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At least 55 records · Page 3Linked to original sources
PubMed1995

Similar orthostatic defense in active, healthy young adult and late middle-aged men.

Orthostatic defense is commonly validated with a 60 degrees to 80 degrees head-up tilt test, addressing the step response rather than the response to permanent orthostatis. During the initial phase of tilt, neural factors predominate, while later, the slower humoral factors fade in. It has been demonstrated that, during adaptation of the circulatory system to the standing conditions, overshoot and undershoot occur. These oscillations hamper straight-forward interpretation of a tilt test, and may contribute to the inconclusiveness of current studies regarding the aging of orthostatic defense. Gradual, progressive, orthostatic load testing seems a valuable alternative. We used a novel, incremental, head-up tilt protocol (0 degrees to 80 degrees, 13 increments) to impose graded orthostatic stress on 46 healthy young adult men (mean age +/- SD 25 +/- 3 years), and on 16 healthy late middle-aged men (60 +/- 4 years), while recording the electrocardiogram and the blood pressure. A first-order estimate of the heart rate range associated with the sympathovagal transition was made by combined analysis of heart rate and heart rate variability trends. We observed similar responses in heart rate, heart rate variability, and blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Haemodynamic response to head-up tilt in elderly hypertensives and diabetics.

To examine the haemodynamic mechanism associated with postural hypotension (PH) in elderly people, haemodynamic response to head-up tilt was studied in 14 elderly hypertensives and 13 elderly diabetics. Hypertensives and diabetics were divided into those with or without PH, defined as > or = 10 mmHg decline in mean blood pressure in response to head-up tilt. There was no significant change in cardiac output in hypertensives or diabetics with PH, whereas there was a significant increase during tilt in hypertensives without PH (p < 0.0001) and diabetics without PH (p = 0.0054). Hypertensives without PH showed a significant decrease in total peripheral resistance in response to head-up tilt (p = 0.0043). In hypertensives with PH and in both diabetic groups, there was no change in total peripheral resistance in response to head-up tilt. There was no difference in ejection fractions or heart rate responses between subjects with and without PH in either disease group. The difference in cardiac output change was not explained by myocardial changes observed at echocardiography nor by heart rate response nor by differences in total peripheral resistance. The results suggest that an increase in cardiac output in response to changing posture may be more important than vasoconstriction in protecting elderly subjects from PH.

Aged↗
PubMed1995

Hormonal responses in elders experiencing pre-syncopal symptoms during head-up tilt before and after exercise training.

BACKGROUND: Hormonal responses of elderly individuals experiencing pre-syncopal symptoms during head-up tilt testing (HUT) were compared with responses of nonsymptomatic subjects both before (T1) and after (T2) 6 months of endurance training. METHODS: Based on responses to HUT at T1, 35 men and women (ages 61-79 years) were placed into symptomatic and nonsymptomatic groups for analysis. Symptomatic subjects (n = 5) experienced lightheadedness, nausea, sweating, or syncope during T1 HUT but completed 15 minutes of HUT at T2. Training consisted of treadmill walking or stairclimbing 3 x/wk, 30-45 min/day, at 75-85% of maximal heart rate reserve. Adrenocorticotropic hormone (ACTH), vasopressin, aldosterone, norepinephrine, epinephrine, hemoglobin, and hematocrit were measured during supine rest prior to HUT, and either at the end of the 15-minute HUT or at symptom onset. Plasma volume (PV) was measured at supine rest; tilt-induced changes in PV were calculated from changes in hemoglobin and hematocrit. RESULTS: During T1 HUT, symptomatic subjects had greater increases in vasopressin and a greater rate of PV loss (p < .05). Increases in ACTH and aldosterone were greater in symptomatic subjects at T1 and T2, while increases in norepinephrine were greater at T2 (p < .05). Reductions in tilt-induced vasopressin concentration and a decreased rate of PV loss were seen at T2 in symptomatic subjects. CONCLUSIONS: T1 results from symptomatic subjects are consistent with greater stimulation of volume-sensitive receptors induced by a greater rate of fall in PV. Exercise training resulted in increased tilt tolerance for symptomatic subjects associated with reductions in vasopressin concentration and rate of PV loss during tilt.

Aged↗
PubMed2026

Bedtime tetrahydrocannabinol ingestion reduces morning orthostatic cardiovascular reactivity in adults: An exploratory study.

