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When sympathectomy is performed for excessive hand sweating or palmar hyperhidrosis it is known to have a beta blocking effect on the heart. When the sympathectomy was performed at the second rib level there was about 6-8% reduction in the heart rate .For the regular patient who is not engaged in a very heavy physical activity it did not make a significant change. On the other hand those patients who are very physically engaged in demanding physical activities should know that their heart rate could potentially not go above 135 bpm.

Over the last few years some changes were applied to the method in which the operation is carried out. The first one is the clamping method which contains the possibility of reversal. The other change is that the level of the sympatectomy is lowered down to third rib level or T-3 level .What Dr. Reisfeld has found is that undergoing the surgery with the new methods those patients can raise their heart rate to about 155-160 bpm. The exact explanation is not yet known, but this could be due to the way the sympathetic fibers connected to the heart are organized. The cardiac sympathetic fibers come from the necks sympathetic ganglia and they converge to the heart and the aortic root at or about the T2 level. By doing the clamping method at the T3 level it allows most if not all of the sympathetic fibers to reach the heart without interruption and so rate change is much less pronounced.

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