, and panic attacks. In Panic and Phobias 2 (ed. Hand, I. & Wittchen, H.-U.), pp. 129–148. Springer: Berlin.CrossRefGoogle Scholar
Ewing, D. J., Neilson, J. M. M. & Travis, P. (1984). New method for assessing cardiac parasympathetic activity using 24 hour electrocardiograms. British Heart Journal 52, 396–402.CrossRefGoogle ScholarPubMed
Faerman, I., Faccio, E., Milei, J., Nunez, R., Jadzinsky, M., Fox, D. & Rapaport, M. (1977). Autonomic neuropathy and painless myocardial infarction in diabetic patients. Diabetes 26, 1147–1158.CrossRefGoogle ScholarPubMed
Flynn, D. M. & Clemens, W. J. (1988). On the validity of heartbeat tracking tasks. Psychophysiology 25, 92–96.CrossRefGoogle ScholarPubMed
Jones, G. E. & Hollandsworth, J. G. (1981). Heart rate discrimination before and after exercise-induced augmented cardiac activity. Psychophysiology 18, 252–257.CrossRefGoogle ScholarPubMed
Jones, G. E., O'Leary, R. T. & Pipkin, B. L. (1984). Comparison of the Brener Jones and Whitehead procedures for assessing cardiac awareness. Psychophysiology 21, 143–148.CrossRefGoogle Scholar
Jones, G. E., Jones, K. R., Cunningham, R. A. & Caldwell, J. A. (1985). Cardiac awareness in infarct patients and normals. Psychophysiology 22, 480–487.CrossRefGoogle ScholarPubMed
Jones, G. E., Jones, K. R., Rouse, C. H., Scott, D. M. & Caldwell, J. A. (1987). The effect of body position on the perception of cardiac sensations: an experiment and theoretical implications. Psychophysiology 24, 300–311.CrossRefGoogle ScholarPubMed
Kanfer, F. H. & Hagerman, S. (1981). The role of self-regulation. In Behavior Therapy for Depression (ed. Rehm, L. P.), pp. 143–179. Academic Press: New York.Google Scholar
Katkin, E. S. (1985). Blood, sweat, and tears: individual differences in autonomic self-perception. Psychophysiology 22, 125–137.CrossRefGoogle ScholarPubMed
Katkin, E. S., Morell, M. A., Goldband, S., Bernstein, G. L. & Wise, J. A. (1982). Individual differences in heartbeat discrimination. Psychophysiology 19, 160–166.CrossRefGoogle ScholarPubMed
Klosiewski, M. (1984). Hypoglycemia – what does the diabetic experience? The Diabetes Educator 10, 18–21.CrossRefGoogle ScholarPubMed
Krasnow, A. Z. & Bloomfield, D. A. (1978). The relationship between subjective symptomatology and objective findings from ECG monitoring studies in a large unselected population. In Ambulatory ECG Monitoring (ed. Stern, S.), pp. 149–169. Year Book Medical Publishers: Chicago.Google Scholar
Kunz, G., Raeder, E. & Burckhardt, D. (1977). What does the symptom ‘palpitation’ mean? – Correlation between symptoms and the presence of cardiac arrhythmias in the ambulatory ECG. Zeitschrift für Kardiologie 66, 138–141.Google ScholarPubMed
Lautenbacher, S., Stalmann, H., Haslbeck, M. & Strian, F. (1987). Neuroendokrine Einflüsse auf die Wahrnehmung der Herzaktion. Deutsche Medizinische Wochenschrift 112, 1492–1497.CrossRefGoogle Scholar
Lehmann, W. P., Haslbeck, M., Müller, J., Mehnert, H. & Strian, F. (1985). Frühdiagnose der autonomen Diabetes-Neuropathie mil Hilfe der Temperatursensibilität. Deutsche Medizinische Wochenschrift 110, 639–642.CrossRefGoogle Scholar
Levine, B. J., Zeldis, S. M., Morganroth, J. A. & Kastor, J. A. (1978). Lack of correlation between symptoms and significant arrhythmias on long-term electrocardiographic analysis. Clinical Research 26, 247A.Google Scholar
Masaoka, S., Lev-Ran, A., Hill, L. R., Vakil, G. & Hon, E. H. G. (1985). Heart rate variability in diabetes: relationship to age and duration of the disease. Diabetes Care 8, 64–68.CrossRefGoogle ScholarPubMed
Montgomery, W. A. & Jones, G. E. (1984). Laterality, emotionality, and heartbeat perception. Psychophysiology 21, 459–465.CrossRefGoogle ScholarPubMed
Pauli, P., Strian, F., Lautenbacher, S., Karlbauer, G. & Hölzl, R. (1989). Emotionale Auswirkungen der autonomen Deafferentierung bei Diabetes-Neuropathie. Zeitschrift für Klinische Psychologie 18, 168–277.Google Scholar
Pennebaker, J. W. (1982). The Psychology of Physical Symptoms. Springer: New York.CrossRefGoogle Scholar
Pennebaker, J. W. & Hoover, C. W. (1984). Visceral perception versus visceral detection: disentangling methods and assumptions. Biofeedback and Self-Regulation 9, 339–352.CrossRefGoogle ScholarPubMed
Pennebaker, J. W., Cox, D. J., Gonder-Frederick, L., Wunsch, M. G., Evans, W. S. & Pohl, S. (1981). Physical symptoms related to blood glucose in insulin-dependent diabetics. Psychosomatic Medicine 43, 489–500.CrossRefGoogle ScholarPubMed
Rouse, C. H., Jones, G. E. & Jones, K. R. (1988). The effect of body composition and gender on cardiac awareness. Psychophysiology 25, 400–407.CrossRefGoogle ScholarPubMed
Runge, M. & Kühnau, J. (1983). Die autonome kardiale Neuropathie. Deutsche Medizinische Wochenschrift 108, 109–113.CrossRefGoogle Scholar
Schandry, R. (1981). Heart beat perception and emotional experience. Psychophysiology 18, 483–488.CrossRefGoogle ScholarPubMed
Stalmann, H., Hartl, L. & Pauli, P. (1987). Verhaltens-medizinische Aspekte der kardialen Neuropathy bei Diabetes mellitus. In Verhaltensmedizin und Diabetes mellitus (ed. Strian, F., Hölzl, R. and Haslbeck, M.), pp. 145–155. Springer: Berlin.Google Scholar
Stalmann, H., Hartl, L., Pauli, P., Strian, F. & Hölzl, R. (1988). Perception of arrhythmias in mitral valve prolapse, cardiac phobia and panic attacks (abstract). Journal of Psychophysiology 2, 160.Google Scholar
Tyrer, P., Lee, I. & Alexander, J. (1980). Awareness of cardiac function in anxious, phobic and hypochondriacal patients. Psychological Medicine 10, 171–174.CrossRefGoogle ScholarPubMed
Völker, R., Alt, E., Schmidt, G. & Wirtzfeld, A. (1986). Korrelation subjektiver Symptome und objektiver Befunde im Langzeit-EKG. Herz/Kreislauf 18, 323–328.Google Scholar
Whitehead, W. E., Drescher, V. M., Heiman, P. & Blackwell, B. (1977). Relation of heart-rate control to heart beat perception. Biofeedback and Self-Regulation 2, 371–392.CrossRefGoogle Scholar