Acute cannabis use and its primary psychoactive constituent tetrahydrocannabinol (THC) can induce postural dizziness, indicating increased risk of orthostatic instability. However, it is unknown if vulnerabilities persist the morning after bedtime THC consumption. This study investigated the influence of bedtime THC consumption on cardiovascular variables during an orthostatic challenge. Nine individuals with no cannabis use and eight individuals who regularly use cannabis participated in a tilt table test associated with a 3-day in-laboratory stay. Participants underwent an acclimatization day, followed by a placebo dosing day, and a 10&#x2009;mg THC dosing day. Placebo and THC pills were given 1&#x2009;h before a participant's habitual bedtime, and the tilt table test was performed ~1&#x2009;h upon awakening. Participants were instrumented with an electrocardiogram and an automated sphygmomanometer. Fluid intake and output were measured throughout the study. The morning after THC administration, individuals with no cannabis use reported a higher frequency of dizziness and exhibited a significant reduction in both diastolic blood pressure and heart rate reactivity to tilt (reactivity&#x2009;=&#x2009;tilt - baseline) compared to the morning after placebo. Our results indicate a potential increased risk for orthostatic instability the morning after cannabis consumption in individuals with no cannabis use history.

Humans↗
PubMed1995

Comparison of heart rate and arterial pressure spectra during head up tilt and a matched level of LBNP.

Lower Body Negative Pressure (LBNP) can be used to stimulate cardiovascular regulation by inducing blood shifts similar to those produced during head up tilt (HUT). It is unclear, however, whether similar blood shifts produced by these two stresses evoke similar cardiovascular regulatory responses. Hence, we compared the autonomic components of cardiovascular responses to 50 degrees HUT and a matched level of LBNP. A level of LBNP that produced changes in calf circumference similar to those produced during the first 3 min of 50 degrees HUT was considered to be a matched level. Autonomic components of cardiovascular responses were determined by spectral analysis of heart rate and blood pressure. Results from nine subjects showed that in terms of changes in calf circumference at the end of 3 min, 50 degrees HUT and 48 mm Hg LBNP were similar (2.13% and 1.94%). During 20-min exposures to HUT and LBNP, the increase in heart rate during LBNP was greater (+7 bpm) than HUT, while blood pressure increases were similar. For heart rate and blood pressure spectra, power in the respiratory frequency region (0.25 Hz) decreased and power in the low frequency region (0.03 Hz) increased similarly during HUT and LBNP. These results indicated that 50 degrees HUT and a matched level of LBNP evoked similar autonomic responses in cardiovascular regulation, with the autonomic balance shifted toward increased sympathetic and decreased parasympathetic influence.

Adult↗
PubMed1995

[Physiopathology of vasovagal syncope: review of the most endorsed theories and recent findings].

Vasovagal syncope is associated with an abnormal reflex and the physiopathological mechanisms of the phenomenon overall are only partially known. Experimental and clinical studies suggest that the main factor which triggers the syncope is the brusque interruption of the alpha-adrenergic tone with marked, sudden peripheral vasodilation. Although documented, vagal hypertony, with consequent bradycardia and asystolia, is only occasional and is almost always a secondary phenomenon. The most commonly suggested cause of vasovagal syncope is a Bezold-Jarish reflex starting from the cardiac receptors in the walls of the ventricle, mediated by the paradoxical activation of afferent vagal fibres. However, recent studies are suggesting that there may be other pathogenetic mechanisms such as the paradoxical activation of the venous-atrial baroceptors and other "extracardiac" vascular receptors. The neuro-endocrine aspect of the vasovagal reaction is very complex and in spite of the many studies carried out on the catecholamine, renal-angiotensive system, arginine-vasopressin, and b-endorphine trends, there are still many points awaiting clarification. The response of the autonomous nervous system linked to age also require further research.

Age Factors↗
PubMed1994

[The significance of measuring blood flow in the common carotid artery by the Doppler method for detection of orthostatic disturbances of the cardiovascular system in children].

In 35 children of either sex, aged 11-15 years with orthostatic disturbances and in 35 children of the same age without these disturbances, the maximal blood flow rate was assessed in the common carotid artery using Doppler technique during 10-minute passive orthostatic test on a tilting table. During passive tilting to upright position, the mean values of the maximal blood flow rate in the children with orthostatic disturbances were lower than those in the healthy children. The measurement of the maximal blood flow rate in the common carotid artery by the Doppler method may be a useful clinical method of detection of functional cardiovascular disturbances connected with body position in children.

Adolescent↗
PubMed1995

Cardiovascular deconditioning occurs during a 7-day saturation dive at 31 ATA.

