PubMed Health⌕ Search

Biomedical subjects

W J Stok

Publications and source records attributed to W J Stok.

9 recordsLinked to original sources
PubMed2006

Mathematical modeling of gravitational effects on the circulation: importance of the time course of venous pooling and blood volume changes in the lungs.

A dip in blood pressure (BP) in response to head-up tilt (HUT) or active standing might be due to rapid pooling in the veins below the heart (preload) or muscle activation-induced drop in systemic vascular resistance (afterload). We hypothesized that, in the cardiovascular response to passive HUT, where, in contrast to active standing, little BP dip is observed, features affecting the preload play a key role. We developed a baroreflex model combined with a lumped-parameter model of the circulation, including viscoelastic stress-relaxation of the systemic veins. Cardiac contraction is modeled using the varying-elastance concept. Gravity affects not only the systemic, but also the pulmonary, circulation. In accordance with the experimental results, model simulations do not show a BP dip on HUT; the tilt-back response is also realistic. If it is assumed that venous capacities are steady-state values, the introduction of stress-relaxation initially reduces venous pooling. The resulting time course of venous pooling is comparable to measured impedance changes. When venous pressure-volume dynamics are neglected, rapid (completed within 30 s) venous pooling leads to a drop in BP. The direct effect of gravity on the pulmonary circulation influences the BP response in the first approximately 5 s after HUT and tilt back. In conclusion, the initial BP response to HUT is mainly determined by the response of the venous system. The time course of lower body pooling is essential in understanding the response to passive HUT.

Adult↗
PubMed2005

Orthostatic blood pressure control before and after spaceflight, determined by time-domain baroreflex method.

Reduction in plasma volume is a major contributor to orthostatic tachycardia and hypotension after spaceflight. We set out to determine time- and frequency-domain baroreflex (BRS) function during preflight baseline and venous occlusion and postflight orthostatic stress, testing the hypothesis that a reduction in central blood volume could mimic the postflight orthostatic response. In five cosmonauts, we measured finger arterial pressure noninvasively in supine and upright positions. Preflight measurements were repeated using venous occlusion thigh cuffs to impede venous return and "trap" an increased blood volume in the lower extremities; postflight sessions were between 1 and 3 days after return from 10- to 11-day spaceflight. BRS was determined by spectral analysis and by PRVXBRS, a time-domain BRS computation method. Although all completed the stand tests, two of five cosmonauts had drastically reduced pulse pressures and an increase in heart rate of approximately 30 beats/min or more during standing after spaceflight. Averaged for all five subjects in standing position, high-frequency interbeat interval spectral power or transfer gain did not decrease postflight. Low-frequency gain decreased from 8.1 (SD 4.0) preflight baseline to 6.8 (SD 3.4) postflight (P = 0.033); preflight with thigh cuffs inflated, low-frequency gain was 9.4 (SD 4.3) ms/mmHg. There was a shift in time-domain-determined pulse interval-to-pressure lag, Tau, toward higher values (P < 0.001). None of the postflight results were mimicked during preflight venous occlusion. In conclusion, two of five cosmonauts showed abnormal orthostatic response 1 and 2 days after spaceflight. Overall, there were indications of increased sympathetic response to standing, even though we can expect (partial) restoration of plasma volume to have taken place. Preflight venous occlusion did not mimic the postflight orthostatic response.

Adult↗
PubMed2004

Human cerebral venous outflow pathway depends on posture and central venous pressure.

