1.
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 DPA Autonomic Assessment
 Autonomic Nervous System
 Heart Rate Variability
 Time & Frequency Domains
 HRV Sample Reports

2.
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The Vagus Nerve
interfaces with the para-
sympathetic control of
the heart & digestive tract
& supplies motor parasym-
pathetic fibers to all the
organs except the adrenal
glands.
Autonomic Nervous System
Autonomic nerves travel to organs
throughout the body. Most organs receive
Parasympathetic supply by the Vagus
nerve & Sympathetic supply by
Splanchnic nerves.
The Splanchnic Nerves
The splanchnic nerves are
paired visceral (internal or-
gans) nerves, primarily car-
rying sympathetic fibers as
well as sensory fibers from
the organs.

3.
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What Is Heart Rate Variability?
 HRV is a noninvasive test of cardiovascular autonomic regulation.
 Specifically, HRV is a measurement of the interaction between
the sympathetic ("fight or flight") nervous system and the
parasympathetic ("relaxation") nervous system in the
overall autonomic nervous system
 HRV – reflects the heart’s ability to adapt to changing circumstanc-
es by detecting and quickly responding to unpredictable stimuli.
 HRV measures overall health and well-being. Reflects on how the
body adapts to perform at maximum efficiency.
Clinical significance
Reduced HRV has
been shown to be a
predictor of mortali-
ty after a heart at-
tack (myocardial in-
farction). A range of
other outcomes &
conditions may also
be associated with
usually lower HRV:
The Sinoatrial Node (often abbreviated SA node; also called
sinus or sinuatrial node) is the normal and natural pacemaker of
the heart and is responsible for the initiation of the heartbeat.
 It spontaneously generates an electrical impulse, which af-
ter conducting throughout the heart, causes the heart to contract.
 The SA node is richly innervated by parasympathetic nervous
system fibers and by sympathetic nervous system fibers.
 Stimulation of the vagus nerve (the parasympathetic fibers)
causes a decrease in the SA node rate (thereby decreasing HR).
 Stimulation via sympathetic fibers causes an increase in the
SA node (thereby increasing HR).
The Atrioventicular Node
The atrioventricular (AV) node is a
part of the electrical conduction sys-
tem of the heart that coordinates
the top of the heart. It electrically
connects atrial and ventricular
chambers. The AV node is an area
of specialized tissue between the
atria & ventricles of the heart, spe-
cifically in the postero-inferior re-
gion of the interatrial septum near
the opening of the coronary sinus,
which conducts the normal electri-
cal impulse from the atria to the
ventricles. Heart; conduction system. 1. SA node.
2. AV node. 3. Bundle of His. 8. Septum

4.
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According to the Task Force of the European Society of Cardiology &
North American Society of Pacing & Electrophysiology in 1996, there
are two methods of analysis of HRV
data:
 Time Domain
 Frequency Domain
Mean Heart Rate -
Average Heart Rate over the 5 minute test period.
Reference Range [59.5 –95.5] It is important to note the natural rela-
tionship between heart rate (HR) and amount of HRV. As HR increases
there is less time between heartbeats for variability to occur, thus
HRV decreases. At lower heart rates, there is more time between
heartbeats and variability naturally increases.
Mean NN - Measurement of average time between two regular Normal
to Normal heartbeats in ms. Normal Range [628.2ms –1008 ms]
SDNN - The Standard Deviation of Normal to Normal intervals in the re-
cording, in milliseconds. This measure reflects the ebb & flow of all fac-
tors that contribute to HRV & is the most common index of overall HRV.
Heart Rate Electronic measurement:
A more precise method of determining heart rate involves the use of
an electrocardiograph - ECG or EKG). On the ECG, instantaneous
heart rate is calculated using the R wave-to-R wave (RR) interval and
multiplying/dividing in order to derive heart rate in heartbeats/min.
Multiple methods exist:
HR = 1,500/(RR interval in
millimeters)
HR = 60/(RR interval in sec-
onds)
HR = 300/number of "large"
squares between succes-
sive R waves.
Meridian DPA: Time Domain Analysis

5.
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6.
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7.
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8.
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GOOD HRV GRAPH / FREQUENCY DOMAINS IN NORMAL
HEART RATE IN GOOD RANGE / AUTONOMIC BALANCE
DIAGRAM IN NORMAL / SNS & PNS = PERFECT BALANCE
BAD HRV GRAPH / FREQUENCY DOMAINS ALL BELOW
NORMAL / AUTONOMIC BALANCE DIAGRAM OUTSIDE
NORMAL RANGE / PARASYMPATHETIC DOMINANCE

9.
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BAD HRV GRAPH / HEART RATE & FREQUENCY DOMAINS
EXTREMELY HIGH / AUTONOMIC BALANCE DIAGRAM
OUTSIDE NORMAL RANGE / SYMPATHETIC DOMINANCE
BAD HRV GRAPH / HIGH HEART RATE / FREQUENCY DO-
MAINS EXTREMELY LOW / AUTONOMIC BALANCE DIAGRAM
OUTSIDE NORMAL RANGE / SYMPATHETIC DOMINANCE