Cardiovascular deconditioning (CD) has been reported to occur within 24-48 h of exposure to 4, 11, or 31 ATA environment and following decompression to sea level pressure. The CD was indicated by orthostatic intolerance, exaggerated cardiovascular responses to a passive tilt, an elevated resting heart rate and a reduced stroke volume postdive. In this dive, one of the New Seatopia series, we used a non-syncope criterion, the cardiovascular index of deconditioning (CID; Bungo MW, Johnson PJ Jr. Aviat Space Environ Med 1983; 54:1001), to evaluate CD in 3 male subjects. The CID sums the changes in heart rate and blood pressure in response to orthostatic stress. An elevated CID indicates CD. We used a passive 70 degrees head up tilt as the orthostatic stress. The CID was measured before and after a bout of underwater exercise at predive, during the early, mid, and late exposure of the 7-d 31 ATA, and after the dive. The CID and circulatory responses to tilt were similar before and after the exercise. The CID increased (p < 0.05) from the predive value of 20 +/- 1.6 to 25 +/- 0.9 on the 2nd day, to 25 +/- 0.8 on the 4th day at 31 ATA, indicating the presence of CD at the early and mid periods of hyperbaric exposure. However, CID was indifferent (18 +/- 0.6) from the predive on the 7th day at 31 ATA. The increased CID corresponded to decreases in plasma volume during the early and mid periods of 31 ATA exposure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Orthostatic tolerance at different times of the day in physically average and very fit dayworkers.

We studied the relationship between the physical exercise capacity and the orthostatic tolerance of physically average fit and very fit dayworkers at different times of the day. Six male railroad workers were physically very fit and six were averagely fit (mean of the maximal oxygen consumption 57.4 and 34.6 ml.kg-1.min-1, respectively. The mean age was 32 years. The orthostatic tests were performed with a tilt-table at 2.00, 6.00, 10.00, 14.00, 18.00, and 22.00 hours on six different days. Orthostatic lability at night was seen in both groups. At 14.00 and 18.00 hours the orthostatic tolerance in average fit men was slightly lower than in very fit men. This difference in the orthostatic tolerance between the groups may be a sign of the interdependence of good exercise tolerance and orthostatic tolerance.

Adult↗
PubMed1976

Significance of daily rhythm for the interpretation of functional diagnostic procedures.

For the first time, the reaction of the cardiovascular system during day and night in young people was examined. We were mostly interested in the influence of the nervous system and any autonomic mechanism. We examined 20 subjects at 4-hour intervals on the ergometer (active exercise) and on the tilt-table (passive exercise) to find out the rhythm in the circulatory regulation. The test person was kept in vertical position on the tilt-table for 10 minutes. On the ergometer he had to perform a work-load of 100 Watt for 10 minutes. We measured pulse rate and blood pressure; we introduced new terms for the evaluation. "Orthostatic Index" and "Performance Index" will be further explained. The results were: A minimum in the orthostatic stability around 1 p.m. and 1--5 am, and a performance maximum at 1 p.m. and 5 p.m. Further details will be reported.

Blood Pressure↗
PubMed1990

Syncope: current diagnostic evaluation and management.

OBJECTIVE: To provide a comprehensive review of the causes, current diagnostic evaluation, and treatment of syncope. DATA IDENTIFICATION: New data and knowledge in this evolving field were critically analyzed by doing a MEDLINE search on syncope supplemented by selective review of English language literature citations in the Index Medicus before 1980. STUDY SELECTION: We reviewed approximately 200 published articles on syncope and closely related topics as well as using our own clinical experience. We selected articles if they addressed the pathophysiology of syncope, classification and causes, differential diagnosis, noninvasive and invasive evaluation, and current therapy. RESULTS OF DATA SYNTHESIS: Syncope is a common clinical problem, occurring in 30% to 50% of the adult population. The prognosis for syncope depends on its cause. Cardiac syncope has the worst prognosis and therefore mandates thorough evaluation and prompt treatment. Diagnostic evaluation is made difficult by the transient nature of the episodes and the many causes. Noninvasive testing reveals the cause of syncope in approximately 50% of cases. More extensive evaluation, including invasive electrophysiologic studies, has assumed a larger role in defining the cause of syncope in selected patients with structural heart disease in whom a noninvasive evaluation has been nondiagnostic. Recently tilt-table studies have been proposed as a clinically useful noninvasive test for vagally mediated syncope. CONCLUSIONS: A rational stepwise diagnostic and therapeutic approach to patients with syncope can be developed by initially doing a careful history and physical examination followed by a noninvasive evaluation and selective use of additional, more specialized or invasive tests. Future research should focus on defining the validity and utility of current diagnostic testing in syncope and on exploring further the pathophysiology of patients with recurrent, unexplained syncope.

Cardiovascular Diseases↗
PubMed1977

Case reports and studies of paraneoplastic hypotension: abnormal low pressure baroreceptor responses.

