Skip to main content
SpringerLink
Log in

Summary: General Applications of Parasympathetic and Sympathetic Monitoring

  • Chapter
  • First Online:
Clinical Autonomic Dysfunction

  • 1853 Accesses

Abstract

As the last chapter of the book, we summarize it by answering the question, “Why autonomic (P&S) assessment?” Included in the answer are discussions on proactive patient management, individualized therapy titration, documenting outcomes, evidence-based medicine, value-based medicine, comparative effectiveness benefit, PQRI documentation, and improved patient care, and we finish with a look at P&S monitoring in different specialties.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    American Academy of Family Physicians, American Academy of Neurology, American Diabetes Association, American Heart Association, Juvenile Diabetes Research Foundation, and the National Institutes of Health.

  2. 2.

    At the time of publication, no editor has a financial relationship with the manufacturers of Carvedilol.

References

  1. Vinik AI, Arora RR, Colombo J. Age matched attenuation of both autonomic branches in chronic disease: II. Diabetes Mellitus. Cleveland Clinic Heart-Brain Summit, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas; 23–24 Sept 2010.

    Google Scholar 

  2. Arora RR, Ghosh-Dastidar S, Colombo J. Age matched attenuation of both autonomic branches in chronic disease: I. Hypertension. Presented at the Cleveland Clinic Heart-Brain Summit, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas; 23–24 Sept 2010.

    Google Scholar 

  3. Arora RR, Ghosh-Dastidar S, Colombo J. Age matched attenuation of both autonomic branches in chronic disease: III. Coronary Artery Disease. Presented at the Cleveland Clinic Heart-Brain Summit, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas; 23–24 Sept 2010.

    Google Scholar 

  4. Nemechek P, Ghosh-Dastidar S, Colombo J. Age matched attenuation of both autonomic branches in chronic disease: IV. HIV/AIDS. Presented at the Cleveland Clinic Heart-Brain Summit, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas; 23–24 Sept 2010.

    Google Scholar 

  5. Gentlesk PJ, Wiley T, Taylor AJ. A prospective evaluation of the effect of Simvastatin on heart rate variability in non-ischemic cardiomyopathy. Am Heart J. 2005;150:478–83.

    Article  CAS  PubMed  Google Scholar 

  6. Arora RR, Ghosh Dastidar S, Colombo J Autonomic balance is associated with decreased morbidity. American Autonomic Society, 17th international symposium, Kauai; 29 Oct–1 Nov 2008.

    Google Scholar 

  7. Pereira E, Baker S, Bulgarelli RJ, Murray G, Arora RR, Colombo J. Gender differences in longevity and sympathovagal balance. Presented at the Cleveland Clinic Heart-Brain Summit, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas; 23–24 Sept 2010.

    Google Scholar 

  8. Bloomfield DM, Kaufman ES, Bigger Jr JT, Fleiss J, Rolnitzky L, Steinman R. Passive head-up tilt and actively standing up produce similar overall changes in autonomic balance. Am Heart J. 1997;134(2 Pt 1):316–20.

    Article  CAS  PubMed  Google Scholar 

  9. Vinik AI, Aysin B, Colombo J. Enhanced frequency domain analysis identifies early autonomic dysfunction that may lead to elevated blood pressure in diabetics. Diabetes Technology conference, San Francisco; 10–12 Nov 2005.

    Google Scholar 

  10. Nanavati SH, Bulgarelli RJ, Vazquez-Tanus J, Ghosh-Dastidar S, Colombo J, Arora RR. Altered autonomic activity with atrial fibrillation as demonstrated by non-invasive autonomic monitoring. US Cardiol. 2010;7(1):47–50.

    Google Scholar 

  11. Colombo J, Jacot J, Aysin E, Aysin B, Iffrig K, Vinik AI. Symptoms of orthostasis may be due to sympathetic/parasympathetic autonomic imbalance and can be evaluated by hrv with respiratory analysis with appropriate pathogenesis oriented therapeutic choices. International Symposium on Diabetes Neuropathy, 7th Annual Congress, Cape Town, South Africa, 29 Nov–2 Dec 2007.

    Google Scholar 

  12. Arora RR, Ghosh Dastidar S, Colombo J. Altered sympathetic and parasympathetic activity is associated in patients with chronic coronary artery disease. Clin Auton Res. 2008;18(5):277.

