# Heart rate increase results in case of positional venous entrapment

## TL;DR

This study shows that increased heart rate during arm movements is caused by venous entrapment, not nerve compression.

## Contribution

The study provides evidence that positional venous entrapment, not adrenergic nerve compression, causes heart rate increases during upper limb movements.

## Key findings

- Patients with venous entrapment had a 6.9 bpm higher heart rate during the 'surrender' position compared to rest.
- Heart rate increases in venous entrapment patients were significantly higher than in those without vascular compression.
- The heart rate increase is likely due to decreased cardiac pre-charge rather than adrenergic nerve excitation.

## Abstract

Tachycardia has previously been reported as a possible sign of neurovascular entrapment during upper‐limb abduction and assumed to result from compression of the adrenergic nerve. However, this increase in heart rate could also be caused by a vascular factor, such as venous entrapment. The aim of this study was to determine whether heart rate increases specifically in the case of venous entrapment during upper‐limb dynamic mobilization tasks.

One hundred and sixteen patients were asked to perform a provocative manoeuvre consisting of consecutive upper limb mobilizations by raising their arms to the “surrender” position (Su, 90° abduction) and then keeping their arms raised in front of the body (“prayer” position, Pra) prior to returning to the initial position (“End”). During this manoeuvre, simultaneous venous (V‐PPG) and arterial (A‐PPG) photoplethysmography (PPG) recordings were obtained. Participants were categorized by PPG recording analysis as having bilateral venous compression only (V‐group) or having no vascular compression (C‐group). All other responses (n = 75) were excluded. Heart rate responses in V‐group and C‐group were compared across arm positions using a linear mixed model.

V‐group (n = 17) showed a significantly higher heart rate during the ‘Su’ phase compared to the ‘Rest’ phase (+6.9 bpm, p < 0.001) and compared to the 24 patients of the C‐group (+4.9 bpm, p = 0.02).

This study suggests that the cardiovascular response to dynamic provocative manoeuvres is found specifically in the presence of positional venous upper‐limb entrapment and likely results from decreased cardiac pre‐charge rather than from adrenergic nerve excitation.