Intrathoracic stretch receptors regulate adjustments of the vasculature to gravitational changes and influence urinary water and solute excretion. Few reports of pathologic states involving interruption of these regulatory mechanisms have appeared. Two patients with orthostatic hypotenstion related to advanced intrathoracic carcinoma were studied, utilizing tilt-table examinations and immersion of the entire body in water to test the function of their intrathoracic baroreceptor reflex arcs. Both patients showed abnormalities of antidiuretic hormone level and sodium excretion as compared with normal controls. This suggests that total immersion is a safe and convenient test of the low-pressure baroreceptor system in patients with suspected dysfunction. Three patients are also reported whose charts were reviewed posthumously. Although they were not tested in the laboratory, their clinical data suggest that they too had been suffering from an interference with the transmission of impulses from the intrathoracic receptors.

Adult↗
PubMed1991

Transcranial Doppler evaluation of syncope: an application in aerospace physiology.

A non-invasive method which combines the simultaneous measurement of mean arterial blood pressure (MBP), heart rate (HR) and mean cerebral blood flow velocity (MFV) was used to monitor patients with history of syncope, in horizontal and vertical posture tilt at 80 degrees. MFV in the right middle cerebral artery was measured using a transcranial Doppler instrument (TCD). MFV decreased concurrently with the onset of symptoms, and at the time of syncope reached an average of 68% below pre-tilt values. At the same time MBP showed an average decline of 25%, and HR increased by 38%. There was no correlation between MBP and MFV, at the onset of tilt, presyncope and syncope. MFV, but not HR or MBP, showed significant transition from one condition to the other. These data suggest that there may be a useful application of TCD measurements of MFV in aeromedical evaluation of syncope or syncopal tendency. These measurements would necessarily be used in conjunction with a tilt-table procedure. The possibility exists that MFV might be useful to preclude the actual occurrence of syncope in test subjects, or to show an abnormal tendency toward syncope, but will require more extensive testing than that carried out in the present study.

Adult↗
PubMed1990

[Vestibular ataxia caused by meningeal carcinomatosis].

A 74-year-old man developed progressive deafness and unsteady gait two years after gastrectomy for a gastric cancer. Neurological examination revealed an alert and intelligent Japanese male in no acute distress. The optic fundi were normal. The pupils and the extraocular muscles were normal, however, horizontal nystagmus was noted in right and left gaze. He showed marked bilateral deafness, and loss of caloric response bilaterally. No muscle atrophy nor weakness was noted. His gait was wide-based and ataxic. Tandem gait was impossible. Romberg sign was present. No cerebellar ataxia was noted in the finger-to-nose or the heel-to-knee test. No adiadochokinesis was noted. Hyperextensibility was noted in the lower extremities. Deep reflexes were normal in the upper limbs, and diminished in the lower extremities. Sensation was intact. He showed the jumbling phenomenon, and the disturbance of the righting reflex in the tilt-table examination. Neuroradiological as well as laboratory studies were unremarkable except for the high titer of CEA in the CSF. Four months after his admission, malignant tumor cells were found in the CSF. It seemed likely that he had completely lost bilateral vestibular and auditory functions caused by meningeal carcinomatosis. His disturbance of gait and station was apparently similar to cerebellar ataxic gait, however, he did not have limb ataxia. The cranial CT scans failed to show cerebellar atrophy. It was our impression that his motor disturbance was in all likelihood caused by the bilateral loss of vestibular functions, i.e., vestibular ataxia.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1981

Evaluation of the effects of muscle stretch and weight load in patients with spastic paraplegia.

Clinical observations on patients with spastic paraplegia have indicated that a training regime including weight load on the lower limbs may reduce the muscular hypertonus. Due to the spontaneous fluctuations and great variability in muscle tone it is difficult to judge from clinical findings how the effects may be related to muscle stretch and weight load. Therefore, quantitative determination of the effects on muscle tone by stretch and loading was made in 9 paraplegic patients. Muscle tone was measured before and after 30 min of stretch or weight load in 8 sessions on 4 consecutive days. Stretch was obtained by bracing the foot in maximal dorsal flexion with patient in supine position. For weight load on the lower limbs, the patient stood on a tilt-table at an angle of 85 degrees with feet in 15 degrees dorsal or plantar flexion. Resistance to passive movements was determined during a series of sinusoidal ankle joint movements at three different speeds. After weight load in standing with the feet in dorsal or plantar flexion, the average reduction was 32 and 26%, respectively. After stretch in supine, the average reduction was 17%. Thus, the three procedures tested all resulted in reduction of muscle tone. The largest reductions were obtained by weight load with stretch imposed upon the calf muscles.

Adult↗