    Google Scholar 

  13. Arora RR, Gosh Dastidar S, Colombo J. Age matched attenuation of autonomic activity in both branches in chronic hypertension. American Autonomic Society, 17th International Symposium, Kauai; 29 Oct–1 Nov 2008.

    Google Scholar 

  14. Karpen J, Ortiz R, Shoemaker WC. Parasympathetic and sympathetic monitoring in pain management. Online publication at Pain.com. Accessed 14 Jan 2010.

  15. Salpeter SR, Ormiston TM, Salpeter EE. Cardiovascular effects of β-agonists in patients with asthma and COPD: a meta-analysis. Chest. 2004;125:2309–21.

    Article  CAS  PubMed  Google Scholar 

  16. Sovani MP, Whale CI, Tattersfield AE. A benefit-risk assessment of inhaled long-acting beta2-agonists in the management of obstructive pulmonary disease. Drug Saf. 2004;27(10):689–715.

    Article  CAS  PubMed  Google Scholar 

  17. Tobias H, Vinitsky A, Bulgarelli RJ, Ghosh-Dastidar S, Colombo J. Autonomic nervous system monitoring of patients with excess parasympathetic responses to sympathetic challenges – clinical observations. US Neurol. 2010;5(2):62–6.

    Google Scholar 

  18. Stoupakis G, Colombo J, Rendas-Baum R, Budhwani N, Arora R. Postural drop of low frequency component of heart rate variability in diagnosis of orthostasis. Presented at Scientific Sessions of the American Heart Association, Chicago; 2002.

    Google Scholar 

  19. Curtis BM, O’Keefe JH. Autonomic tone as a cardiovascular risk factor: the dangers of chronic fight or flight. Mayo Clin Proc. 2002;77:45–54.

    Article  PubMed  Google Scholar 

  20. Narkiewicz K, Montano N, Cogliati C, van de Borne PJH, Dyken ME, Somers VK. Altered cardiovascular variability in obstructive sleep apnea. Circulation. 1998;98:1071–7.

    Article  CAS  PubMed  Google Scholar 

  21. Vinik AI, Maser RE, Ziegler D. Neuropathy. The crystal ball for cardiovascular disease. Diabetes Care. 2010;33(7):1688–90.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Pop-Busui R, Evans GW, Gerstein HC, Fonseca V, Fleg JL, Hoogwerf BJ, Genuth MS, Grimm RH, Corson MA, Prineas R, ACCORD Study Group. Effects of cardiac autonomic dysfunction on mortality risk in the action to control cardiovascular risk in diabetes (ACCORD) trial. Diabetes Care. 2010;33:1578–84.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Calles-Escandon J, Lovato L, Simons-Morton D, Kendell D, Pop-Busui R, Cohen R, Bonds D, Fonseca V, Ismail-Beigi F, Banerji M, Failor A, Hamilton B. Effect of intensive compared with standard glycemia treatment strategies on mortality by baseline subgroup characteristics. Diabetes Care. 2010;33:721–7.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Vinik AI, Murray GL. Autonomic neuropathy is treatable. US Endocrinol. 2008;2:82–4.

    Google Scholar 

  25. Vinik AI, Maser RE, Nakave AA. Diabetic cardiovascular autonomic nerve dysfunction. US Endocr Dis. 2007;2:2–9.

    Google Scholar 

  26. Vinik A, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation. 2007;115:387–97.

    Article  PubMed  Google Scholar 

  27. Bullinga JR, Alharethi R, Schram MS, Bristow MR, Gilbert EM. Changes in heart rate variability are correlated to hemodynamic improvement with chronic CARVEDILOL therapy in heart failure. J Card Fail. 2005;11(9):693–9.

    Article  CAS  PubMed  Google Scholar 

  28. Fatoni C, Raffa S, Regoli F, Giraldi F, La Rovere MT, Prentice J, Pastori F, Fratini S, Salerno-Uriarte JA, Klein HU, Auricchio A. Cardiac resynchronization therapy improves heart rate profile and heart rate variability of patients with moderate to severe heart failure. J Am Coll Cardiol. 2005;46(10):1875–82.

    Article  Google Scholar 

  29. Barefoot JC, Helms MJ, Mark DB, Blumenthal JA, Califf RM, Haney TL, O’Connor CM, Siegler IC, Williams RB. Depression and long-term mortality risk in patients with coronary artery disease. Am J Cardiol. 1996;78:613–7.