Internal jugular veins are the major cerebral venous outflow pathway in supine humans. In upright humans the positioning of these veins above heart level causes them to collapse. An alternative cerebral outflow pathway is the vertebral venous plexus. We set out to determine the effect of posture and central venous pressure (CVP) on the distribution of cerebral outflow over the internal jugular veins and the vertebral plexus, using a mathematical model. Input to the model was a data set of beat-to-beat cerebral blood flow velocity and CVP measurements in 10 healthy subjects, during baseline rest and a Valsalva manoeuvre in the supine and standing position. The model, consisting of 2 jugular veins, each a chain of 10 units containing nonlinear resistances and capacitors, and a vertebral plexus containing a resistance, showed blood flow mainly through the internal jugular veins in the supine position, but mainly through the vertebral plexus in the upright position. A Valsalva manoeuvre while standing completely re-opened the jugular veins. Results of ultrasound imaging of the right internal jugular vein cross-sectional area at the level of the laryngeal prominence in six healthy subjects, before and during a Valsalva manoeuvre in both body positions, correlate highly with model simulation of the jugular cross-sectional area (R(2) = 0.97). The results suggest that the cerebral venous flow distribution depends on posture and CVP: in supine humans the internal jugular veins are the primary pathway. The internal jugular veins are collapsed in the standing position and blood is shunted to an alternative venous pathway, but a marked increase in CVP while standing completely re-opens the jugular veins.

Adult↗
PubMed2002

Dynamic cerebral autoregulation under sinusoidal gravitational loading.

Dynamic cerebral autoregulation (CA) has been studied previously using spectral analysis of oscillations in arterial blood pressure (ABP) and cerebral blood flow velocity (CBFV). The dynamics of the CA can be modeled as a high-pass filter. The purpose of this study is to compare CA of blood pressure oscillations induced by gravitational loading to CA during resting conditions. We subjected twelve healthy subjects to repeated sinusoidal head-up (0 degrees - 60 degrees) tilts at several set frequencies (0.07 to 0.25 Hz) on a computer controlled tilt table while we recorded ABP (Finapres) and CBFV (transcranial Doppler ultrasound). We fitted the data sets to a high-pass filter model and computed an average time constant (T). Our results show similar phase leads of CBFV to ABPbrain in the rest recording and in sinusoidal tilting, in the studied frequency range. The transfer function gain of the resting spectra increased with increasing frequency, the gain of the tilting spectra did not. Fitting the phase responses of both data sets to a high pass filter model yielded similar time constants.

Journal Article↗
PubMed1999

Noninvasive cardiac output measurement in orthostasis: pulse contour analysis compared with acetylene rebreathing.

We tested the reliability of noninvasive cardiac output (CO) measurement in different body positions by pulse contour analysis (CO(pc)) by using a transmission line model (K. H. Wesseling, B. De Wit, J. A. P. Weber, and N. T. Smith. Adv. Cardiol. Phys. 5, Suppl. II: 16-52, 1983). Acetylene rebreathing (CO(rebr)) was used as a reference method. Twelve subjects (age 21-34 yr) were studied: 1) six in whom CO(rebr) and CO(pc) were measured in the standing and 6 degrees head-down tilt (HDT) postures and 2) six in whom CO was measured in the 30 degrees HDT, supine, 30 degrees head up-tilt (HUT), and 70 degrees HUT postures on a tilt table. The CO(rebr)-to-CO(pc) ratio in (near) the supine position during rebreathing was used as the calibration factor for CO(pc) measurements. Calibrated CO(pc) (CO(cal sup)) consistently overestimated CO in the upright posture. The drop in CO with upright posture was underestimated by approximately 50%. CO(cal sup) and CO(rebr) values did not differ in the 30 degrees HDT position. Changes in the CO(rebr)-to-CO(pc) ratio are highly variable among subjects in response to a change in posture. Therefore, CO(pc) must be recalibrated for each subject in each posture.

Acetylene↗
PubMed1997

Circadian blood pressure and systemic haemodynamics during 42 days of 6 degrees head-down tilt.

