Heart rate variability: from bench to bedside

Power spectrum analysis of cardiovascular signal variability, and in particular of the RR period (heart rate variability, HRV), is a widely used methodology for investigating autonomic neural regulation in health and disease that can quantify the sympathovagal balance modulating the sinus node pacemaker. In some cases, it can also quantify the neural regulation of other organs or apparatuses. However, use of the correct methodology is crucial to extract the information embedded in the frequency domain. In numerous abnormal conditions, such as essential arterial hypertension, acute myocardial infarction and heart failure, the sympathovagal balance may be altered in basal conditions. However, a reduced responsiveness to an excitatory stimulus is the most common feature that characterizes numerous pathophysiological states. The attenuation of an oscillatory pattern can also reflect an altered target function, thus providing important prognostic markers. The general features of this approach correspond well to the needs of an internist attempting to envisage the involvement of the whole organism in a disease process.