    Article  CAS  PubMed  Google Scholar 

  30. Davidson KW, Rieckmann N, Lesperance F. Psychological theories of depression: potential application for the prevention of acute coronary syndrome recurrence. Psychosom Med. 2004;66:165–73.

    Article  PubMed  Google Scholar 

  31. Lett HS, Blumenthal JA, Babyak MA, Sherwood A, Strauman T, Robins C, Newman MF. Depression as a risk factor for coronary artery disease: evidence, mechanisms, and treatment. Psychosom Med. 2004;66:305–15.

    PubMed  Google Scholar 

  32. Frasure-Smith N, Lesperance F, Gravel G, Masson A, Juneau M, Talajic M, Bourassa MG. Social support, depression, and mortality during the first year after myocardial infarction. Circulation. 2000;101:1919–24.

    Article  CAS  PubMed  Google Scholar 

  33. Lespérance F, Frasure-Smith N, Juneau M, Théroux P. Depression and 1-year prognosis in unstable angina. Arch Intern Med. 2000;160(9):1354–60.

    Article  PubMed  Google Scholar 

  34. Joynt KE, Whellan DJ, O’Connor CM. Depression and cardiovascular disease: mechanisms of interaction. Biol Psychiatry. 2003;54:248–61.

    Article  PubMed  Google Scholar 

  35. Pereira E, Baker S, Bulgarelli R, Arora RR, Ghosh Dastidar S, Colombo J. Autonomic imbalance may underlie labile hypertension: I Possible remedy. Clin Auton Res. 2010;20(5):318.

    Google Scholar 

  36. Baker S, Pereira E, Bulgarelli R, Arora RR, Ghosh Dastidar S, Colombo J. Autonomic imbalance may underlie labile hypertension: II Possible physiology. Clin Auton Res. 2010;20(5):319.

    Google Scholar 

  37. Prendergast JJ. Diabetic autonomic neuropathy: part 1 early detection. Pract Diabetol. 2001;20(1):7–14.

    Google Scholar 

  38. Prendergast JJ. Diabetic autonomic neuropathy: part 2 treatment. Pract Diabetol. 2001;20(2):30–6.

    Google Scholar 

  39. Lachmann J, Banerjee A, Davoudi M, Aragon D, Talerja A, Sonnenblick EH, Shirani J, Le Jemtel T. Withdrawal of angiotensin receptor blocker from triple neurohormonal therapy partially restores sympathetic activity in chronic heart failure. American Heart Association, Scientific Sessions, Anaheim; 11–14 Nov 2001.

    Google Scholar 

  40. Low PA, Engstrom JW. Disorders of the autonomic nervous system. In: Harrison’s principles of internal medicine. 16th ed. New York: McGraw-Hill; 2003.

    Google Scholar 

  41. Malik M, The Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability, standards of measurement, physiological interpretation, and clinical use. Circulation. 1996;93:1043–65.

    Article  Google Scholar 

  42. American Heart Association web site, www.americanheart.org, 2010.

  43. American Diabetes Association web site, www.diabetes.org, 2010.

  44. Joint Editorial Statement by the American Diabetes Association; the National Heart, Lung, and Blood Institute; the Juvenile Diabetes Foundation International; the National Institute of Diabetes and Digestive and Kidney Diseases; and the American Heart Association. Diabetes mellitus: a major risk factor for cardiovascular disease. Circulation. 1999;100:1132–3.

    Article  Google Scholar 

  45. Grundy SM, Benjamin IJ, Burke GL, Chait A. AHA scientific statement: diabetes and cardiovascular disease, a statement for healthcare professionals from the American Heart Association. Circulation. 1999;100:1134–46.

    Article  CAS  PubMed  Google Scholar 

  46. Aring AM, Jones DE, Falko JM. Evaluation and prevention of diabetic neuropathy. Am Fam Phys. 2005;71:2123–30.

    Google Scholar 

  47. Boulton AJM, Vinik AI, Arrezzo JC, Bril V, Feldman EI, Freeman R, Malik RA, Maser RE, Sosenko JM, Ziegler D. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care. 2005;28(4):956–62.

    Article  PubMed  Google Scholar 

  48. Low PA and the Therapeutics and Technology Assessment Subcommittee. Assessment: Clinical autonomic testing report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 1996;46:873–80.