Head-down tilted bedrest is a ground-based microgravity simulation model. Since in this position the influence of chief external determinants of circadian blood pressure variation, i.e. activity and posture, are reduced, it may reveal endogenous oscillatory factors. The effects of 42 days of 6 degrees head-down tilt on the circadian profiles of continuous finger blood pressure, heart rate, stroke volume, cardiac output and total peripheral resistance were analysed. In seven healthy volunteers (25-31 years) twelve 22 h Portapres registrations were performed: two in an ambulatory baseline period, eight during 42 days of head-down tilt, and two during recovery. Stroke volume was estimated by a pulse contour method ('Modelflow') from the finger arterial blood pressure tracing. Head-down tilt rapidly reduced circadian BP variation, especially for diastolic blood pressure. No effect of long-term head-down tilt on blood pressure level was observed. The day-night difference in heart rate was essentially unaffected. Cardiac output was maintained through an increase of heart rate and simultaneous decline of stroke volume. Our observations confirm the overriding importance of physical activity and orthostatic load on the diurnal variation of BP. The time-frame of the changes in stroke volume and heart rate during head-down tilt might point to a contribution of other factors besides a reduction of circulating blood volume affecting cardiovascular performance under these conditions.

Adult↗
PubMed1993

Noninvasive cardiac output measurement by arterial pulse analysis compared with inert gas rebreathing.

Noninvasive cardiac output (CO) measured by arterial pulse analysis was compared with that measured by inert gas rebreathing in six healthy male volunteers. Pulse contour analysis was applied to the pressure wave output of a Finapres, which noninvasively measures continuous arterial pressure in a finger. Data were collected before, during, and after a 10-day 6 degrees head-down tilt experiment. Intravenous saline loading and lower body negative pressure stimuli varied CO over 2.8-9.6 l/min, as measured by the rebreathing technique. Because pulse contour provides only relative changes in CO, to obtain absolute values it must be calibrated against another measurement. Pulse contour data were calibrated every measurement day against the mean of two to four control rebreathing CO measurements before the lower body negative pressure or intravenous saline loading stimuli. Using one averaged calibration factor per subject for a total of 27 days, we compared the results of both methods. The linear regression between pulse contour (Pc CO) and rebreathing CO (Rebr CO) was Pc CO = 0.15 + 0.98(Rebr CO) (r = 0.96). The standard deviation of the difference of the two methods was 0.5 l/min (n = 205), excluding data used for calibration. By monitoring pulse contour CO before and during rebreathing, the rebreathing maneuver itself was shown to produce a substantial increase in CO that was mainly related to an increase in heart rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Body position and volume status as determinants of cardiovascular responses to transition into microgravity in parabolic flight.

The condition of microgravity during spaceflight imposes a new challenge to the cardiovascular system and to its homeostatic mechanisms. Initial fluids shifts from the dependent parts to the upper parts of the body are supposed to induce a plethora of effects which eventually lead to the well-known puffy faces and chicken legs' of astronauts. At the same time some 2-3 kgs. in fluid is lost in urine and by diminished uptake. For research into these longer-term effects of spaceflight extensive physiologic experiments are required in space. In view of the high cost and the logistic problems related to space-research much work is done in simulation experiments like bedrest or head down tilt studies. For the very initial effects of micro-G parabolic flight can be used. In parabolic flights we have addressed the question of immediate cardiovascular effects of the transition into microgravity. Since a parabola will last for not more than some 25 seconds, one may expect to observe mainly changes in the outflow of the autonomic nervous system, reflecting in blood pressure and heart rate as easily measurable parameters. Such changes can be expected to be caused by the sudden disappearance of hydrostatic effects and the shifts of fluid from pools where it is kept under the influence of gravity. Hydrostatic effects will play a role in the position of the baroreceptors with respect to the heart: in the upright position the carotid sinuses are some 25 cm above heart level, consequently they observe a lower pressure than that at the heart. When this effect disappears in micro-G a suddenly increased pressure will be observed and the baroreflex is called into action. On the venous side blood will rush to the right atrium when it is no longer pulled down in the compliant vessels of the abdomen and legs. This may be expected to lead to increased pressures on the low-pressure side of the heart. Apart from changes in filling of the left heart this may lead to autonomic nervous effects on systemic blood pressure and heart rate as well.

Adult↗