    Google Scholar 

  49. Arora RR, Aysin E, Aysin B, Colombo J. Therapeutic implications of sympathetic stimulus in orthostatic patients: measured by spectral domain analysis. AHA Scientific Sessions, Orlando, FL, 4–7 Nov 2007.

    Google Scholar 

  50. Robertson D, Bisggioni I, Burnstock G, Low PA, Paton JFR, editors. Primer on the autonomic nervous system. 3rd ed. Waltham: Academic; 2012.

    Google Scholar 

  51. Saper CB. Autonomic disorders and their management. In: Cecil textbook of medicine. 22nd ed. Philadelphia: WB Saunders; 2003.

    Google Scholar 

  52. Low PA, editor. Clinical autonomic disorders: evaluation and management. Philadelphia: Lippincott-Raven; 1997.

    Google Scholar 

  53. Arora RR, Bulgarelli RJ, Ghosh-Dastidar S, Colombo J. Autonomic mechanisms and therapeutic implications of postural diabetic cardiovascular abnormalities. J Diabetes Sci Technol. 2008;2(4):568–71.

    Article  Google Scholar 

  54. Waheed A, Ali MA, Jurivich DA, et al. Gender differences in longevity and autonomic function. Presented at the Geriatric Medicine Society Meeting, Chicago; 3–7 May 2006.

    Google Scholar 

  55. Fathizadeh P, Shoemaker WC, Woo CCJ, Colombo J. Autonomic activity in trauma patients based on variability of heart rate and respiratory rate. Crit Care Med. 2004;32(5):1300–5.

    Article  PubMed  Google Scholar 

  56. Chen JY, Fung JW, Yu CM. The mechanisms of atrial fibrillation. J Cardiovasc Electrophysiol. 2006;17 Suppl 3:S2–7.

    Article  PubMed  Google Scholar 

  57. Copie X, Lamaison D, Salvador M, Sadoul N, DaCosta A, Faucher L, Legal F, Le Heuzey JY, VALID Investigators. Heart rate variability before ventricular arrhythmias in patients with coronary artery disease and an implantable cardioverter defibrillator. Ann Noninvasive Electrocardiol. 2003;8(3):179–84.

    Article  PubMed  Google Scholar 

  58. Alter P, Grimm W, Vollrath A, Czerny F, Maisch B. Heart rate variability in patients with cardiac hypertrophy–relation to left ventricular mass and etiology. Am Heart J. 2006;151(4):829–36.

    Article  PubMed  Google Scholar 

  59. Debono M, Cachia E. The impact of cardiovascular autonomic neuropathy in diabetes: is it associated with left ventricular dysfunction? Auton Neurosci. 2007;132(1–2):1–7.

    Article  PubMed  Google Scholar 

  60. Just H. Peripheral adaptations in congestive heart failure: a review. Am J Med. 1991;90:23S–6.

    Article  CAS  PubMed  Google Scholar 

  61. Nakamura K, Matsumura K, Kobayashi S, Kaneko T. Sympathetic premotor neurons mediating thermoregulatory functions. Neurosci Res. 2005;51(1):1–8.

    Article  PubMed  Google Scholar 

  62. Manfrini O, Morgagni G, Pizzi C, Fontana F, Bugiardini R. Changes in autonomic nervous system activity: spontaneous versus balloon-induced myocardial ischaemia. Eur Heart J. 2004;25(17):1502–8.

    Article  PubMed  Google Scholar 

  63. Ahrens EH. Drugs spotlight program: the management of hyperlipidemia: whether, rather than how. Ann Intern Med. 1976;85(1):87–93.

    Article  PubMed  Google Scholar 

  64. Kumar V (editor), Abbas AK, Fausto N, Mitchell RS. Robbins basic pathology. 8th ed. Philadelphia: Saunders Elsevier; 2007.

    Google Scholar 

  65. Boyd G, Stout D, Aultman M, Wyatt K, Vetter T. Are there reliable clinical predictors of cardiac autonomic neuropathy in diabetic patients? American Society of Anesthesiologists, Annual Meeting, San Diego; 16–20 Oct 2010a.

    Google Scholar 

  66. Boyd G, Stout D, Morris R, Witherspoon CD, Vetter T. et al. Prevalence and severity of autonomic dysfunction in diabetic patients presenting for retinal surgery American Society of Anesthesiologists, Annual Meeting, San Diego; 16–20 Oct 2010b.

    Google Scholar 

  67. Umetani K, Singer DH, McCraty R, Atkinson M. Twenty-four hour time domain heart rate variability and heart rate: relations to age and gender over nine decades. J Am Coll Cardiol. 1998;31(3):593–601.

    Article  CAS  PubMed  Google Scholar 

  68. Low PA. Clinical autonomic disorders. 2nd ed. New York: Lippincott Press; 2006.

    Google Scholar 

  69. Clarke B, Ewing D, Campbell I. Diabetic autonomic neuropathy. Diabetologia. 1979;17:195–212.

    Article  CAS  PubMed  Google Scholar 

  70. Nanavati S, Bulgarelli RJ, Vazquez-Tanus J, Ghosh-Dastidar S, Colombo J, Arora RR. Altered autonomic activity with atrial fibrillation as demonstrated by non-invasive autonomic monitoring. American Autonomic Society, 17th International Symposium. Kauai;. 29 Oct–1 Nov 2008.

    Google Scholar 

  71. Tsuji H, Venditti Jr FJ, Manders ES, Evans JC, Larson MG, Feldman CL, Levy D. Reduced heart rate variability and mortality risk in an elderly cohort. The Framingham Heart Study. Circulation. 1994;90(2):878–83.

    Article  CAS  PubMed  Google Scholar 

  72. Cohn JN, Tognoni G, for the Valsartan Heart Failure Trial Investigators. A randomized trial of the angiotensin-receptor blocker Valsartan in chronic heart failure. N Engl J Med. 2001;345:1667–75.

    Google Scholar 

  73. Malik M, and the Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability, standards of measurement, physiological interpretation, and clinical use. Eur Heart J. 1996;17:354–81

    Google Scholar 

  74. Parati G, Valentini M. Prognostic relevance of blood pressure variability. Hypertension. 2006;47(2):137–8.

    Article  CAS  PubMed  Google Scholar 

  75. Parati G, Mancia G. Blood pressure variability as a risk factor. Blood Press Monit. 2001;6(6):341–7.

    Article  CAS  PubMed  Google Scholar 

  76. Parati G, Saul JP, Di Rienzo M, Mancia G. Spectral analysis of blood pressure and heart rate variability in evaluating cardiovascular regulation. A critical appraisal. Hypertension. 1995;25(6):1276–86.

    Article  CAS  PubMed  Google Scholar 

  77. Parati G, Bilo G, Vettorello M, Groppelli A, Maronati A, Tortorici E, Caldara G, Mancia G. Assessment of overall blood pressure variability and its different components. Blood Press Monit. 2003;8(4):155–9.

    Article  PubMed  Google Scholar 

  78. Bilo G, Giglio A, Styczkiewicz K, Caldara G, Kawecka-Jaszcz K, Mancia G, Parati G. How to improve the assessment of 24-h blood pressure variability. Blood Press Monit. 2005;10(6):321–3.

    Article  PubMed  Google Scholar 

  79. Parati G, Rizzoni D. Assessing the prognostic relevance of blood pressure variability: discrepant information from different indices. J Hypertens. 2005;23(3):483–6.

    Article  CAS  PubMed  Google Scholar 

  80. Parati G, Di Rienzo M. Determinants of heart rate and heart rate variability. J Hypertens. 2003;21(3):477–80.

    Article  CAS  PubMed  Google Scholar 

  81. Parati G, Frattola A, Di Rienzo M, Mancia G. Blood pressure variability. Importance in research and in clinical hypertension. Arq Bras Cardiol. 1996;67(2):131–3.

    CAS  PubMed  Google Scholar 

  82. Akselrod S, Gordon S, Ubel FA, Shannon DC, Berger AC, Cohen RJ. Power spectrum analysis of heart rate fluctuations: a quantitative probe of beat-to- beat cardiovascular control. Science. 1981;213:213–20.

    Article  Google Scholar 

  83. Akselrod S, Gordon D, Madwed JB, Snidman NC, Shannon DC, Cohen RJ. Hemodynamic regulation: investigation by spectra analysis. Am J Physiol. 1985;249:H867–75.

    CAS  PubMed  Google Scholar 

  84. Akselrod S, Eliash S, Oz O, Cohen S. Hemodynamic regulation in SHR: investigation by spectral analysis. Am J Physiol. 1987;253:H176–83.

    CAS  PubMed  Google Scholar 

  85. Aysin B, Aysin E. Effect of respiration in heart rate variability (HRV) analysis. Conf Proc IEEE Eng Med Biol Soc. 2006;1:1776–9. PubMed: 17946068.

    Article  PubMed  Google Scholar 

  86. Aysin B, Aysin E, Colombo J Comparison of HRV analysis methods during orthostatic challenge: HRV with respiration or without? IEEE engineering in medicine and biology conference, Lyons: 2007.

    Google Scholar 

  87. Salpeter SR. Bronchodilators in COPD: impact of β-agonists and anticholinergics on severe exacerbations and mortality. Int J COPD. 2007;2(1):11–8.

    Article  Google Scholar 

  88. de Vries F, Pouwels S, Bracke M, Lammers J, Klungel O, Leufkens H, van Staal T. Use of beta-2 agonists and risk of acute myocardial infarction in patients with hypertension. Br J Clin Pharmacol. 2008;65(4):580–6.

    Article  PubMed Central  PubMed  Google Scholar 

  89. Faulkner MA, Hilleman DE. Pharmacologic treatment of chronic obstructive pulmonary disease: past, present, and future. Pharmacotherapy. 2003;23(10):1300–15.

    Article  CAS  PubMed  Google Scholar 

  90. Cazzola M, Matera MG, Donner CF. Inhaled beta2-adrenoceptor agonists: cardiovascular safety in patients with obstructive lung disease. Drugs. 2005;65(12):1595–610.

    Article  CAS  PubMed  Google Scholar 

  91. Salpeter SR, Buckley NS, Ormiston TM, Salpeter EE. Meta-analysis: Effect of long-acting β -agonists on severe asthma exacerbations and asthma-related deaths. Ann Intern Med. 2006;144:904–12.

    Article  CAS  PubMed  Google Scholar 

  92. Gupta P, O’Mahony MS. Potential adverse effects of bronchodilators in the treatment of airways obstruction in older people: recommendations for prescribing. Drug Aging. 2008;25(5):415–43.

    Article  CAS  Google Scholar 

  93. Salpeter SR, Aaron SD. Rebuttal: Should we avoid beta-agonists for moderate and severe chronic obstructive pulmonary disease? Can Fam Physician. 2007;53:1429–30.

    PubMed Central  PubMed  Google Scholar 

  94. Salpeter SR. Should we avoid beta-agonists for moderate and severe chronic obstructive pulmonary disease? YES. Can Fam Physician. 2007;53(8):1290–7.

    PubMed Central  PubMed  Google Scholar 

  95. Salpeter SR. An update on the safety of long-acting beta-agonists in asthma patients using inhaled corticosteroids. Expert Opin Drug Saf. 2010;9(3):407–19.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Autonomic Laboratory Department of Cardiology, Drexel University College of Medicine, Philadelphia, PA, USA

    Joseph Colombo PhD

  2. ANSAR Medical Technologies, Inc., Philadelphia, PA, USA

    Joseph Colombo PhD

  3. Department of Medicine, Captain James A. Lovell Federal Health Care Center, North Chicago, IL, USA

    Rohit Arora MD, FACC, FAHA, FACP, FSCAI

  4. Department of Cardiology, The Chicago Medical School, North Chicago, IL, USA

    Rohit Arora MD, FACC, FAHA, FACP, FSCAI

  5. Department of Cardiology, Hahnemann Hospital Drexel University College of Medicine, Philadelphia, PA, USA

    Nicholas L. DePace MD, FACC

  6. Department of Medicine, Eastern Virginia Medical School Strelitz Diabetes Research Center, Norfolk, VA, USA

    Aaron I. Vinik MD, PhD, FCP, MACP

Authors
  1. Joseph Colombo PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rohit Arora MD, FACC, FAHA, FACP, FSCAI
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicholas L. DePace MD, FACC
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aaron I. Vinik MD, PhD, FCP, MACP
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Colombo, J., Arora, R., DePace, N.L., Vinik, A.I. (2015). Summary: General Applications of Parasympathetic and Sympathetic Monitoring. In: Clinical Autonomic Dysfunction. Springer, Cham. https://doi.org/10.1007/978-3-319-07371-2_32

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-07371-2_32

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-07370-5

  • Online ISBN: 978-3-319-07371-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation