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Sample records for orthostatic hypotension arterial

  1. Orthostatic Hypotension (Postural Hypotension)

    Science.gov (United States)

    ... standing up. Endocrine problems. Thyroid conditions, adrenal insufficiency (Addison's disease) and low blood sugar (hypoglycemia) can cause orthostatic hypotension, as can diabetes — which can damage ...

  2. Effect of perturbations and a meal on superior mesenteric artery flow in patients with orthostatic hypotension

    Science.gov (United States)

    Fujimura, J.; Camilleri, M.; Low, P. A.; Novak, V.; Novak, P.; Opfer-Gehrking, T. L.

    1997-01-01

    Our aims were to evaluate to role of superior mesenteric blood flow in the pathophysiology of orthostatic hypotension in patients with generalized autonomic failure. METHODS: Twelve patients with symptomatic neurogenic orthostatic hypotension and 12 healthy controls underwent superior mesenteric artery flow measurements using Doppler ultrasonography during head-up tilt and tilt plus meal ingestion. Autonomic failure was assessed using standard tests of the function of the sympathetic adrenergic, cardiovagal and postganglionic sympathetic sudomotor function. RESULTS: Superior mesenteric flow volume and time-averaged velocity were similar in patients and controls at supine rest; however, responses to cold pressor test and upright tilt were attenuated (p stress can be significantly attenuated by reducing the splanchnic-mesenteric volume increase in response to food. Evaluation of mesenteric flow in response to eating and head-up tilt provide important information on intra-abdominal sympathetic adrenergic function, and the ability of the patient to cope with orthostatic stress.

  3. Hemodynamics in diabetic orthostatic hypotension

    DEFF Research Database (Denmark)

    Hilsted, J; Parving, H H; Christensen, N J

    1981-01-01

    Hemodynamic variables (blood pressure, cardiac output, heart rate, plasma volume, splanchnic blood flow, and peripheral subcutaneous blood flow) and plasma concentrations of norepinephrine, epinephrine, and renin were measured in the supine position and after 30 min of quiet standing. This was done...... in normal subjects (n = 7) and in juvenile-onset diabetic patients without neuropathy (n = 8), with slight neuropathy (decreased beat-to-beat variation in heart rate during hyperventilation) (n = 8), and with severe neuropathy including orthostatic hypotension (n = 7). Blood pressure decreased precipitously...

  4. Orthostatic hypotension: definition, diagnosis and management.

    Science.gov (United States)

    Kanjwal, Khalil; George, Anil; Figueredo, Vincent M; Grubb, Blair P

    2015-02-01

    Orthostatic hypotension commonly affects elderly patients and those suffering from diabetes mellitus and Parkinson's disease. It is a cause of significant morbidity in the affected patients. The goal of this review is to outline the pathophysiology, evaluation, and management of the patients suffering from orthostatic hypotension.

  5. Spontaneous Intracranial Hypotension without Orthostatic Headache

    Directory of Open Access Journals (Sweden)

    Tülay Kansu

    2009-03-01

    Full Text Available We report 2 cases of spontaneous intracranial hypotension that presented with unilateral abducens nerve palsy, without orthostatic headache. While sixth nerve palsies improved without any intervention, subdural hematoma was detected with magnetic resonance imaging. We conclude that headache may be absent in spontaneous intracranial hypotension and spontaneous improvement of sixth nerve palsy can occur, even after the development of a subdural hematoma

  6. Vertigo and nystagmus in orthostatic hypotension.

    Science.gov (United States)

    Choi, J-H; Seo, J-D; Kim, M-J; Choi, B-Y; Choi, Y R; Cho, B M; Kim, J S; Choi, K-D

    2015-04-01

    Generalized cerebral ischaemia from cardiovascular dysfunction usually leads to presyncopal dizziness, but several studies reported a higher frequency of rotatory vertigo in cardiovascular patients. Whether generalized cerebral ischaemia due to cardiovascular disorders may produce objective vestibular dysfunction was investigated. Thirty-three patients with orthostatic dizziness/vertigo due to profound orthostatic hypotension and 30 controls were recruited. All participants underwent recording of eye movements during two orthostatic challenging tests: the Schellong and the squatting-standing tests. Most patients had neuroimaging, and patients with abnormal eye movements were subjected to follow-up evaluations. Symptoms associated with orthostatic dizziness/vertigo included blurred vision, fainting and tinnitus. Ten (30%) of 33 patients developed rotatory vertigo and nystagmus during the Schellong (n = 5) or squatting-standing test (n = 5). Four of them showed pure downbeat nystagmus whilst five had downbeat and horizontal nystagmus with or without torsional component. Patients with orthostatic nystagmus had shorter duration of orthostatic intolerance than those without nystagmus (1.0 ± 1.6 vs. 11.0 ± 9.7 months, P vertigo due to objective vestibular dysfunction. The presence of orthostatic vertigo and nystagmus has an association with the duration of orthostatic intolerance. © 2014 EAN.

  7. Recent advances in orthostatic hypotension presenting orthostatic dizziness or vertigo.

    Science.gov (United States)

    Kim, Hyun-Ah; Yi, Hyon-Ah; Lee, Hyung

    2015-11-01

    Orthostatic hypotension (OH), a proxy for sympathetic adrenergic failure, is the most incapacitating sign of autonomic failure. Orthostatic dizziness (OD) is known to be the most common symptom of OH. However, recent studies have demonstrated that 30-39 % of patients with OH experienced rotatory vertigo during upright posture (i.e., orthostatic vertigo, OV), which challenges the dogma that OH induces dizziness and not vertigo. A recent population-based study on spontaneously occurring OD across a wide age range showed that the one-year and lifetime prevalence of OD was 10.9 and 12.5 %, respectively. Approximately 83 % of patients with OD had at least one abnormal autonomic function test result. So far, 11 subtypes of OD have been proposed according to the pattern of autonomic dysfunction, and generalized autonomic failure of sympathetic adrenergic and parasympathetic cardiovagal functions was the most common type. Four different patterns of OH, such as classic, delayed, early, and transient type have been found in patients with OD. The head-up tilt test and Valsalva maneuver should be performed for a comprehensive evaluation of sympathetic adrenergic failure in patients with OD/OV. This review summarizes current advances in OH presenting OD/OV, with a particular focus on the autonomic dysfunction associated with OD.

  8. Bed Rest and Orthostatic-Hypotensive Intolerance

    Science.gov (United States)

    Schneider, Suzanne M.

    2000-01-01

    Orthostatic tolerance may be defined as the ability of humans to maintain cerebral perfusion and consciousness upon movement from a supine or sitting position to the upright posture; for example, subjects can stand suddenly or be tilted to the head-up body position. Similar but not identical physiological responses can be induced by positive G(sub Z) (head to foot) acceleration or exposure to lower body negative pressure (LBNP). The objective is to suddenly shift blood to the lower body to determine how effectively cardiovascular and neural-hormonal compensatory responses react to maintain blood pressure. In the most precise method for measuring tolerance, individuals would be stressed until they faint (syncope). However, the potential consequences and discomforts of such a test usually prohibit such a procedure so that few investigators actually induce syncope. In a more common approach, subjects are exposed to a given level of stress, for example, head-up tilt for 15 min, and any increases in heart rate or decreases in blood pressure are interpreted as indicators of progress toward syncope. Presumably, the greater the perturbation of heart rate and blood pressure, the closer to "tolerance," i.e., point of unconsciousness. Another more appropriate approach is to induce a progressively increasing hypotensive stress until pre-determined physiological responses or pre-syncopal symptoms appear. The physiological criteria may include a sudden drop in systolic blood pressure (greater than 25 mm/min), a sudden drop in heart rate (greater than 15 beats/min), or a systolic blood pressure less than 70 mmHg. The most common pre-syncopal symptoms include lightheadedness, stomach awareness or distress, feelings of warmth, tingly skin, and light to profuse sweating. Usually a combination of physiological responses and symptoms occurs such that, on different days, the tolerance time to the same orthostatic protocol is reproducible for a given individual. The assumption is that

  9. The clinical relevance of orthostatic hypotension in elderly patients

    NARCIS (Netherlands)

    Hartog, Laura; Kleefstra, Nanne; Luigies, Rene; de Rooij, Sophia; Bilo, Henk; van Hateren, Kornelis

    2017-01-01

    Aim: Orthostatic hypotension (OH) is highly prevalent in old age. The impact of OH on orthostatic complaints and falling is questionable. We wondered if the consensus definition of OH plays an essential role in the accuracy and direction of the prediction of these endpoints. We aimed to explore the

  10. The clinical relevance of orthostatic hypotension in elderly patients

    NARCIS (Netherlands)

    Hartog, Laura; Kleefstra, Nanne; Luigies, Rene; de Rooij, Sophia; Bilo, Henk; van Hateren, Kornelis

    2017-01-01

    AimOrthostatic hypotension (OH) is highly prevalent in old age. The impact of OH on orthostatic complaints and falling is questionable. We wondered if the consensus definition of OH plays an essential role in the accuracy and direction of the prediction of these endpoints. We aimed to explore the

  11. Venlafaxine-Induced Orthostatic Hypotension in a Geriatric Patient

    Directory of Open Access Journals (Sweden)

    Vidyashree Chikkaramanjegowda

    2013-01-01

    Full Text Available Venlafaxine is not usually associated with risk of orthostatic hypotension. A 65-year-old US Caucasian female taking 225 mg/day of venlafaxine extended-release developed symptomatic orthostatic hypotension. The systolic and diastolic blood pressure dropped by 25 and 18 mm Hg, respectively, from supine position to standing position within 3 minutes. The patient was otherwise healthy and the orthostatic hypotension resolved with venlafaxine discontinuation. This was a probable venlafaxine adverse drug reaction according to the Naranjo scale. This case contributes to the scarce literature that indicates that clinicians need to be aware that occasionally venlafaxine can induce clinically significant orthostatic hypotension, particularly in geriatric patients. Our patient did not have orthostatic hypotension when she was taking venlafaxine at 60 years of age in higher venlafaxine doses (300 mg/day but developed this adverse drug reaction when venlafaxine was restarted at the geriatric age. This case indicates that a history of prior tolerance to venlafaxine does not guarantee tolerance after 65 years of age. If a clinician decides to use venlafaxine in geriatric patients, the clinician should warn the patient about the risk of orthostatic hypotension and consider very slow titration and low doses.

  12. Initial orthostatic hypotension: review of a forgotten condition

    NARCIS (Netherlands)

    Wieling, Wouter; Krediet, C. T. Paul; van Dijk, Nynke; Linzer, Mark; Tschakovsky, Michael E.

    2007-01-01

    Several studies have shown that standing up is a frequent (3-10 %) trigger of loss of consciousness both in young and old subjects. An exaggerated transient BP (blood pressure) fall upon standing is the underlying cause. IOH (initial orthostatic hypotension) is defined as a transient BP decrease

  13. Effect of strength training on orthostatic hypotension in older adults.

    Science.gov (United States)

    Brilla, L R; Stephens, A B; Knutzen, K M; Caine, D

    1998-01-01

    This preliminary study attempted to identify the frequency of orthostatic hypotension (OH) in community dwelling older adults who volunteered to participate in an 8-week, heavy-resistance, strength-training program. It also assessed the effect of the strength-training program on OH. From a larger study (n = 53) on high-resistance strength training in older adults (mean age 71.4 +/- 6.6 years), a subset of subjects (n = 24), mean age 71.0 +/- 5.8 years, was evaluated who met at least one criterion for OH. All subjects were tested for resting blood pressures (BP) and heart rates (HR) in the supine, sitting, and standing positions. Also noted was their response to orthostatism in rising from a cot after 10 minutes and rising from a chair after 5 minutes. The subset was not different from the overall group in gender ratio, age, or effect of medication on BP. The treatment was an 8-week strength-training program at 80% of their one repetition maximum. Significant changes (P response to the orthostatic challenge, significant (P positive adaptation to an orthostatic challenge.

  14. Prevalence of orthostatic hypotension among diabetic patients in a community hospital of Peshawar

    International Nuclear Information System (INIS)

    Rahman, S.U.; Ahmad, R.; Aamir, A.H.

    2010-01-01

    background: The postural drop in blood pressure caused by autonomic neuropathy in diabetes mellitus is regarded as a risk factor for cardiovascular disease. The objectives of this study were to assess the prevalence of orthostatic hypotension and its relation with hypertension in patients with diabetes mellitus admitted in a tertiary care hospital. Methods: Two hundred indoor diabetic patients were assessed. Lying and standing blood pressure of each patient was determined using standard procedure for determination of orthostatic hypotension. Patients having orthostatic hypotension were compared with those having no orthostatic hypotension for different clinical and biochemical parameters using statistical program for social sciences. Results: Twenty-six percent of the patients were found to have orthostatic hypotension. Fifty two percent of the total patients showed hypertension. Proportion of hypertension in the patients having orthostatic hypotension was more than those without orthostatic hypotension while other parameters showed no difference. Conclusion: Orthostatic hypotension is a common phenomenon in our diabetic patients admitted to tertiary care facilities. Diabetic hypertensive patients are more likely to have postural drop in blood pressure as compared to diabetic normotensive patients. (author)

  15. The relationship between orthostatic hypotension and falling in older adults.

    Science.gov (United States)

    Shaw, Brett H; Claydon, Victoria E

    2014-02-01

    Falls are devastating events and are the largest contributor towards injury-related hospitalization of older adults. Orthostatic hypotension (OH) represents an intrinsic risk factor for falls in older adults. OH refers to a significant decrease in blood pressure upon assuming an upright posture. Declines in blood pressure can reduce cerebral perfusion; this can impair consciousness, lead to dizziness, and increase the likelihood of a fall. Although theoretical mechanisms linking OH and falls exist, the magnitude of the association remains poorly characterized, possibly because of methodological differences between previous studies. The use of non-invasive beat-to-beat blood pressure monitoring has altered the way in which OH is now defined, and represents a substantial improvement for detecting OH that was previously unavailable in many studies. Additionally, there is a lack of consistency and standardization of orthostatic assessments and analysis techniques for interpreting blood pressure data. This review explores the previous literature examining the relationship between OH and falls. We highlight the impact of broadening the timing, degree, and overall duration of blood pressure measurements on the detection of OH. We discuss the types of orthostatic stress assessments currently used to evaluate OH and the various techniques capable of measuring these often transient blood pressure changes. Overall, we identify future solutions that may better clarify the relationship between OH and falling risk in order to gain a more precise understanding of potential mechanisms for falls in older adults.

  16. Camphor-Crataegus berry extract combination dose-dependently reduces tilt induced fall in blood pressure in orthostatic hypotension.

    Science.gov (United States)

    Belz, G G; Butzer, R; Gaus, W; Loew, D

    2002-10-01

    In order to test the efficacy of a combination of natural D-camphor and an extract of fresh crataegus berries (Korodin Herz-Kreislauf-Tropfen) on orthostatic hypotension, two similar, controlled, randomized studies were carried out in a balanced crossover design in 24 patients each with orthostatic dysregulation. The camphor-crataegus berry combination (CCC) was orally administered as a single regimen in 3 different dosages of 5 drops, 20 drops and 80 drops; a placebo with 20 drops of a 60% alcoholic solution served as control. Orthostatic hypotension was assessed with the tilt table test before and after medication. Source data of both studies were pooled and meta-analytically evaluated for all 48 patients. CCC drops decreased the orthostatic fall in blood pressure versus placebo, as almost uniformly established at all times by mean arterial pressure and diastolic blood pressure. Mean arterial pressure demonstrated the very fast onset of action by a clearly dose-dependent statistically significant effect even after 1-minute orthostasis. Increase of mean arterial pressure as compared to the orthostasis test before medication was on average 4.5 mmHg. CCC affected diastolic blood pressure after 1 minute of orthostasis in all dosages as compared to placebo. A statistically significant effect of the highest dose of 80 drops on diastolic blood pressure could be demonstrated after 1-, 3-, and 5-minute orthostasis. The hemodynamic findings of a stabilizing effect on arterial pressure in orthostasis corroborate the long-term medical experience with CCC and justify the indication orthostatic hypotension.

  17. Orthostatic hypotension and overall mortality in 1050 older patients of the outpatient comprehensive geriatric assessment unit.

    Science.gov (United States)

    Freud, Tamar; Punchik, Boris; Kagan, Ella; Barzak, Alex; Press, Yan

    2018-03-02

    Orthostatic hypotension is a common problem in individuals aged ≥65 years. Its association with mortality is not clear. The aim of the present study was to evaluate associations between orthostatic hypotension and overall mortality in a sample of individuals aged ≥65 years who were seen at the Outpatient Comprehensive Geriatric Assessment Unit, Clalit Health Services, Beer-Sheva, Israel. Individuals who were evaluated in the Outpatient Comprehensive Geriatric Assessment Unit between January 2005 and December 2015, and who had data on orthostatic hypotension were included in the study. The database included sociodemographic characteristics, body mass index, functional and cognitive state, geriatric syndromes reached over the course of the assessment, and comorbidity. Data on mortality were also collected. The study sample included 1050 people, of whom 626 underwent comprehensive geriatric assessment and 424 underwent geriatric consultation. The mean age was 77.3 ± 5.4 years and 35.7% were men. Orthostatic hypotension was diagnosed in 294 patients (28.0%). In univariate analysis, orthostatic hypotension was associated with overall mortality only in patients aged 65-75 years (HR 1.5, 95% CI 1.07-2.2), but in the multivariate model this association disappeared. In older frail patients, orthostatic hypotension was not an independent risk factor for overall mortality. Geriatr Gerontol Int 2018; ••: ••-••. © 2018 Japan Geriatrics Society.

  18. Public and patient research priorities for orthostatic hypotension.

    Science.gov (United States)

    Frith, James; Bashir, Ayat S; Elliott, Chris S; Newton, Julia L

    2014-11-01

    With a rapidly expanding older population and increased survival of older people with chronic disease, we can expect to see increasing numbers of people with orthostatic hypotension (OH). Unfortunately the evidence base for people with OH, with particular relevance to older people, has not kept up and has resulted in a real lack of progress and little good evidence. There are several areas of research that could potentially benefit patients but establishing which ones are priority areas requires public and patient involvement (PPI). This process includes people/patients in the research team to maximise the relevance, success and translation of the research. This brief report describes the early involvement of older people in prioritising the research question, methods to improve adherence during a trial and the preferred methods to disseminate research output. The individuals' priority was to research non-pharmacological treatment strategies and to improve the education of patients about their condition. Education was felt to be the best strategy to promote adherence during a trial, with change in symptoms and quality of life felt to be the most important outcome measures as opposed to blood pressure. This report offers guidance for academics that are undertaking OH-related research and how they can improve its relevance and increase its translation into clinical practice. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  19. Effect of pre-operative methylprednisolone on orthostatic hypotension during early mobilization after total hip arthroplasty

    DEFF Research Database (Denmark)

    Lindberg-Larsen, V; Petersen, P B; Jans, Ø

    2018-01-01

    a standardized mobilization protocol pre-operatively, 6, and 24 h after surgery. Systolic and diastolic arterial pressure and heart rate were measured non-invasively (Nexfin® ). The systemic inflammation was monitored by the C-reactive protein (CRP) response. RESULTS: At 6 h post-operatively, 11 (38%) versus 11......BACKGROUND: Orthostatic hypotension (OH) and intolerance (OI) are common after total hip arthroplasty (THA) and may delay early mobilization. The pathology of OH and OI includes a dysregulated post-operative vasopressor response, by a hitherto unknown mechanism. We hypothesized that OI could...... be related to the inflammatory stress response which is inhibited by steroid administration. Consequently, this study evaluated the effect of a pre-operative high-dose methylprednisolone on OH and OI early after THA. METHODS: Randomized, double-blind, placebo-controlled study in 59 patients undergoing...

  20. Orthostatic Hypotension in Middle-Age and Risk of Falls.

    Science.gov (United States)

    Juraschek, Stephen P; Daya, Natalie; Appel, Lawrence J; Miller, Edgar R; Windham, Beverly Gwen; Pompeii, Lisa; Griswold, Michael E; Kucharska-Newton, Anna; Selvin, Elizabeth

    2017-02-01

    One-third of older adults fall each year. Orthostatic hypotension (OH) has been hypothesized as an important risk factor for falls, but findings from prior studies have been inconsistent. We conducted a prospective study of the association between baseline OH (1987-1989) and risk of falls in the Atherosclerosis Risk in Communities (ARIC) Study. Falls were ascertained during follow-up via ICD-9 hospital discharge codes or Centers for Medicare & Medicaid Services claims data. OH was defined as a drop in systolic blood pressure (SBP) ≥20mm Hg or diastolic blood pressure (DBP) ≥10mm Hg within 2 minutes of moving from the supine to standing position. Changes in SBP or DBP during OH assessments were also examined as continuous variables. During a median follow-up of 23 years, there were 2,384 falls among 12,661 participants (mean age 54 years, 55% women, 26% black). OH was associated with risk of falls even after adjustment for demographic characteristics and other risk factors (hazard ratio (HR): 1.30; 95% confidence interval (CI): 1.10, 1.54; P = 0.002). Postural change in DBP was more significantly associated with risk of falls (HR 1.09 per -5mm Hg change in DBP; 95% CI: 1.05, 1.13; P postural change in SBP (HR 1.03 per -5mm Hg change in SBP; 95% CI: 1.01, 1.05; P = 0.002). In a community-based, middle-aged population, OH, and in particular, postural change in DBP, were independent risk factors for falls over 2 decades of follow-up. Future studies are needed to examine OH thresholds associated with increased risk of falls. © American Journal of Hypertension, Ltd 2016. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  1. Orthostatic Hypotension and Mortality in Elderly Frail Patients

    Science.gov (United States)

    Freud, Tamar; Punchik, Boris; Yan, Press

    2015-01-01

    Abstract Orthostatic hypotension (OH) is a common problem in the elderly age group, and some studies have reported an association between OH and increased mortality. We evaluated possible associations between OH and mortality in a retrospective study of frail elderly patients who came for a comprehensive geriatric assessment. The study included all patients ≥65 years who were assessed in the outpatient Comprehensive Geriatric Assessment Unit. Data were collected from the computerized medical record, including blood pressure, sociodemographic data, lifestyle, falls, pulse rate, body mass index, functional and cognitive status, and comorbidity. Data on mortlaity were also collected. The study population consisted of 571 patients who underwent assessment over a 9-year study period. The mean age was 83.7 ± 6.1, 35.9% were males, and 183 (32.1%) were diagnosed with OH. Systolic OH (OHS) was more common than diastolic OH (25.2% vs 15.6%). In univariate analyses, OHS was associated with increased overall mortality. Over the follow-up period, 30.2% of the OHS patients died compared with 22.3% (P = 0.037), but in the Cox models there was no statistically significant associations between OHS and overall mortality. In contrast, age, burden of comorbidity, a low high-density lipoprotein level, and low creatinine clearance were independent predictors of increased overall mortality. In a population of frail elderly patients with a high burden of comorbidity, OH was not an independent risk factor for overall mortality. PMID:26091470

  2. Cerebral perfusion in orthostatic hypotensive patients with and without symptoms

    International Nuclear Information System (INIS)

    Balan, K.; Parry-Jones, D.; Puliyel, M.M.; Set, P.; Solanki, C.; Campbell, G.A.

    2002-01-01

    Aim: Patients with orthostatic hypotension (OH) may be symptomatic or asymptomatic. This study was undertaken to determine whether postural response in cerebral perfusion plays any significant role in causing symptoms of OH. Materials and methods: 5 symptomatic OH patients and 5 asymptomatic OH patients were studied using 99mTc-HMPAO. Two dynamic studies were acquired within an interval of two days, with the patient injected either supine or erect. The brain perfusion index (BPI) was derived from Patlak-Rutland analysis of the aortic arch and the cerebral hemispheres. SPECT images were used to determine regional counts over frontal, temporal, occipital, cerebellar and basal ganglia regions. Paired t-test was used to compare the difference in the ratios between erect and supine studies and unpaired t-test for comparison between the two groups. Results: There was significant improvement in BPI in asymptomatic patients on assuming supine position (10.1±1.9 vs. 11.9±3.2), but not in the symptomatic group (12.9±4.5 vs. 13.1±2.8). No significant difference was noted between the two groups. In the SPECT studies, two areas of difference between the asymptomatic and symptomatic groups were identified: L temporal (0.038±0.018 vs. -0.004±0.025) and L basal ganglia (-0.02±0.043 vs. 0.044±0.035). However, these mean differences were comparable to those of other subsets. Paired t-tests between the erect and supine ratios identified: R frontal in the asymptomatic group (0.884±0.067 vs. 0.918±0.078), L basal ganglia in the symptomatic group (0.946±0.093 vs. 0.990±0.102). Again, these differences were small and only slightly greater than those found in other subsets. Conclusions: 1. Posture-related alterations in global or regional cerebral perfusion do not appear to play a causative role in symptoms of OH and 2. Future studies including larger number of patients may be required for further evaluation

  3. Use of lower abdominal compression to combat orthostatic hypotension in patients with autonomic dysfunction

    NARCIS (Netherlands)

    Smit, Adrianus A. J.; Wieling, Wouter; Fujimura, Jiro; Denq, Jong C.; Opfer-Gehrking, Tonette L.; Akarriou, Mohammed; Karemaker, John M.; Low, Phillip A.

    2004-01-01

    The aim of this study was to investigate in patients with neurogenic orthostatic hypotension the mechanism and usefulness of abdominal compression to increase standing blood pressure. in three protocols, 23 patients underwent abdominal compression. Protocol 1 evaluated in a 40-60degrees head-up-tilt

  4. Orthostatic hypotension, diabetes, and falling in older patients : a cross-sectional study

    NARCIS (Netherlands)

    van Hateren, Kornelis J. J.; Kleefstra, Nanne; Blanker, Marco H.; Ubink-Veltmaat, Lielith J.; Groenier, Klaas H.; Houweling, Sebastiaan; Kemper, Adriaan M.; van der Meer, Klaas; Bilo, Henk J. G.

    2012-01-01

    Background: Although orthostatic hypotension (OH) is more prevalent in old age, and in patients with diabetes, the prevalence of OH in older patients with type 2 diabetes mellitus is unknown. Aim: To establish the prevalence of OH, and its association with falling, in home-dwelling older

  5. Atomoxetine for Orthostatic Hypotension in an Elderly Patient Over 10 Weeks: A Case Report.

    Science.gov (United States)

    Hale, Genevieve M; Brenner, Michael

    2015-09-01

    Several nonpharmacologic strategies for orthostatic hypotension exist including avoiding large carbohydrate-rich meals; limiting alcohol consumption; maintaining adequate hydration; adding salt to foods; and using compression stockings, tilt-table exercises, or abdominal binders. If these fail, however, only limited evidence-based pharmacologic treatment options are available including the use of fludrocortisone, midodrine, pyridostigmine, and droxidopa as well as pseudoephedrine, ocetreotide, and atomoxetine. This report discusses a case of atomoxetine use for 10 weeks in an elderly patient with primary orthostatic hypotension. An 84-year-old man with long-standing primary orthostatic hypotension presented to our ambulatory cardiology pharmacotherapy clinic after several unsuccessful pharmacologic therapies including fludrocortisone, midodrine, and pyridostigmine. Nonpharmacologic strategies were also implemented. Atomoxetine was initiated, and the patient showed gradual improvements in symptoms and blood pressure control over the course of 10 weeks. Our data suggest that low-dose atomoxetine is an effective and safe agent for symptom improvement and blood pressure control in elderly patients with primary orthostatic hypotension. © 2015 Pharmacotherapy Publications, Inc.

  6. Effect of discontinuation of antihypertensive medication on orthostatic hypotension in older persons with mild cognitive impairment: the DANTE Study Leiden.

    Science.gov (United States)

    Moonen, Justine E F; Foster-Dingley, Jessica C; de Ruijter, Wouter; van der Grond, Jeroen; de Craen, Anton J M; van der Mast, Roos C

    2016-03-01

    the relationship between antihypertensive medication and orthostatic hypotension in older persons remains ambiguous, due to conflicting observational evidence and lack of data of clinical trials. to assess the effect of discontinuation of antihypertensive medication on orthostatic hypotension in older persons with mild cognitive impairment. a total of 162 participants with orthostatic hypotension were selected from the Discontinuation of Antihypertensive Treatment in Elderly people (DANTE) Study. This randomised clinical trial included community-dwelling participants aged ≥75 years, with mild cognitive impairment, using antihypertensive medication and without serious cardiovascular disease. Participants were randomised to discontinuation or continuation of antihypertensive treatment (ratio 1:1). Orthostatic hypotension was defined as a drop of at least 20 mmHg in systolic blood pressure and/or 10 mmHg in diastolic blood pressure on standing from a seated position. Outcome was the absence of orthostatic hypotension at 4-month follow-up. Relative risks (RR) were calculated by intention-to-treat and per-protocol analyses. at follow-up, according to intention-to-treat analyses, of the 86 persons assigned to discontinuation of antihypertensive medication, 43 (50%) were free from orthostatic hypotension, compared with 29 (38%) of the 76 persons assigned to continuation of medication [RR 1.31 (95% confidence interval (CI) 0.92-1.87); P = 0.13]. Per-protocol analysis showed that recovery from orthostatic hypotension was significantly higher in persons who completely discontinued all antihypertensive medication (61%) compared with the continuation group (38%) [RR 1.60 (95% CI 1.10-2.31); P = 0.01]. in older persons with mild cognitive impairment and orthostatic hypotension receiving antihypertensive medication, discontinuation of antihypertensive medication may increase the probability of recovery from orthostatic hypotension. © The Author 2016. Published by Oxford

  7. Efficacy of atomoxetine versus midodrine for the treatment of orthostatic hypotension in autonomic failure.

    Science.gov (United States)

    Ramirez, Claudia E; Okamoto, Luis E; Arnold, Amy C; Gamboa, Alfredo; Diedrich, André; Choi, Leena; Raj, Satish R; Robertson, David; Biaggioni, Italo; Shibao, Cyndya A

    2014-12-01

    The clinical presentation of autonomic failure is orthostatic hypotension. Severely affected patients require pharmacological treatment to prevent presyncopal symptoms or frank syncope. We previously reported in a proof of concept study that pediatric doses of the norepinephrine transporter blockade, atomoxetine, increases blood pressure in autonomic failure patients with residual sympathetic activity compared with placebo. Given that the sympathetic nervous system is maximally activated in the upright position, we hypothesized that atomoxetine would be superior to midodrine, a direct vasoconstrictor, in improving upright blood pressure and orthostatic hypotension-related symptoms. To test this hypothesis, we compared the effect of acute atomoxetine versus midodrine on upright systolic blood pressure and orthostatic symptom scores in 65 patients with severe autonomic failure. There were no differences in seated systolic blood pressure (means difference=0.3 mm Hg; 95% confidence [CI], -7.3 to 7.9; P=0.94). In contrast, atomoxetine produced a greater pressor response in upright systolic blood pressure (means difference=7.5 mm Hg; 95% CI, 0.6 to 15; P=0.03) compared with midodrine. Furthermore, atomoxetine (means difference=0.4; 95% CI, 0.1 to 0.8; P=0.02), but not midodrine (means difference=0.5; 95% CI, -0.1 to 1.0; P=0.08), improved orthostatic hypotension-related symptoms as compared with placebo. The results of our study suggest that atomoxetine could be a superior therapeutic option than midodrine for the treatment of orthostatic hypotension in autonomic failure. © 2014 American Heart Association, Inc.

  8. Does training-induced orthostatic hypotension result from reduced carotid baroreflex responsiveness?

    Science.gov (United States)

    Pawelczyk, James A.; Raven, Peter B.

    1994-01-01

    As manned space travel has steadily increased in duration and sophistication, the answer to a simple, relevant question remains elusive. Does endurance exercise training - high intensity rhythmic activity, performed regularly for extended periods of time - alter the disposition to, or severity of, postflight orthostatic hypotension? Research results continue to provide different views; however, data are difficult to compare because of the following factors that vary between investigations: the type of orthostatic stress imposed (+Gz, lower body negative pressure (LBNP), head-up tilt); pretest perturbations used (exercise, heat exposure, head-down tilting, bed rest, water immersion, hypohydration, pharmacologically-induced diuresis); the length of the training program used in longitudinal investigations (days versus weeks versus months); the criteria used to define fitness; and the criteria used to define orthostatic tolerance. Generally, research results indicate that individuals engaged in aerobic exercise activities for a period of years have been reported to have reduced orthostatic tolerance compared to untrained control subjects, while the results of shorter term longitudinal studies remain equivocal. Such conclusions suggest that chronic athletic training programs reduce orthostatic tolerance, whereas relatively brief (days to weeks) training programs do not affect orthostatic tolerance to any significant degree (increase or decrease). A primary objective was established to identify the alterations in blood pressure control that contribute to training-induced orthostatic hypotension (TIOH). Although any aspect of blood pressure regulation is suspect, current research has been focused on the baroreceptor system. Reductions in carotid baroreflex responsiveness have been documented in exercise-trained rabbits, reportedly due to an inhibitory influence from cardiac afferent, presumably vagal, nerve fibers that is abolished with intrapericardiac denervation. The

  9. Prediction of orthostatic hypotension in multiple system atrophy and Parkinson disease

    Science.gov (United States)

    Sun, Zhanfang; Jia, Dandan; Shi, Yuting; Hou, Xuan; Yang, Xiaosu; Guo, Jifeng; Li, Nan; Wang, Junling; Sun, Qiying; Zhang, Hainan; Lei, Lifang; Shen, Lu; Yan, Xinxiang; Xia, Kun; Jiang, Hong; Tang, Beisha

    2016-01-01

    Orthostatic hypotension (OH) is common in multiple system atrophy (MSA) and Parkinson disease (PD), generally assessed through a lying-to-standing orthostatic test. However, standing blood pressure may not be available due to orthostatic intolerance or immobilization for such patients. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were successively measured in supine, sitting, and standing positions in patients with MSA and PD. Receiver operating characteristic analysis was used to evaluate diagnostic performance of the drops of sitting SBP or DBP. OH and severe OH were respectively regarded as “gold standard”. The drops of SBP in standing position were associated with increased disease severity for MSA and correlated with age for PD. In MSA group, drops in sitting SBP ≥ 14 mmHg or DBP ≥ 6 mmHg had highest validity for prediction of OH, and drops in sitting SBP ≥ 18 mmHg or DBP ≥ 8 mmHg for severe OH. In PD group, drops in sitting SBP ≥ 10 mmHg or DBP ≥ 6 mmHg had highest validity for prediction of OH. The lying-to-sitting orthostatic test is an alternative method for detection of OH in MSA and PD, especially when standing BP could not be validly measured due to various reasons. PMID:26867507

  10. The use of antigravity suits in the treatment of idiopathic orthostatic hypotension

    Science.gov (United States)

    Landmark, K.; Kravik, S.

    1980-01-01

    Idiopathic orthostatic hypotension is an uncommon disease characterized by a drop in blood pressure when going from a recumbent to a standing position. Treatment by medication generally produces poor results. Three patients at the Royal Hospital in Oslo were treated with antigravity suits and all were able to maintain adequate blood pressures in the standing position. One patient improved dramatically and was able to take short walks while wearing the suit. The two other patients, however, felt that wearing the suits eventually became uncomfortable. This treatment represents a useful treatment alternative for intractable cases.

  11. Orthostatic hypotension and cognitive function: cross-sectional results from the ELSA-Brasil study.

    Science.gov (United States)

    Suemoto, Claudia K; Baena, Cristina P; Mill, Jose G; Santos, Itamar S; Lotufo, Paulo A; Benseñor, Isabela

    2018-03-20

    The association between orthostatic hypotension (OH) and cognitive impairment is controversial, and most studies have investigated older white adults from Western Europe and the United States. Therefore, we investigated the association between OH and cognitive performance in a large and racially diverse sample of adults using cross-sectional data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). OH was defined when systolic blood pressures (SBP) decreased 20 mmHg and/or diastolic blood pressure (DBP) decreased 10 mmHg from supine to standing position. We investigated the association between OH and composite global cognition, memory, verbal fluency (VF), and Trail Making test z-scores, using multiple linear regression models. We also investigated the association of orthostatic hypertension and SBP/DBP changes with cognitive performance, as well as the interaction between OH and compensatory heart rate (HR) after postural change on cognitive performance. We evaluated 12,826 participants (mean age=51.5±9.0 years, 46% male, 53% white). Participants with OH (4% of the sample) had poorer z-scores for VF (β=-0.108, 95% CI=-0.189; -0.025, p=0.01) than participants without OH. Orthostatic hypertension was also associated with worse performance on the VF test (β=-0.080, 95% CI=-0.157; -0.003, p=0.04). SBP orthostatic change had a non-linear association with VF. The interaction terms between OH and compensatory increase in HR for the Trail Making Test z-score (p=0.09) was borderline significant, suggesting that participants who lack compensatory HR after postural change might have poorer performance. OH and orthostatic hypertension were associated with poorer performance on the VF test in participants from Brazil.

  12. Diminished Dynamic Physical Performance Is Associated With Orthostatic Hypotension in Geriatric Outpatients.

    Science.gov (United States)

    de Bruïne, Eline S; Reijnierse, Esmee M; Trappenburg, Marijke C; Pasma, Jantsje H; de Vries, Oscar J; Meskers, Carel G M; Maier, Andrea B

    2018-03-23

    Orthostatic hypotension (OH), a blood pressure drop after postural change, is a highly prevalent and disabling syndrome in older adults. Yet, the association between physical performance and OH is not clearly established. The aim of this study was to determine whether different types of physical performance are associated with OH in a clinically relevant population of geriatric outpatients. This cross-sectional study included 280 geriatric outpatients (mean age: 82.2 years, standard deviation: 7.1). Orthostatic hypotension was determined using intermittently measured blood pressure and continuously measured blood pressure in a random subgroup of 58 patients. Physical performance was classified into a dynamic type (4-m Walk Test, Chair Stand Test, and Timed Up and Go test) and a static type (standing balance tests, handgrip strength). Associations were analyzed using logistic regression models with adjustments for age, sex, weight, and height. Diminished physical performance on the Chair Stand Test was associated with OH measured intermittently. Diminished physical performance on all dynamic physical domains (4-m Walk Test, Chair Stand Test, and Timed Up and Go test) was associated with OH measured continuously. Static physical performance was not significantly associated with OH. Dynamic physical performance tests with a substantial postural change and center of mass displacement were significantly associated with OH. The influence of physical performance on OH in daily routine activities should be further explored to establish counteracting interventions.

  13. Orthostatic Hypotension in Drug-Naïve Patients with Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    Hyo-Jin Bae

    2011-05-01

    Full Text Available Background and Purpose Orthostatic hypotension (OH is known to be present even in patients with early Parkinson’s disease (PD. To affirm the presence of OH and find correlation between OH and other dysautonomic symptoms in PD, this study has done in newly-diagnosed PD patients. Methods Forty-five non-demented patients with no prior history of treatment for PD were recruited (17 men, 63.8 ± 10.1 years of age. All the patients were evaluated for OH before starting medications. Autonomic symptoms were evaluated with structured questionnaires. Clinical characteristics of PD were evaluated (median Hoehn and Yahr stage 2.0 (1–3, 1.3 ± 1.1 years of disease duration, and comorbid medical conditions that could affect blood pressure were also recorded. Results OH was prevalent, and eighteen patients (40% showed orthostatic hypotension, and twenty-seven (60% did not (normotensive group. There was no significant difference in demographic and clinical characteristics between groups. The presence or severity of symptoms of autonomic dysfunction in the OH group also not differed from those of the normotensive group. Conclusions OH was prevalent even in the early stage of PD, and was not related to presence or severity of any other symptoms of autonomic dysfunction. Our findings suggest that clinicians should pay attention to OH from the early stage of disease.

  14. Temazepam, but not zolpidem, causes orthostatic hypotension in astronauts after spaceflight

    Science.gov (United States)

    Shi, Shang-Jin; Garcia, Kathleen M.; Meck, Janice V.

    2003-01-01

    Insomnia is a common symptom, not only in the adult population but also in many astronauts. Hypnotics, such as temazepam (a benzodiazepine) and zolpidem (an imidazopyridine), are often taken to relieve insomnia. Temazepam has been shown clinically to have hemodynamic side effects, particularly in the elderly; however, the mechanism is not clear. Zolpidem does not cause hemodynamic side effects. The purpose of this study was to determine whether the use of different hypnotics during spaceflight might contribute significantly to the high incidence of postflight orthostatic hypotension, and to compare the findings in astronauts with clinical research. Astronauts were separated into three groups: control (n = 40), temazepam (15 or 30 mg; n = 9), and zolpidem (5 or 10 mg; n = 8). In this study, temazepam and zolpidem were only taken the night before landing. The systolic and diastolic blood pressures and heart rates of the astronauts were measured during stand tests before spaceflight and on landing day. On landing day, systolic pressure decreased significantly and heart rate increased significantly in the temazepam group, but not in the control group or in the zolpidem group. Temazepam may aggravate orthostatic hypotension after spaceflight when astronauts are hemodynamically compromised. Temazepam should not be the initial choice as a sleeping aid for astronauts. These results in astronauts may help to explain the hemodynamic side effects in the elderly who are also compromised. Zolpidem may be a better choice as a sleeping aid in these populations.

  15. Recurrent syncope, orthostatic hypotension and volatile hypertension: think outside the box

    Directory of Open Access Journals (Sweden)

    Thein Aung

    2013-07-01

    Full Text Available The baroreceptors in the neck and aortic arch are important regulators of sudden blood pressure changes. They are innervated by CN IX and X and synapse in the brainstem. Baroreceptor failure is an under-recognized cause of recurrent syncope, orthostatic hypotension, and volatile hypertension, which is refractory to and may in fact worsen with conventional treatments. Baroreflex failure can be the result of neck and chest radiation, head and neck surgery, and cerebrovascular accidents involving the brainstem nuclei. The management of baroreflex failure is a challenge since patient education, lifestyle changes, and family support are extremely important in managing blood pressure. Leg exercises and Thrombo-Embolic Deterrent Stockings (TED stockings are important in treating orthostatic hypotension. Clonidine is the antihypertensive of choice for supine hypertension. Low-dose benzodiazepines are helpful in suppressing sympathetic surges. We have encountered two patients with baroreflex failure after chemotherapy and radiation to the neck or upper chest. Temporal relationship between symptoms onset and the history of head, neck, and upper chest radiation or trauma is important in reaching a diagnosis.

  16. Recurrent syncope, orthostatic hypotension and volatile hypertension: think outside the box.

    Science.gov (United States)

    Aung, Thein; Fan, Wuqiang; Krishnamurthy, Mahesh

    2013-01-01

    The baroreceptors in the neck and aortic arch are important regulators of sudden blood pressure changes. They are innervated by CN IX and X and synapse in the brainstem. Baroreceptor failure is an under-recognized cause of recurrent syncope, orthostatic hypotension, and volatile hypertension, which is refractory to and may in fact worsen with conventional treatments. Baroreflex failure can be the result of neck and chest radiation, head and neck surgery, and cerebrovascular accidents involving the brainstem nuclei. The management of baroreflex failure is a challenge since patient education, lifestyle changes, and family support are extremely important in managing blood pressure. Leg exercises and Thrombo-Embolic Deterrent Stockings (TED) stockings are important in treating orthostatic hypotension. Clonidine is the antihypertensive of choice for supine hypertension. Low-dose benzodiazepines are helpful in suppressing sympathetic surges. We have encountered two patients with baroreflex failure after chemotherapy and radiation to the neck or upper chest. Temporal relationship between symptoms onset and the history of head, neck, and upper chest radiation or trauma is important in reaching a diagnosis.

  17. A randomized trial of Korodin Herz-Kreislauf-Tropfen as add-on treatment in older patients with orthostatic hypotension.

    Science.gov (United States)

    Kroll, M; Ring, C; Gaus, W; Hempel, B

    2005-06-01

    In a randomized, double-blind, placebo-controlled, parallel group, phase III clinical trial efficacy and safety of Korodin, a combination of natural D-camphor and an extract from fresh crataegus berries, was investigated in patients 50 years and older with orthostatic hypotension. At visit 1 eligibility of patients was checked and a placebo medication was given to all patients. At visit 2 orthostatic hypotension had to be reconfirmed, then the patient was randomized either to Korodin or placebo, study medication (25 drops) was applied once and then outcome was measured. After 7 days of home treatment with daily 3 x 25 drops outcome was measured at visit 3. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were documented 10, 5, 2 and 0 min before as well as 1, 3, 5, 8, and 10 min after getting in the upright position at visit 1, at visit 2 before and after application of study medication and at visit 3. Primary outcome was the change of mean arterial blood pressure (MAP) from just before standing up to the nadir within the first 3 min after standing up. Secondary outcome variables were SBP, DBP, HR, quality of life (SF-12) and seven typical signs and symptoms of orthostatic hypotension. The study was performed in a rehabilitation clinic and in two doctor's practices in Germany from November 2002 to May 2003. During this time, 57 patients were admitted to the study, 39 patients were eligible and randomized, 38 patients were treated according to protocol and evaluated, 21 patients with Korodin and 17 patients with placebo. After a single application the median decrease of MAP was 11.4 mmHg for Korodin and 14.0 mmHg for placebo. Compared to baseline, the median MAP improved 4.3 mmHg for Korodin and 0.3 mmHg for placebo. After 1 week of treatment the decrease of median MAP after standing up was 9.3 mmHg for Korodin and 13.3 mmHg for placebo. Compared to baseline, the improvement was 5.9 mmHg for Korodin and 1.6 mmHg for placebo. Efficacy

  18. Orthostatic Hypotension

    Science.gov (United States)

    ... bed rest. The disorder may be associated with Addison's disease, diabetes, and certain neurological disorders including Multiple System ... bed rest. The disorder may be associated with Addison's disease, diabetes, and certain neurological disorders including Multiple System ...

  19. Pharmacological options in the management of orthostatic hypotension in older adults.

    LENUS (Irish Health Repository)

    Kearney, Fiona

    2009-11-01

    Orthostatic hypotension (OH) is a common disorder in older adults with potentially serious clinical consequences. Understanding the key underlying pathophysiological processes that predispose individuals to OH is essential when making treatment decisions for this group of patients. In this article, we discuss the key antihypotensive agents used in the management of OH in older adults. Commonly, midodrine is used as a first-line agent, given its supportive data in randomized, controlled trials. Fludrocortisone has been evaluated in open-label trials and has long-established usage in clinical practice. Other agents are available and in clinical use, either alone or in combination, but larger randomized trial evaluations are yet to be published. It is important to bear in mind that a patient may be taking medications that predispose to or exacerbate the symptoms of OH. Withdrawal of such medications, where possible, should be considered before commencing other pharmacological agents that attenuate the symptoms of OH.

  20. TIA, stroke and orthostatic hypotension: a disease spectrum related to ageing vasculature?

    Science.gov (United States)

    Kwok, C S; Ong, A C L; Potter, J F; Metcalf, A K; Myint, P K

    2014-06-01

    We sought to identify the determinants of orthostatic hypotension (OH) among patients referred to the transient ischaemic attack (TIA) clinic. We conducted a retrospective analysis of prospectively collected data on patients who attended the TIA clinic in a UK hospital between January 2006 and September 2009. Each patient had their supine and standing or sitting blood pressure measured. Logistic regression was used to estimate the univariate and multivariate odds of OH for the subgroups of patients based on their diagnosis. A 10% significance level for the univariate analysis was used to identify variables in the multivariate model. A total of 3222 patients were studied of whom 1131 had a TIA, 665 a stroke and 1426 had other diagnoses. The prevalence of either systolic or diastolic OH in the TIA, stroke and patients with other diagnoses was similar being 22% (n = 251), 24% (n = 162) and 20% (n = 292), respectively. Multivariate analyses showed age, prior history of TIA, and diabetes were independently significantly associated with systolic OH alone or diastolic OH alone or either systolic or diastolic OH [ORs 1.03 (1.02-1.05); 1.56 (1.05-2.31); 1.65 (1.10-2.47), respectively]. Among the patients with the diagnosis of stroke, peripheral vascular disease (PVD) was significantly associated with increased odds of OH (3.56, 1.53-8.31), whereas male gender had a significantly lower odds of OH (0.61, 0.42-0.88). In patients with other diagnoses, age (1.04, 1.02-1.05) and diabetes (1.47, 1.04-2.09) were associated with OH, whereas male gender was (0.76, 0.58-1.00) not associated with OH. Orthostatic hypotension is prevalent among patients presenting to TIA clinic. Previous history of vascular disease (prior TIA/stroke/PVD) appears to be a significant associate of OH in this patient population. © 2014 John Wiley & Sons Ltd.

  1. Initial circulatory response to active standing in Parkinson's disease without typical orthostatic hypotension

    Directory of Open Access Journals (Sweden)

    Guillermo Delgado

    2014-03-01

    Full Text Available While the circulatory response to orthostatic stress has been already evaluated in Parkinson's disease patients without typical orthostatic hypotension (PD-TOH, there is an initial response to the upright position which is uniquely associated with active standing (AS. We sought to assess this response and to compare it to that seen in young healthy controls (YHC. Method In 10 PD-TOH patients (8 males, 60±7 years, Hoehn and Yahr ≤3 the changes in systolic blood pressure (SBP and heart rate that occur in the first 30 seconds (sec of standing were examined. Both parameters were non-invasively and continuously monitored using the volume-clamp method by Peñáz and the Physiocal criteria by Wesseling. The choice of sample points was prompted by the results of previous studies. These sample points were compared to those of 10 YHC (8 males, 32±8 years. Results The main finding of the present investigation was an increased time between the AS onset and SBP overshoot in PD-TOH group (24±4 vs. 19±3 sec; p<0.05. Conclusion This delay might reflect a prolonged latency in the baroreflex-mediated vascular resistance response, but more studies are needed to confirm this preliminary hypothesis.

  2. Relationship between orthostatic hypotension and white matter hyperintensity load in older patients with mild dementia.

    Directory of Open Access Journals (Sweden)

    Hogne Soennesyn

    Full Text Available BACKGROUND/OBJECTIVES: White matter hyperintensities (WMH in magnetic resonance imaging (MRI scans of the brain, and orthostatic hypotension (OH are both common in older people. We tested the hypothesis that OH is associated with WMH. DESIGN: Cross-sectional study. SETTING: Secondary care outpatient clinics in geriatric medicine and old age psychiatry in western Norway. PARTICIPANTS: 160 older patients with mild dementia, diagnosed according to standardised criteria. MEASUREMENTS: OH was diagnosed according to the consensus definition, measuring blood pressure (BP in the supine position and within 3 minutes in the standing position. MRI scans were performed according to a common protocol at three centres, and the volumes of WMH were quantified using an automated method (n=82, followed by manual editing. WMH were also quantified using the visual Scheltens scale (n=139. Multiple logistic regression analyses were applied, with highest vs. lowest WMH quartile as response. RESULTS: There were no significant correlations between WMH volumes and systolic or diastolic orthostatic BP drops, and no significant correlations between Scheltens scores of WMH and systolic or diastolic BP drops. In the multivariate analyses, only APOEε4 status remained a significant predictor for WMH using the automated method (p=0.037, OR 0.075 (0.007-0.851, whereas only age remained a significant predictor for WMH scores (p=0.019, OR 1.119 (1.018-1.230. CONCLUSION: We found no association between OH and WMH load in a sample of older patients with mild dementia.

  3. Depressive Symptoms and Orthostatic Hypotension Are Risk Factors for Unexplained Falls in Community-Living Older People.

    Science.gov (United States)

    Menant, Jasmine C; Wong, Alfred K W; Trollor, Julian N; Close, Jacqueline C T; Lord, Stephen R

    2016-05-01

    To investigate risk factors for unexplained falls in older community-dwelling individuals. Prospective cohort study. Community population, Sydney, Australia. Older adults (N = 529; mean age 79.8 ± 4.4, 52.2% female). Participants provided information demographic, medical, and medication characteristics and completed cardiovascular (tilt table test, pulse wave velocity), cognitive, and sensorimotor assessments at baseline. Falls were then recorded in monthly fall diaries for 12 months. Unexplained fallers (UFs) were those who reported falls due to a blackout, dizziness, feeling faint, or "found themselves suddenly on the ground." Of the 523 participants available at follow-up, 238 (45.5%) reported one or more falls; 35 participants fulfilled the definition of UFs. UFs were more likely than balance-related fallers (BFs) (n = 203) and nonfallers (n = 291) to have orthostatic hypotension (39.4%, 20.5% and 22.4%, respectively) and depressive symptoms (24.2%, 10.1%, and 7.9% respectively). More UFs (88.6%) than BFs (70.9%) had injurious falls. A multivariate logistic regression model revealed that depressive symptoms and orthostatic hypotension were significant and independent determinants of UF status. Approximately 15% of fallers had unexplained falls, which were more likely to result in injuries. Depressive symptoms and orthostatic hypotension increased the risk of unexplained falls, whereas cognitive deficits and sensorimotor and balance impairments did not. Future research should investigate whether psychotherapy and physical exercise to improve mood and medication reviews and nonpharmacological therapies for the treatment of orthostatic hypotension and depression are effective at reducing the risk of unexplained falls in older people. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  4. Spacelab Life Sciences flight experiments: an integrated approach to the study of cardiovascular deconditioning and orthostatic hypotension

    Science.gov (United States)

    Gaffney, F. A.

    1987-01-01

    The microgravity environment of spaceflight produces rapid cardiovascular changes which are adaptive and appropriate in that setting, but are associated with significant deconditioning and orthostatic hypotension on return to Earth's gravity. The rapidity with which these space flight induced changes appear and disappear provides an ideal model for studying the underlying pathophysiological mechanisms of deconditioning and orthostatic hypotension, regardless of etiology. Since significant deconditioning is seen after flights of very short duration, muscle atrophy due to inactivity plays, at most, a small role. These changes in circulatory control associated with cephalad fluid shifts, rather than inactivity per se, are probably more important factors. In order to test this hypothesis in a systematic way, a multidisciplinary approach which defines and integrates inputs and responses from a wide variety of circulatory sub-systems is required. The cardiovascular experiments selected for Spacelab Life Sciences flights 1 and 2 provide such an approach. Both human and animal models will be utilized. Pre- and post-flight characterization of the payload crew includes determination of maximal exercise capacity (bicycle ergometry), orthostatic tolerance (lower body negative pressure), alpha and beta adrenergic sensitivity (isoproterenol and phenylephrine infusions), baroreflex sensitivity (ECG-gated, stepwise changes in carotid artery transmural pressure with a pneumatic neck collar), and responses to a 24 h period of 5 deg head-down tilt. Measurements of cardiac output (CO2 and C2H2 rebreathing), cardiac chamber dimensions (phased-array 2-dimensional echocardiography), direct central venous pressure, leg volume (Thornton sock), limb blood flow and venous compliance (occlusion plethysmography), blood and plasma volumes, renal plasma flow and glomerular filtration rates, and various hormonal levels including catecholamines and atrial natriuretic factor will also be obtained

  5. Robotic tilt table reduces the occurrence of orthostatic hypotension over time in vegetative states.

    Science.gov (United States)

    Taveggia, Giovanni; Ragusa, Ivana; Trani, Vincenzo; Cuva, Daniele; Angeretti, Cristina; Fontanella, Marco; Panciani, Pier Paolo; Borboni, Alberto

    2015-06-01

    The aim of this study is to evaluate the effects of verticalization with or without combined movement of the lower limbs in patients in a vegetative state or a minimally conscious state. In particular, we aimed to study whether, in the group with combined movement, there was better tolerance to verticalization. This was a randomized trial conducted in a neurorehabilitation hospital. Twelve patients with vegetative state and minimally conscious state 3-18 months after acute acquired brain injuries were included. Patients were randomized into A and B treatment groups. Study group A underwent verticalization with a tilt table at 65° and movimentation of the lower limbs with a robotic system for 30 min three times a week for 24 sessions. Control group B underwent the same rehabilitation treatment, with a robotic verticalization system, but an inactive lower-limb movement system. Systolic and diastolic blood pressure and heart rate were determined. Robotic movement of the lower limbs can reduce the occurrence of orthostatic hypotension in hemodynamically unstable patients. Despite the small number of patients involved (only eight patients completed the trial), our results indicate that blood pressures and heart rate can be stabilized better (with) by treatment with passive leg movements in hemodynamically unstable patients.

  6. Orthostatic hypotension during postoperative continuous thoracic epidural bupivacaine-morphine in patients undergoing abdominal surgery

    DEFF Research Database (Denmark)

    Crawford, M E; Møiniche, S; Orbæk, Janne

    1996-01-01

    Fifty patients undergoing colonic surgery received combined thoracic epidural and general anesthesia followed by continuous epidural bupivacaine 0.25% and morphine 0.05 mg/mL, 4 mL/h, for 96 h postoperatively plus oral tenoxicam 20 mg daily. Heart rate (HR) and arterial blood pressure (BP) were...... hypotension. The results suggest that patients undergoing abdominal surgery and treated with continuous small-dose thoracic epidural bupivacaine-morphine are subjected to a decrease of BP at rest and during mobilization, but not to an extent that seriously impairs ambulation in most patients....

  7. Sitting and standing blood pressure measurements are not accurate for the diagnosis of orthostatic hypotension.

    LENUS (Irish Health Repository)

    Cooke, J

    2012-01-31

    INTRODUCTION: Orthostatic hypotension (OH) is associated with troublesome symptoms and increased mortality. It is treatable and deserving of accurate diagnosis. This can be time consuming. The current reference standard for its diagnosis is head-up tilt (HUT) testing with continuous beat-to-beat plethysmography. Our objective was to assess the accuracy of sit-stand testing with semi-automatic sphygmomanometry for the diagnosis of OH. DESIGN: Retrospective test of diagnostic accuracy. METHODS: This was a retrospective study performed using a database maintained by a busy syncope unit. HUT testing was performed using an automated tilt table with Finometer monitoring. A 3 min 70 degrees HUT was performed following 5 min supine. Sitting blood pressure (BP) was measured following 3 min rest. Standing BP was measured within 30 s of assuming the upright posture. The results of sit-stand testing were compared with HUT testing as a reference standard. Both tests happened within 5 min of each other and patients underwent no intervention between tests. RESULTS: From a total of 1452 consecutive HUTs, we identified 730 with pre-test measures of sitting and standing BP. The mean age of this group was 70.57 years (SD = 15.1), 62% were female. The sensitivity of sit-stand testing was calculated as 15.5%, specificity as 89.9%, positive predictive value as 61.7%, negative predictive value as 50.2% and the likelihood ratio as 1.6. The area under the Receiver Operator Curve was 0.564. CONCLUSION: We have demonstrated that sit-stand testing for OH has very low diagnostic accuracy. We recommend that the more time-consuming reference standard method of diagnosis be used if the condition is suspected.

  8. Plasma biomarkers of decreased vesicular storage distinguish Parkinson disease with orthostatic hypotension from the parkinsonian form of multiple system atrophy.

    Science.gov (United States)

    Goldstein, David S; Kopin, Irwin J; Sharabi, Yehonatan; Holmes, Courtney

    2015-02-01

    Parkinson disease with orthostatic hypotension (PD + OH) and the parkinsonian form of multiple system atrophy (MSA-P) can be difficult to distinguish clinically. Recent studies indicate that PD entails a vesicular storage defect in catecholaminergic neurons. Although cardiac sympathetic neuroimaging by (18)F-dopamine positron emission tomography can identify decreased vesicular storage, this testing is not generally available. We assessed whether plasma biomarkers of a vesicular storage defect can separate PD + OH from MSA-P. We conceptualized that after F-dopamine injection, augmented production of F-dihydroxyphenylacetic acid (F-DOPAC) indicates decreased vesicular storage, and we therefore predicted that arterial plasma F-DOPAC would be elevated in PD + OH but not in MSA-P. We measured arterial plasma F-DOPAC after (18)F-dopamine administration (infused i.v. over 3 min) in patients with PD + OH (N = 12) or MSA-P (N = 21) and in healthy control subjects (N = 26). Peak F-DOPAC:dihydroxyphenylglycol (DHPG) was also calculated to adjust for effects of denervation on F-DOPAC production. Plasma F-DOPAC accumulated rapidly after initiation of (18)F-dopamine infusion. Peak F-DOPAC (5-10 min) in PD + OH averaged three times that in MSA-P (P 300 nCi-kg/cc-mCi, in contrast with 7 of 12 PD + OH patients (χ(2) = 16.6, P < 0.0001). DHPG was lower in PD + OH (3.83 ± 0.36 nmol/L) than in MSA-P (5.20 ± 0.29 nmol/L, P = 0.007). All MSA-P patients had peak F-DOPAC:DHPG < 60, in contrast with 9 of 12 PD + OH patients (χ(2) = 17.5, P < 0.0001). Adjustment of peak F-DOPAC for DHPG increased test sensitivity from 58 to 81% at similar high specificity. After F-dopamine injection, plasma F-DOPAC and F-DOPAC:DHPG distinguish PD + OH from MSA-P.

  9. Atrial myxoma presenting with orthostatic hypotension in an 84-year-old Hispanic man: a case report

    Directory of Open Access Journals (Sweden)

    Halstead Michael

    2009-12-01

    Full Text Available Abstract Introduction Left atrial myxomas remain the most common benign primary cardiac tumors, and these cardiac growths can masquerade as mitral stenosis, infective endocarditis and collagen vascular disease. Atrial myxomas are found in approximately 14-20% of the population and can lead to embolization, intercardiac obstructions, conduction disturbances and lethal valve obstructions. Case presentation An 84-year-old Hispanic man presented with complaints of dizziness upon standing, and with no prior history of heart murmurs, syncope, shortness of breath, or chest pain. Physical examination revealed evidence of orthostatic hypotension and a soft grade 1/6 systolic murmur at the left sternal border. A transthoracic echocardiogram revealed a large atrial myxoma occupying the majority of the left atrium, with the posterior border of the large atrial mass defined by eccentric mitral regurgitation identified during cardiac catheterization. Left atrial myxoma excision was performed, revealing a 7 × 6.5 × 4.5 cm atrial tumor attached to a 4 × 3 × 2 cm stalk of atrial septal tissue. Conclusion This patient didn't present with the common symptoms associated with an atrial myxoma, which may include chest pain, dyspnea, orthopnea, peripheral embolism or syncope. Two-dimensional echocardiography provides substantial advantages in detecting intracardiac tumors. We recommend a two-dimensional echocardiogram in the workup of orthostatic hypotension of unknown etiology after the common causes such as autonomic disorders, dehydration, and vasodilative dysfunctions have been ruled out. By illustrating this correlation between orthostasis and an atrial myxoma, we hope to facilitate earlier identification of these intracardiac growths.

  10. Which is preferable for orthostatic hypotension diagnosis in older adults: active standing test or head-up tilt table test?

    Science.gov (United States)

    Aydin, Ali Ekrem; Soysal, Pinar; Isik, Ahmet Turan

    2017-01-01

    Correct evaluation of orthostatic hypotension (OH) is crucial in geriatric practice, since OH is associated with mortality and morbidity. The study aimed to determine the most appropriate method for measuring blood pressure in transition from supine to upright position in order to diagnose OH in older adults. Active standing test (AST) and head-up tilt table (HUT) test as well as comprehensive geriatric assessment (CGA), including mini-mental state examination or the cognitive state test, mini-nutritional assessment, basic and instrumental activities of daily living, and Tinetti performance-oriented mobility assessment indexes, were performed in 290 geriatric patients. The prevalence of OH during HUT and AST was 19% and 37%, respectively. In patients with OH during HUT, the frequency of dementia and recurrent falls were higher ( P 0.05). Comparison of the groups according to CGA measurements revealed significant differences in terms of cognition, nutritional status, activities of daily life, and balance function in patients with OH only during HUT ( P 0.05). The sensitivity, specificity, positive predictive value, and negative predictive values of AST were 49.0%, 65.5%, 25.0%, and 84.6% respectively, according to HUT. The results suggest that orthostatic blood pressure changes determined by HUT might be of higher clinical significance than that by AST in older adults. It might be important that the evaluation of OH by HUT should be included in daily geriatric practice.

  11. The association between orthostatic hypotension and cognitive state among adults 65 years and older who underwent a comprehensive geriatric assessment

    Science.gov (United States)

    Punchick, Boris; Freud, Tamar; Press, Yan

    2016-01-01

    Abstract The prevalence of cognitive impairment and orthostatic hypotension (OH) increases with age, but the results of studies that assessed possible associations between them are inconsistent. The aim of this study is to assess possible associations between cognitive impairment and OH in patients ≥65 years of age who underwent a comprehensive geriatric assessment. A retrospective analysis was conducted of the computerized medical records of the study population from 2005 to 2013. Data collected included blood pressure measurements that enabled the calculation of OH, results of the mini-mental state examination (MMSE), results of the Montreal cognitive assessment (MoCA) test, and cognitive diagnoses that were determined over the course of the assessment. The rate of OH in the study population of 571 adults was 32.1%. The mean MMSE score was 22.5 ± 5.2 among participants with OH and 21.6 ± 5.8 among those without OH (P = 0.09). The absence of a significant association between OH and MMSE remained after adjusting the MMSE score for age and education level. The mean MoCA score was 16.4 ± 5.0 among participants with OH and 16.4 ± 4.8 among those without (P = 0.33). The prevalence of OH was 39% among participants without cognitive impairment, 28.9% among those with mild cognitive impairment (MCI), and 30.6% among those with dementia (P = 0.13). There was no association between OH and cognitive impairment in adults who underwent a comprehensive geriatric assessment. PMID:27442658

  12. Genome-Wide Association Study of Orthostatic Hypotension and Supine-Standing Blood Pressure Changes in Two Korean Populations

    Directory of Open Access Journals (Sweden)

    Kyung-Won Hong

    2013-09-01

    Full Text Available Orthostatic hypotension (OH is defined by a 20-mm Hg difference of systolic blood pressure (dtSBP and/or a 10-mm Hg difference of diastolic blood pressure (dtDBP between supine and standing, and OH is associated with a failure of the cardiovascular reflex to maintain blood pressure on standing from a supine position. To understand the underlying genetic factors for OH traits (OH, dtSBP, and dtDBP, genome-wide association studies (GWASs using 333,651 single nucleotide polymorphisms (SNPs were conducted separately for two population-based cohorts, Ansung (n = 3,173 and Ansan (n = 3,255. We identified 8 SNPs (5 SNPs for dtSBP and 3 SNPs for dtDBP that were repeatedly associated in both the Ansung and Ansan cohorts and had p-values of <1 × 10-5 in the meta-analysis. Unfortunately, the SNPs of the OH case control GWAS did not pass our p-value criteria. Four of 8 SNPs were located in the intergenic region of chromosome 2, and the nearest gene (CTNNA2 was located at 1 Mb of distance. CTNNA2 is a linker between cadherin adhesion receptors and the actin cytoskeleton and is essential for stabilizing dendritic spines in rodent hippocampal neurons. Although there is no report about the function in blood pressure regulation, hippocampal neurons interact primarily with the autonomic nervous system and might be related to OH. The remaining SNPs, rs7098785 of dtSBP trait and rs6892553, rs16887217, and rs4959677 of dtDBP trait were located in the PIK3AP1 intron, ACTBL2-3' flanking, STAR intron, and intergenic region, respectively, but there was no clear functional link to blood pressure regulation.

  13. Therapeutic use of compression stockings for orthostatic hypotension: an assessment of patient and physician perspectives and practices.

    Science.gov (United States)

    Quinn, Colin; Deegan, Brian; Cooke, John; Carew, Sheila; Hannigan, Ailish; Dunne, Colum; Lyons, Declan

    2015-03-01

    Elastic compression stockings (ECS) can be used as a non-pharmacological therapeutic option for older patients with orthostatic hypotension (OH). We aimed to investigate the practices and views of patients and physicians regarding the use of ECS for OH. Two surveys were designed. The first was sent to 90 patients known to have been prescribed ECS for OH. This questionnaire included items related to the frequency of use and issues related to non-compliance. The second was sent to 69 consultant physicians in geriatric medicine. This included items related to prescribing practices and perceived patient compliance. Sixty-seven patients responded (response rate, 74%) and of those 64% were female. Mean age (SD) was 75.1 years (10.5), range 45-91 years. Thirty-three per cent wore ECS daily, whereas 43% never used them. Over half (51%) of the patients reported difficulty in application and 31% reported discomfort. Those aged 75 or older were more likely to report difficulty in application (P=0.003). Forty-eight physicians responded (response rate, 70%). Eighty-nine per cent prescribe ECS for OH. There were significant differences between the frequency of use reported by patients and predicted by physicians (P<0.001), with physicians less likely to predict daily or non-use. Eighty-nine per cent of physicians predicted that difficulty in application was the main reason for non-compliance. Although prescribed frequently, the use of ECS in patients with OH is often limited by issues related to practicality. Physicians correctly predicted the main reasons for non-compliance although underestimated the scale of patient compliance with ECS. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  14. Insights into the clinical management of the syndrome of supine hypertension--orthostatic hypotension (SH-OH): the Irish Longitudinal Study on Ageing (TILDA).

    Science.gov (United States)

    Romero-Ortuno, Roman; O'Connell, Matthew D L; Finucane, Ciaran; Soraghan, Christopher; Fan, Chie Wei; Kenny, Rose Anne

    2013-07-15

    Our previously proposed morphological classification of orthostatic hypotension (MOH) is an approach to the definition of three typical orthostatic hemodynamic patterns using non-invasive beat-to-beat monitoring. In particular, the MOH pattern of large drop/non-recovery (MOH-3) resembles the syndrome of supine hypertension-orthostatic hypotension (SH-OH), which is a treatment challenge for clinicians. The aim of this study was to characterise MOH-3 in the first wave of The Irish Longitudinal Study of Ageing (TILDA), with particular attention to concurrent symptoms of orthostatic intolerance (OI), prescribed medications and association with history of faints and blackouts. The study included all TILDA wave 1 participants who had a Finometer® active stand. Automatic data signal checks were carried out to ensure that active stand data were of sufficient quality. Characterisation variables included demographics, cardiovascular and neurological medications (WHO-ATC), and self-reported information on comorbidities and disability. Multivariable statistics consisted of logistic regression models. Of the 4,467 cases, 1,456 (33%) were assigned to MOH-1 (small drop, overshoot), 2,230 (50%) to MOH-2 (medium drop, slower but full recovery), and 781 (18%) to MOH-3 (large drop, non-recovery). In the logistic regression model to predict MOH-3, statistically significant factors included being on antidepressants (OR = 1.99, 95% CI: 1.50 - 2.64, P hypertensive patients with cardiovascular medications that were not associated with adverse outcomes in our study. Therefore, the evidence of benefit does not necessarily have to conflict with the evidence of potential harm.

  15. Oral Midodrine Hydrochloride for Prevention of Orthostatic Hypotension during Early Mobilization after Hip Arthroplasty

    DEFF Research Database (Denmark)

    Jans, Øivind; Mehlsen, Jesper; Kjærsgaard-Andersen, Per

    2015-01-01

    or older and scheduled for total hip arthroplasty under spinal anesthesia to either 5 mg midodrine hydrochloride or placebo orally 1 h before mobilization at 6 and 24 h postoperatively. The primary outcome was the prevalence of OH (decrease in systolic or diastolic arterial pressures of > 20 or 10 mm.......36 to 1.10; P = 0.095), whereas OI was present in 15 (25.0%; 15 to 38%) versus 22 (37.3%; 25 to 51%) patients, relative risk 0.68 (0.39 to 1.18; P = 0.165). At 24 h, OI and OH prevalence did not differ between groups. CONCLUSIONS: Preemptive use of oral 5 mg midodrine did not significantly reduce...

  16. Treatment of Post-SCI Hypotension

    Science.gov (United States)

    2018-02-15

    Spinal Cord Injury; Autonomic Dysreflexia; Orthostatic Hypotension; Baroreceptor Integrity; Sympathetic Integrity; Vagal Integrity; Hypotension; Cerebral Blood Flow; Blood Pressure; Venous Occlusion Plethysmography

  17. Effects of patient-controlled abdominal compression on standing systolic blood pressure in adults with orthostatic hypotension.

    Science.gov (United States)

    Figueroa, Juan J; Singer, Wolfgang; Sandroni, Paola; Sletten, David M; Gehrking, Tonette L; Gehrking, Jade A; Low, Phillip; Basford, Jeffrey R

    2015-03-01

    To assess the effects of patient-controlled abdominal compression on postural changes in systolic blood pressure (SBP) associated with orthostatic hypotension (OH). Secondary variables included subject assessments of their preferences and the ease-of-use. Randomized crossover trial. Clinical research laboratory. Adults with neurogenic OH (N=13). Four maneuvers were performed: moving from supine to standing without abdominal compression; moving from supine to standing with either a conventional or an adjustable abdominal binder in place; application of subject-determined maximal tolerable abdominal compression while standing; and while still erect, subsequent reduction of abdominal compression to a level the subject believed would be tolerable for a prolonged period. The primary outcome variable included postural changes in SBP. Secondary outcome variables included subject assessments of their preferences and ease of use. Baseline median SBP in the supine position was not affected by mild (10mmHg) abdominal compression prior to rising (without abdominal compression: 146mmHg; interquartile range, 124-164mmHg; with the conventional binder: 145mmHg; interquartile range, 129-167mmHg; with the adjustable binder: 153mmHg, interquartile range, 129-160mmHg; P=.85). Standing without a binder was associated with an -57mmHg (interquartile range, -40 to -76mmHg) SBP decrease. Levels of compression of 10mmHg applied prior to rising with the conventional and adjustable binders blunted these drops to -50mmHg (interquartile range, -33 to -70mmHg; P=.03) and -46mmHg (interquartile range, -34 to -75mmHg; P=.01), respectively. Increasing compression to subject-selected maximal tolerance while standing did not provide additional benefit and was associated with drops of -53mmHg (interquartile range, -26 to -71mmHg; P=.64) and -59mmHg (interquartile range, -49 to -76mmHg; P=.52) for the conventional and adjustable binders, respectively. Subsequent reduction of compression to more

  18. Spontaneous intracranial hypotension.

    LENUS (Irish Health Repository)

    Fullam, L

    2012-01-31

    INTRODUCTION: Spontaneous\\/primary intracranial hypotension is characterised by orthostatic headache and is associated with characteristic magnetic resonance imaging findings. CASE REPORT: We present a case report of a patient with typical symptoms and classical radiological images. DISCUSSION: Spontaneous intracranial hypotension is an under-recognised cause of headache and can be diagnosed by history of typical orthostatic headache and findings on MRI brain.

  19. [Efficacy and safety of a herbal drug containing hawthorn berries and D-camphor in hypotension and orthostatic circulatory disorders/results of a retrospective epidemiologic cohort study].

    Science.gov (United States)

    Hempel, Bernd; Kroll, Michael; Schneider, Berthold

    2005-01-01

    Korodin Herz-Kreislauf-Tropfen, a herbal drug containing D-camphor (CAS 76-22-2; 2.5 %) and a liquid extract of fresh hawthorn berries (97.3%), has been used since many years for the treatment of orthostatic hypotension. The combination as well as its constituents were tested in clinical trials against placebo with healthy volunteers and patients using tilt-tests. The objective of this study was to investigate efficacy and safety of the drug under the conditions of medical practice in comparison to other drugs admitted for this indication. The study was performed as an epidemiological retrospective cohort study in 46 medical practices in Germany. In the practices the files were reviewed for patients who were treated between 1st January 2000 and 31st December 2002 for orthostatic hypotension. Included in the study were all patients who were treated either with the test drug or a control drug containing etilefrine, oxilofrine, midodrine, norfenefrine or dihydroergotamine and who met the inclusion criteria. The data of the files were coded, transferred to case report forms and augmented by the physician's statements about symptoms and success. Effect criteria were the improvement of symptoms and change of blood pressure during treatment. The correctness of the data was controlled using anonymous copies of the files. A total of 490 patients (399 in the test-group and 91 in the control group) between 11 and 102 years were included in the study. To correct heterogeneities in baseline conditions, treatment results were adjusted by regression and stratification to equal baseline conditions using the propensity score. The adjusted odds ratio for improvement was 5.6, the adjusted mean increase of the systolic blood pressure the 2-fold compared to the control group. The difference was highly significant and did not depend on age or initial blood pressure. In the test group two adverse events were observed which had no relation to the medication; in the control group one

  20. Treatment of erectile dysfunction with sildenafil citrate (Viagra) in parkinsonism due to Parkinson's disease or multiple system atrophy with observations on orthostatic hypotension

    Science.gov (United States)

    Hussain, I; Brady, C; Swinn, M; Mathias, C; Fowler, C

    2001-01-01

    OBJECTIVES—To assess the efficacy and safety of sildenafil citrate (Viagra) in men with erectile dysfunction and parkinsonism due either to Parkinson's disease or multiple system atrophy.
METHODS—Twenty four patients with erectile disease were recruited, 12 with Parkinson's disease and 12 with multiple system atrophy, into a randomised, double blind, placebo controlled, crossover study of sildenafil citrate. The starting dose was 50 mg active or placebo medication with the opportunity for dose adjustment depending on efficacy and tolerability. The international index of erectile function questionnaire (IIEF) was used to assess treatment efficacy and a quality of life questionnaire to assess the effect of treatment on sex life and whole life. Criteria for entry included a definite neurological diagnosis and a standing systolic blood pressure of 90-180 mm Hg and diastolic blood pressure of 50-110 mm Hg, on treatment if necessary. Blood pressure was taken at randomisation (visit 2) and crossover (visit 5) lying, sitting, and standing, before and 1 hour after taking the study medication in hospital.
RESULTS—Sidenafil citrate was efficacious in men with parkinsonism with a significant improvement, as demonstrated in questionnaire responses, in ability to achieve and maintain an erection and improvement in quality of sex life. In Parkinson's disease there was minimal change in blood pressure between active and placebo medication. In multiple system atrophy, six patients were studied before recruitment was stopped because three men showed a severe drop in blood pressure 1 hour after taking the active medication. Two were already known to have orthostatic hypotension and were receiving treatment with ephedrine and midodrine but the third had asymptomatic hypotension. However, the blood pressures in all three had been within the inclusion criterion for the study protocol. Despite a significant postural fall in blood pressure after sildenafil, all patients with

  1. Use of Minute-by-Minute Cardiovascular Measurements During Tilt Tests to Strengthen Inference on the Effect of Long-Duration Space Flight on Orthostatic Hypotension

    Science.gov (United States)

    Feiveson, Alan H.; Lee, Stuart M. C.; Stenger, Michael B.; Stein, Sydney P.; Platts, Steven H.

    2011-01-01

    Typical methodology for evaluating the effects of spaceflight on orthostatic hypotension (OH) has been survival analysis of tolerance times from 80 head-up tilt tests. However when scheduled test durations are short, there may not be enough failures to allow survival analysis to adequately estimate and compare the effects of flight phase (e.g. pre-flight, number of days post-flight), flight duration, and their interaction, as well as interactions with effects of interventions or countermeasures. The problem is exacerbated in the presence of a repeated measures design, in which subjects participate in tilt tests during various flight phases. Here we show how it is possible to dramatically improve the efficiency of statistical inference in this setting by making use of the additional information contained in minute-by-minute observations of cardiovascular parameters thought to be reflective of progression towards presyncope during tilt testing. Methods: We retrospectively examined operational tilt test (OTT; 10 -min 80 head-up tilt) data from 20 International Space Station (ISS) and 66 Shuttle astronauts 10 d before launch (L-10), on landing day (R+0) and during recovery (R+1, R+3, R+6-10) depending on the level of participation. Data from 5 ISS astronauts tested on R+0 or R+1 who used non-standard countermeasures were excluded. In addition to OTT survival time, 8 cardiovascular parameters (CP: heart rate, systolic, diastolic, and mean arterial blood pressure, pulse pressure, stroke volume, cardiac output, and total peripheral resistance) that might be predictive of progression towards presyncope were measured every minute of each OTT. Statistical analysis was predicated on a two ]stage model of causation. In the first stage, flight duration and time from landing affect the astronauts' degree of OH, which is manifested in the time trends and variation of the above CPs during OTTs. In the second stage, the behavior of these parameters directly affects OTT survival

  2. [Intra-anesthetic arterial hypotension in elderly patients during emergency surgery: what are the risk factors?

    Science.gov (United States)

    Boubacar Ba, El Hadji; Leye, Papa Alassane; Traoré, Mamadou Mour; Ndiaye, Pape Ibrahima; Gaye, Ibrahima; Bah, Mamadou Diawo; Fall, Mamadou Lamine; Diouf, Elisabeth

    2017-01-01

    Emergency anesthesia in elderly patients aged 65 years and older is complex. The occurrence of intraoperative incidents and arterial hypotension is conditioned by patients' initial health status and by the quality of intraoperative management. This study aimed to determine the incidence of intra-anesthetic arterial hypotension in elderly patients during emergency surgery and to assess the involvement of certain factors in its occurrence: age, sex, patient's history, ASA class, anesthetic technique. We conducted a retrospective descriptive and analytical study in the Emergency Surgery Department at the Aristide Le Dantec University Hospital from 1 March 2014 to 28 February 2015. We collected data from 210 patients out of 224 elderly patients aged 65 years and older undergoing emergency anesthesias (10.93%). Data of 101 men and 109 women were included in the analysis, of whom 64.3% had at least one defect. Patients' preoperative status was assessed using American Society of Anesthesiology (ASA) classification: 71% of patients were ASA class 1 and 2 and 29% were ASA class 3 and 4. Locoregional anesthesia was the most practiced anesthetic technique (56.7%). 28 patients (13.33%) had intra-anesthetic arterial hypotension, of whom 16 under general anesthesia and 12 under locoregional anesthesia. It was more frequent in patients with high ASA class and a little less frequent in patients with PAH and underlying heart disease. Arterial hypotension in elderly patients during emergency surgery exposes the subject to the risk of not negligible intraoperative hypotension, especially in patients with high ASA class. Prevention is based on adequate preoperative assessment and anesthetic management.

  3. Orthostatic changes in blood pressure and mortality in a nursing home population

    NARCIS (Netherlands)

    Hartog, Laura C.; Hendriks, Steven H.; Cimzar-Sweelssen, Mateja; Knipscheer, Astrid; Groenier, Klaas H.; Kleefstra, Nanne; Bilo, Henk J. G.; van Hateren, Kornelis J. J.

    Objective: Hypertension, orthostatic hypotension and orthostatic hypertension (OHT) are highly prevalent in old age. The associations in the very elderly and frail patients between blood pressure, and especially orthostatic changes in blood pressure, and mortality are unclear. We aimed to

  4. Prevalence and associative factors of orthostatic hypotension in older adults: Results from the Well-being of the Singapore Elderly (WiSE) study.

    Science.gov (United States)

    Ong, Hui Lin; Abdin, Edimansyah; Seow, Esmond; Pang, Shirlene; Sagayadevan, Vathsala; Chang, Sherilyn; Vaingankar, Janhavi Ajit; Chong, Siow Ann; Subramaniam, Mythily

    2017-09-01

    Orthostatic hypotension (OH) is commonly reported among older adults and is associated with an increased risk of mortality. This study aimed to describe the prevalence and investigate the possible associations between OH with sociodemographic variables, chronic medical conditions, health service utilisation, dementia and cognitive status among older adults residing in Singapore. Data was collected from 2266 participants aged 60 years and older who participated in the Well-being of the Singapore Elderly (WiSE) study in 2013. Face-to-face interviews were conducted and data collected includes sociodemographic information, blood pressure measurements, medical history, health services utilisation, and cognitive status. The prevalence of OH among older adults in Singapore was 7.8%. OH was highest in participants aged 85 years and above (OR: 2.33; 1.26-4.30; p=0.007) compared to those aged 75-84 years (OR: 1.76; 1.08-2.85; p=0.023). Participants with hypertension were more likely to have OH (OR: 3.03; 1.56-5.88, p=0.001) than those without hypertension. Those with dementia were also more likely to have OH than those with normal cognitive status (p=0.007). Older age, hypertension, and dementia were independently associated with OH in the older adult population in Singapore. Interventions such as home safety assessment and preventive measures should be implemented to improve older adult's functional capacity and quality of life to prevent injury. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Associations of baroreflex sensitivity, heart rate variability, and initial orthostatic hypotension with prenatal and recent postnatal methylmercury exposure in the Seychelles Child Development Study at age 19 years.

    Science.gov (United States)

    Périard, Daniel; Beqiraj, Bujar; Hayoz, Daniel; Viswanathan, Bharathi; Evans, Katie; Thurston, Sally W; Davidson, Philip W; Myers, Gary J; Bovet, Pascal

    2015-03-23

    A few studies have suggested an association between prenatal exposure to methylmercury and decreased heart rate variability (HRV) related to autonomic heart function, but no study has examined this association using baroreflex sensitivity (BRS). In this study we assessed the distribution of BRS and immediate orthostatic hypotension (IOH) in young Seychellois adults and their associations with exposure to prenatal and recent postnatal methylmercury. Subjects in the Seychelles Child Development Study (SCDS) main cohort were evaluated at age 19 years. Non-invasive beat-to-beat blood pressure (BP) monitoring (Finapres, Ohmeda) was performed at rest and during active standing in 95 consecutive subjects. Recent postnatal mercury exposure was measured in subjects' hair at the age of 19 years and prenatal exposure in maternal hair grown during pregnancy. BRS was estimated by sequence analysis to identify spontaneous ascending and descending BP ramps. HRV was estimated by the following markers: PNN50 (relative numbers of normal-to-normal intervals which are shorter by more than 50 ms than the immediately following normal-to-normal intervals); rMSSD (root mean of the squared sum of successive interval differences); LF/HF (low frequency/high frequency component ratio); ratio of the mean expiratory/inspiratory RR intervals (EI ratio); and the ratio between the longest RR interval 30 s after active standing and the shortest RR interval at 15 s (Max30/Min15). IOH was estimated by the deepest BP fall within the first 15 s after active standing up. Prenatal MeHg exposures were similar in boys and girls (6.7±4.3, 6.7±3.8 ng/g) but recent postnatal mercury levels were higher in males than females (11.2±5.8 vs 7.9±4.3 ng/g, p=0.003). Markers of autonomic heart rate control were within the normal range (BRS: 24.8±7 ms/mm Hg, PNN50: 24.9±6.8%, rMSSD: 68±22, LF/HF: 0.61±0.28) in both sexes. After standing, 51.4% of subjects had a transient systolic BP drop>40 mm Hg, but only 5

  6. Refractory Hypotension as an Initial Presentation of Bilateral Subclavian Artery Stenosis

    Directory of Open Access Journals (Sweden)

    Maxwell Eyram Afari

    2016-01-01

    Full Text Available Bilateral subclavian stenosis is a rare clinical condition. An interbrachial pressure difference of 15 mm Hg can raise suspicion for unilateral subclavian artery stenosis, but the diagnosis of bilateral subclavian artery stenosis can be challenging. We present a case of a 75-year-old woman who presented with refractory hypotension after surgery. Initial vitals revealed blood pressure in the 60s/50s mm Hg in both arms. Cardiopulmonary examination was remarkable for diminished pulses in all 4 extremities and audible carotid bruits. She continued to be hypotensive despite aggressive fluid resuscitation. Troponin T peaked at 0.24 ng/mL (reference < 0.04, and an echocardiogram revealed a reduction in ejection fraction (37% from 50%. Left and right heart catheterization demonstrated normal filling pressures and cardiac output. During the procedure, however, it was noted that the patient’s central blood pressure was 70–80 mm Hg higher than cuff pressures obtained in either arm. Selective angiography revealed 90% left subclavian ostial stenosis as well as 70% stenosis of the right subclavian artery.

  7. THE USE OF ARTERIAL OSCILLOGRAPHY TO ASSESS THE QUALITY OF ADAPTATION OF THE CARDIOVASCULAR SYSTEM TO CHANGES IN BODY POSITION (ORTHOSTATIC TEST

    Directory of Open Access Journals (Sweden)

    D. V. Vakulenko

    2017-03-01

    Full Text Available It is considered the application of oscillographic method, arterial oscillograms (at morphological, temporal and spectral methods. Indicated method makes it possible to assess the condition of specific (related to the regulation of vascular tone and sympathoadrenal nonspecific mechanisms of adaptation on active orthostatic test. Application of oscillographic method during orthostatic test enables early detection of prenosological and premorbid conditions and assessing the reserve capacity of the organism to help doctor better plan preventive, diagnostic and therapeutic process.

  8. Associations of Baroreflex Sensitivity, Heart Rate Variability, and Initial Orthostatic Hypotension with Prenatal and Recent Postnatal Methylmercury Exposure in the Seychelles Child Development Study at Age 19 Years

    Directory of Open Access Journals (Sweden)

    Daniel Périard

    2015-03-01

    Full Text Available Background: A few studies have suggested an association between prenatal exposure to methylmercury and decreased heart rate variability (HRV related to autonomic heart function, but no study has examined this association using baroreflex sensitivity (BRS. In this study we assessed the distribution of BRS and immediate orthostatic hypotension (IOH in young Seychellois adults and their associations with exposure to prenatal and recent postnatal methylmercury. Methods: Subjects in the Seychelles Child Development Study (SCDS main cohort were evaluated at age 19 years. Non-invasive beat-to-beat blood pressure (BP monitoring (Finapres, Ohmeda was performed at rest and during active standing in 95 consecutive subjects. Recent postnatal mercury exposure was measured in subjects’ hair at the age of 19 years and prenatal exposure in maternal hair grown during pregnancy. BRS was estimated by sequence analysis to identify spontaneous ascending and descending BP ramps. HRV was estimated by the following markers: PNN50 (relative numbers of normal-to-normal intervals which are shorter by more than 50 ms than the immediately following normal-to-normal intervals; rMSSD (root mean of the squared sum of successive interval differences; LF/HF (low frequency/high frequency component ratio; ratio of the mean expiratory/inspiratory RR intervals (EI ratio; and the ratio between the longest RR interval 30 s after active standing and the shortest RR interval at 15 s (Max30/Min15. IOH was estimated by the deepest BP fall within the first 15 s after active standing up. Results: Prenatal MeHg exposures were similar in boys and girls (6.7 ± 4.3, 6.7 ± 3.8 ng/g but recent postnatal mercury levels were higher in males than females (11.2 ± 5.8 vs 7.9 ± 4.3 ng/g, p = 0.003. Markers of autonomic heart rate control were within the normal range (BRS: 24.8 ± 7 ms/mm Hg, PNN50: 24.9 ± 6.8%, rMSSD: 68 ± 22, LF/HF: 0.61 ± 0.28 in both sexes. After standing, 51.4% of subjects

  9. Associations of Baroreflex Sensitivity, Heart Rate Variability, and Initial Orthostatic Hypotension with Prenatal and Recent Postnatal Methylmercury Exposure in the Seychelles Child Development Study at Age 19 Years

    Science.gov (United States)

    Périard, Daniel; Beqiraj, Bujar; Hayoz, Daniel; Viswanathan, Bharathi; Evans, Katie; Thurston, Sally W.; Davidson, Philip W.; Myers, Gary J.; Bovet, Pascal

    2015-01-01

    Background: A few studies have suggested an association between prenatal exposure to methylmercury and decreased heart rate variability (HRV) related to autonomic heart function, but no study has examined this association using baroreflex sensitivity (BRS). In this study we assessed the distribution of BRS and immediate orthostatic hypotension (IOH) in young Seychellois adults and their associations with exposure to prenatal and recent postnatal methylmercury. Methods: Subjects in theSeychelles Child Development Study (SCDS) main cohort were evaluated at age 19 years. Non-invasive beat-to-beat blood pressure (BP) monitoring (Finapres, Ohmeda) was performed at rest and during active standing in 95 consecutive subjects. Recent postnatal mercury exposure was measured in subjects’ hair at the age of 19 years and prenatal exposure in maternal hair grown during pregnancy. BRS was estimated by sequence analysis to identify spontaneous ascending and descending BP ramps. HRV was estimated by the following markers: PNN50 (relative numbers of normal-to-normal intervals which are shorter by more than 50 ms than the immediately following normal-to-normal intervals); rMSSD (root mean of the squared sum of successive interval differences); LF/HF (low frequency/high frequency component ratio); ratio of the mean expiratory/inspiratory RR intervals (EI ratio); and the ratio between the longest RR interval 30 s after active standing and the shortest RR interval at 15 s (Max30/Min15). IOH was estimated by the deepest BP fall within the first 15 s after active standing up. Results: Prenatal MeHg exposures were similar in boys and girls (6.7 ± 4.3, 6.7 ± 3.8 ng/g) but recent postnatal mercury levels were higher in males than females (11.2 ± 5.8 vs 7.9 ± 4.3 ng/g, p = 0.003). Markers of autonomic heart rate control were within the normal range (BRS: 24.8 ± 7 ms/mm Hg, PNN50: 24.9 ± 6.8%, rMSSD: 68 ± 22, LF/HF: 0.61 ± 0.28) in both sexes. After standing, 51.4% of subjects had a

  10. Predictors of arterial blood pressure control during deliberate hypotension with sodium nitroprusside in children.

    Science.gov (United States)

    Spielberg, David R; Barrett, Jeffrey S; Hammer, Gregory B; Drover, David R; Reece, Tammy; Cohane, Carol A; Schulman, Scott R

    2014-10-01

    Sodium nitroprusside (SNP) is used to decrease arterial blood pressure (BP) during certain surgical procedures. There are limited data regarding efficacy of BP control with SNP. There are no data on patient and clinician factors that affect BP control. We evaluated the dose-response relationship of SNP in infants and children undergoing major surgery and performed a quantitative assessment of BP control. One hundred fifty-three subjects at 7 sites received a blinded infusion followed by open-label SNP during operative procedures requiring controlled hypotension. SNP was administered by continuous infusion and titrated to maintain BP control (mean arterial BP [MAP] within ±10% of clinician-defined target). BP was recorded using an arterial catheter. Statistical process control methodology was used to quantify BP control. A multivariable model assessed the effects of patient and procedural factors. BP was controlled an average 45.4% (SD 23.9%; 95% CI, 41.5%-49.18%) of the time. Larger changes in infusion rate were associated with worse BP control (7.99% less control for 1 μg·kg·min increase in average titration size, P = 0.0009). A larger difference between a patient's baseline and target MAP predicted worse BP control (0.93% worse control per 1-mm Hg increase in MAP difference, P = 0.0013). Both effects persisted in multivariable models. SNP was effective in reducing BP. However, BP was within the target range less than half of the time. No clinician or patient factors were predictive of BP control, although 2 inverse relationships were identified. These relationships require additional study and may be best coupled with exposure-response modeling to propose improved dosing strategies when using SNP for controlled hypotension in the pediatric population.

  11. AORTIC POST-RESISTANCE EXERCISE HYPOTENSION IN PATIENTS WITH PERIPHERAL ARTERY DISEASE

    Directory of Open Access Journals (Sweden)

    Marilia de Almeida Correia

    Full Text Available ABSTRACT Introduction: A single session of resistance training decreases brachial blood pressure (BP in patients with peripheral artery disease (PAD. However, it is not known whether similar responses occur in aortic BP, which is a better predictor of cardiovascular risk. Objective: This study aimed to analyze the effects of a single session of resistance training on aortic BP in PAD patients. Methods: This randomized, crossover, controlled trial involved 16 patients. All of them performed a session of resistance training (R - 3 x 10 reps in eight exercises, 5-7 on the OMNI Scale and a control session (C - resting for 50 min. Before and after each session, aortic BP was assessed by applanation tonometry technique. Results: There was an increase in systolic (P<0.002 and mean (P<0.001 aortic BP in both sessions; however, higher increases were observed in C session (P<0.001. Additionally, diastolic aortic BP only increased after C session (P=0.004. The hypotensive effect of the exercise on systolic, diastolic, and mean aortic BP were -12±2, -6±2, and -7±2 mmHg, respectively. Conclusion: A single session of resistance training promoted a hypotensive effect on aortic BP of patients with PAD, indicating an acute reduction in cardiovascular risk in this population. Level of Evidence I; Therapeutic studies - Investigating the results of treatment.

  12. Hypotensive effect and vascular relaxation in different arteries induced by the nitric oxide donor RuBPY.

    Science.gov (United States)

    Pereira, Amanda de Carvalho; Araújo, Alice Valença; Paulo, Michele; Andrade, Fernanda Aparecida de; Silva, Bruno Rodrigues; Vercesi, Juliana Aparecida; da Silva, Roberto Santana; Bendhack, Lusiane Maria

    2017-01-30

    NO donors are compounds that release NO that can be used when the endogenous NO bioavailability is impaired. The compound cis-[Ru(bpy) 2 (py)(NO 2 )](PF 6 ) (RuBPY) is a nitrite-ruthenium, since it has a NO 2 in its molecule. The aim of the present study was to evaluate the effect of RuBPY on arterial pressure, as well as on the vascular relaxation of different vascular arteries in renal hypertensive (2K-1C) and normotensive (2K) rats. We have evaluated the arterial pressure and heart rate changes as well as the RuBPY and SNP-induced relaxation (thoracic aorta, mesenteric resistance, coronary and basilar arteries). The administration of RuBPY in awake rats evoked a smaller but long lasting hypotensive effect when compared to SNP, with no increase in heart rate. The relaxation induced by RuBPY was similar between 2K-1C and 2K rats in thoracic aorta, mesenteric resistance and coronary arteries. However, the relaxation induced by RuBPY was smaller in basilar arteries from 2K-1C than in 2K. Taken together, our results show that RuBPY presents several advantages over SNP, since it does not induce hypotensive effect in normotensive animals, the hypotensive effect is slower, with no reflex tachycardia, and it is long lasting. In addition, RuBPY induces coronary artery relaxation (useful for angina) and presented only a small effect on basilar artery (may not induce headache). Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Orthostatic hypertension: An underestimated cause of orthostatic intolerance.

    Science.gov (United States)

    Lee, Hyung; Kim, Hyun-Ah

    2016-04-01

    To investigate the frequency and mechanism of orthostatic hypertension (OHT) in patients with orthostatic intolerance. We retrospectively reviewed 1033 consecutive case series of orthostatic intolerance that underwent autonomic function tests including a head-up tilt test. OHT was defined as a paradoxical orthostatic increase in systolic blood pressure (BP) of at least 20 mmHg during the tilt. We collected autonomic parameters during the standardized autonomic function tests, which included the beat-to-beat derived hemodynamic parameters during the tilt table test and compared them with age and sex-matched normal controls and the orthostatic hypotension (OH) group with orthostatic symptoms. We identified 38 (3.7%) patients who showed OHT during the tilt. The increase in mean systolic BP during the tilt was 26.5 mmHg. Approximately 87% (33/38) of the OHT patients showed an increase in total peripheral resistance during the tilt. The mean increase in total peripheral resistance from a supine baseline was significantly higher in OHT patients compared to normal controls, but the OH group showed a decrease in mean total peripheral resistance during the tilt. A select few patients with orthostatic dizziness can show OHT during the tilt and they have signs of increased peripheral resistance. OHT may be considered in the differential diagnosis of orthostatic intolerance. Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  14. The effects of hypotension on differences between the results of simultaneous venous and arterial blood gas analysis

    Directory of Open Access Journals (Sweden)

    Farhad Shirani

    2011-01-01

    Full Text Available Background: Analysis of venous blood gas (VBG can represent arterial blood gas (ABG analysis in patients with various diseases. The effects of hypotension on differences between the results of simultaneous venous and arterial blood gas analyses were reviewed. Methods: This observational, cross-sectional study was conducted from March to October 2010 in emergency depart-ments of two university hospitals in Tehran (Iran on consecutive adult patients for whom ABG had been indicated for diagnosis/treatment. Arterial and peripheral venous bloods were simultaneously sampled with blood pressure measure-ment. The VBG-ABG amount of difference regarding pH, HCO 3 , PCO 2 , PO 2 , SO 2 , and Base Excess (BE was com-pared between those with and without hypotension. Results: During the study, 192 patients (51.6 ± 23.6 years, 67.7% males were entered into the hypotension (n = 78 and normotensive groups (n = 114. The average VBG-ABG amount of difference (95% limits of agreement in the hypotension versus normotensive group were -0.030 (-0.09 to 0.03 vs. -0.016 (-0.1 to 0.068 for pH (p = 0.01, 1.79 (-1.91 to 5.49 vs. 1.32 (-1.94 to 4.58 mEq/L for HCO 3 (p = 0.032, 2.69 (-20.43 to 25.81 vs. 2.03 (-7.75 to 11.81 mmHg for PCO 2 (p = 0.295, -35.97 (-130.17 to 58.23 vs. -32.65 (-104.79 to 39.49 mmHg for PO 2 (p = 0.293, -18.58 (-14.66 to 51.82 vs. -9.06 (-31.28 to 13.16 percent (p < 0.001 for SO 2 , and 0.25 (-3.73 to 4.23 vs. 0.79 (-2.51 to 4.09 for BE (p = 0.036. Conclusions: Hypotensive status is associated with an increase in the amount of difference between VBG and ABG analysis regarding pH, HCO 3 , and BE, though the amount of increase does not seem to be clinically important. Studying the precise effects of replacing ABG with VBG on the clinical decision-making and the following outcomes is worth-while.

  15. Numerical modeling of dynamics of heart rate and arterial pressure during passive orthostatic test

    Science.gov (United States)

    Ishbulatov, Yu. M.; Kiselev, A. R.; Karavaev, A. S.

    2018-04-01

    A model of human cardiovascular system is proposed to describe the main heart rhythm, influence of autonomous regulation on frequency and strength of heart contractions and resistance of arterial vessels; process of formation of arterial pressure during systolic and diastolic phases; influence of respiration; synchronization between loops of autonomous regulation. The proposed model is used to simulate the dynamics of heart rate and arterial pressure during passive transition from supine to upright position. Results of mathematical modeling are compared to original experimental data.

  16. Geriatric hypotensive syndromes are not explained by cardiovascular autonomic dysfunction alone

    NARCIS (Netherlands)

    Lagro, J.; Meel-van den Abeelen, A.S.; Jong, D.L. de; Schalk, B.W.M; Olde Rikkert, M.G.M.; Claassen, J.A.H.R.

    2013-01-01

    BACKGROUND: Though highly prevalent, the pathophysiology of orthostatic hypotension (OH), postprandial hypotension (PPH), and carotid sinus hypersensitivity (CSH) are rarely studied together. Therefore, we conducted such a comprehensive study focusing on the common role of the cardiovascular

  17. Mesenteric artery response to head-up tilt-induced central hypovolaemia and hypotension

    DEFF Research Database (Denmark)

    Perko, M J; Madsen, P; Perko, Grazyna

    1997-01-01

    the normotensive and the hypotensive phase of HUT, the SMA diameter (5.7 +/- 0.03 mm) and blood flow (514 +/- 75 ml min-1) did not change significantly, although the end-diastolic velocity increased from 9.7 +/- 4.8 to 39.7 +/- 4.0 cm s-1 (P

  18. [Indices of 24-hour monitoring of arterial blood pressure in patients with neurogenic syncope and patients with chronic constitution- dependent hypotension].

    Science.gov (United States)

    Musaeva, Z A; Khapaev, B A; Fedotova, A V; Oknin, V Iu

    1999-01-01

    Clinical-psychologic study, spectral analysis of heart rate variability, 24-h monitoring of arterial pressure (AP) were performed in 20 patients with chronic constitutional arterial hypotension and in 18 patients with neurogenic syncopal states. Both groups were characterised by considerable manifestations of the syndrome of autonomic dystonia, by emotional-personal disorders that correlated with elevated level of slow-waves of the second order in heart rhythms' spectrum. That testified activation of supersegmental sympathetic-adrenal systems. Disorders in sympathetic-parasympathetic correlations were specific in each group. In patients with arterial hypotension disorder of circadian rhythm was observed in the form of superfluous decrease of diastolic AP during sleep. Circadian rhythms in patients with neurogenic syncopes have parameters characteristic for normals showing a preverved chronobiologic AP regulation. A role of the alterations revealed in pathogenesis of arterial hypotensionis discussed.

  19. Non-invasive continuous finger blood pressure measurement during orthostatic stress compared to intra-arterial pressure

    NARCIS (Netherlands)

    Imholz, B. P.; Settels, J. J.; van der Meiracker, A. H.; Wesseling, K. H.; Wieling, W.

    1990-01-01

    The aim of the study was to evaluate whether invasive blood pressure responses to orthostatic stress can be replaced by non-invasive continuous finger blood pressure responses. DESIGN - Intrabrachial and Finapres blood pressures were simultaneously measured during passive head up tilt and during

  20. Effects of arm elevation on radial artery pressure: a new method to distinguish hypovolemic shock and septic shock from hypotension.

    Science.gov (United States)

    Xie, Zhiyi; Zhang, Zhenyu; Xu, Yuan; Zhou, Hua; Wu, Sheng; Wang, Zhong

    2018-06-01

    In this prospective observational study, we investigated the variability in radial artery invasive blood pressure associated with arm elevation in patients with different hemodynamic types. We carried out a prospective observational study using data from 73 general anesthesia hepatobiliary postoperative adult patients admitted to an ICU over a 1-year period. A standard procedure was used for the arm elevation test. The value of invasive radial arterial pressure was recorded at baseline, and 30 and 60 s after the arm had been raised from 0° to 90°. We compared the blood pressure before versus after arm elevation, and between hemodynamically stable, hypovolemic shock, and septic shock patient groups. In all 73 patients, systolic arterial pressure (SAP) decreased, diastolic arterial pressure (DAP) increased, and pulse pressure (PP) decreased at 30 and 60 s after arm elevation (Ppressure (MAP) was unchanged (P>0.05). On comparing 30 and 60 s, there was no significant difference in SAP, DAP, PP, or MAP (P>0.05). In 40 hemodynamically stable patients, SAP and PP decreased, and DAP and MAP increased significantly at 30 and 60 s after arm elevation compared with baseline (P0.05). In 17 patients with septic shock, SAP, PP, and MAP decreased significantly versus baseline at 30 and 60 s (P0.05). Comparison of the absolute value of pressure change of septic shock patients at 30 s after raising the arm showed that SAP, DAP, and MAP changes were significantly lower compared with those in hypovolemic shock and hemodynamically stable patients (Parm elevation of SAP. The best cut-off point for the SAP change value was -5 mmHg or less, with a sensitivity of 94.12%, a specificity of 80.36%, a positive likelihood ratio of 4.79 (95% CI: 2.8-8.2), and a negative likelihood ratio of 0.073 (95% CI: 0.01-0.5). Our study shows that hypovolemic shock and septic shock patients have significantly different radial artery invasive blood pressure changes in an arm elevation test

  1. Intravenous saline administration in patients with severe acquired brain injury and orthostatic intolerance for tilt-table mobilization

    DEFF Research Database (Denmark)

    Riberholt, Christian; Olesen, Niels; Hovind, Peter

    2018-01-01

    Primary objective: This study aimed to investigate the effect of intravenous saline administration on orthostatic hypotension (OH) during head up tilt (HUT) and the change in the renin–angiotensin–aldosterone system before and after HUT in patients with severe acquired brain injury (ABI). Research...... artery blood flow velocity. Blood samples were collected before and after two HUT sessions separated by 1 hour and saline was administered in between. Main outcomes and results: Patients’ ability to stand upright did not change after saline administration due to OH. The patients showed signs of reduced...... fluid administration. Research focusing on the ability to retain fluid after bed rest is warranted....

  2. A Case Report and Review of Postural Orthostatic Tachycardia Syndrome in Pregnancy

    OpenAIRE

    Lide, Brianna; Haeri, Sina

    2015-01-01

    Purpose - Postural orthostatic tachycardia syndrome (POTS) is a form of orthostatic intolerance characterized by an increased heart rate upon transition from supine to standing, and head-up tilt without orthostatic hypotension. Its etiology is multifactorial, and no clear cause has been identified. Common symptoms include light-headedness, blurred vision, weakness, cognitive difficulties, and fatigue and are often accompanied by palpitations, shortness of breath, syncope, or gastrointestinal ...

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

    NARCIS (Netherlands)

    Gisolf, J.; Immink, R. V.; van Lieshout, J. J.; Stok, W. J.; Karemaker, J. M.

    2005-01-01

    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

  4. Individual features of autoimmune disoders in patients with arterial hypotension in structure of neurologic symptom complexes of organic lesion of the central nervous system

    Directory of Open Access Journals (Sweden)

    Елена Константиновна Зинченко

    2015-09-01

    Full Text Available This work deals with the special features of formation of individual clinical phenotype with an evident humoral sensitizing in patients with arterial hypotension in structure of neurologic symptom complexes of organic lesion of the central nervous system in accordance with the features of disorders of immune resistance and changes of the hormonal background.Materials and methods. There was carried out an examination of 201 patients: 89 with vegetative dysfunction, 50 in remote period of the closed craniocerebral trauma and 64 with cerebral arachnoiditis on the background of the chronic nidi of infection.45 examined persons with physiological arterial hypotension formed a control group. There were carried out clinical and neurological examinations, monitoring of arterial pressure, definition of the state of the primary, secondary immunity and hormonal background.Results. The main pathogenetic mechanisms in individual clinical phenotype with an evident humoral sensitizing that were formed on the background of the chronic infection are more connected with the humoral link of immunity (the high concentration of circulating immune complexes of the small values of molecular weight and peptides of the mean molecular weight, the growth of IgM content and form autoimmune disorders. This category can be related to the patients with irreversible functional states that complicates prescription of therapeutic measures.Conclusions. For patients with an evident humoral sensitizing it is reasonable to use desensitizing preparations, enterosorbents, plasmapheresis in the complex treatment. At persistent viral infection the use of specific antiviral immunoglobulins of IgG is recommended

  5. Spontaneous intracranial hypotension

    International Nuclear Information System (INIS)

    Haritanti, A.; Karacostas, D.; Drevelengas, A.; Kanellopoulos, V.; Paraskevopoulou, E.; Lefkopoulos, A.; Economou, I.; Dimitriadis, A.S.

    2009-01-01

    Spontaneous intracranial hypotension (SIH) is an uncommon but increasingly recognized syndrome. Orthostatic headache with typical findings on magnetic resonance imaging (MRI) are the key to diagnosis. Delayed diagnosis of this condition may subject patients to unnecessary procedures and prolong morbidity. We describe six patients with SIH and outline the important clinical and neuroimaging findings. They were all relatively young, 20-54 years old, with clearly orthostatic headache, minimal neurological signs (only abducent nerve paresis in two) and diffuse pachymeningeal gadolinium enhancement on brain MRI, while two of them presented subdural hygromas. Spinal MRI was helpful in detecting a cervical cerebrospinal fluid leak in three patients and dilatation of the vertebral venous plexus with extradural fluid collection in another. Conservative management resulted in rapid resolution of symptoms in five patients (10 days-3 weeks) and in one who developed cerebral venous sinus thrombosis, the condition resolved in 2 months. However, this rapid clinical improvement was not accompanied by an analogous regression of the brain MR findings that persisted on a longer follow-up. Along with recent literature data, our patients further point out that SIH, to be correctly diagnosed, necessitates increased alertness by the attending physician, in the evaluation of headaches

  6. Continuous stroke volume monitoring by modelling flow from non-invasive measurement of arterial pressure in humans under orthostatic stress

    NARCIS (Netherlands)

    Harms, M.P.M.; Wesseling, K.H.; Pott, F.; Jenstrup, M.; Goudoever, J. van; Secher, N.H.; Lieshout, J.J. van

    1999-01-01

    The relationship between aortic flow and pressure is described by a three-element model of the arterial input impedance, including continuous correction for variations in the diameter and the compliance of the aorta (Modelflow). We computed the aortic flow from arterial pressure by this model, and

  7. Orthostatic Changes in Blood Pressure and Cognitive Status in the Elderly: The Progetto Veneto Anziani Study.

    Science.gov (United States)

    Curreri, Chiara; Giantin, Valter; Veronese, Nicola; Trevisan, Caterina; Sartori, Leonardo; Musacchio, Estella; Zambon, Sabina; Maggi, Stefania; Perissinotto, Egle; Corti, Maria Chiara; Crepaldi, Gaetano; Manzato, Enzo; Sergi, Giuseppe

    2016-08-01

    We studied a cohort of 1408 older subjects to explore whether postural changes in blood pressure (BP; defined as orthostatic hypo- or hypertension) can predict the onset of cognitive deterioration. Orthostatic hypotension was defined as a drop of 20 mm Hg in systolic or 10 mm Hg in diastolic BP and orthostatic hypertension as a rise of 20 mm Hg in systolic BP. Orthostatic BP values were grouped into quintiles for secondary analyses. Two cognitive assessments were considered: (1) cognitive impairment, that is, Mini-Mental State Examination scores ≤24/30, and (2) cognitive decline (CD), that is, a 3-point decrease in Mini-Mental State Examination score from the baseline to the follow-up. At the baseline, the prevalence of orthostatic hypotension and hypertension was 18.3% and 10.9%, respectively. At the follow-up (4.4±1.2 years), 286 participants were found cognitively impaired and 138 had a CD. Using logistic regression analysis adjusted for potential baseline confounders, participants with orthostatic hypertension were at significantly higher risk of CD (odds ratio =1.50; 95% confidence intervals =1.26-1.78). Neither orthostatic hypotension nor orthostatic hypertension raised the risk of developing a cognitive impairment. Using quintiles of orthostatic BP values, we found that both decreases and increases in systolic and diastolic BP raised the risk of CD, but not of cognitive impairment. In conclusion, we found that orthostatic hypertension predicts the onset of CD, but not of cognitive impairment in the elderly, whereas orthostatic hypotension predicts neither of these conditions. Further studies are needed to confirm our findings. © 2016 American Heart Association, Inc.

  8. Hypotensive anesthesia: Comparing the effects of different drug combinations on mean arterial pressure, estimated blood loss, and surgery time in orthognathic surgery.

    Science.gov (United States)

    Jeong, James; Portnof, Jason E; Kalayeh, Mona; Hardigan, Patrick

    2016-07-01

    Sevoflurane, an inhalational hypotensive anesthetic agent with a vasodilatory property, has been commonly used as a single agent to induce hypotension and effectively decrease blood loss in orthognathic surgery. However, it is common for patients to receive other hypotensive anesthetic agents in combination with sevoflurane. The purpose of our retrospective cohort study is to investigate whether administering an additional hypotensive agent has greater effect at reducing mean arterial pressure (MAP), estimated blood loss (EBL) and surgery time during orthognathic surgery. 57 subjects, aged 0-89 of both genders, who underwent orthognathic surgery were investigated in this study. Each patient's anesthesia records were reviewed to record the following variables of interest: EBL, duration of surgery, and MAP reduction in %. 41 subjects were placed in Group I and they received sevoflurane alone. 16 subjects were placed in Group II and they received sevoflurane plus a "supportive" agent. These "supportive" agents were esmolol, labetalol, metoprolol, nicardipine, and dexmedetomidine. The significant differences between two groups were assessed by using ANCOVA and p surgery time. Subjects in Group II experienced a greater reduction in MAP during surgery than subjects in Group I, 27.30% and 20.44%, respectively (p = 0.027). There was no significant difference for sex (p = 0.417) or age group (p = 0.113) in estimated blood loss, however. The mean surgery time in Group I was 1.93, 2.77, and 4.54 h with respect to LeFort, BSSO/IVRO, and double jaw surgery. Patients in Group II had a mean surgery time of 1.73, 2.07, and 5.64 h with respect to LeFort, BSSO/IVRO, and double jaw surgery. No statistically significant difference was demonstrated in surgery time between Group I vs. Group II (p > 0.05). Subjects in Group II experienced, on average, more blood loss than subjects in Group I, 355.50 ml and 238.90 ml, respectively. The use of multi-drug combination may offer

  9. Avaliação das pressões venosa e arterial em cães submetidos a diferentes tipos de hipotensão Evaluation of venous and arterial blood pressures in dogs submitted to hypotension

    Directory of Open Access Journals (Sweden)

    R.C. Rabelo

    2005-12-01

    Full Text Available Estabeleceram-se a pressão venosa periférica (PVP, a pressão venosa central (PVC, a pressão arterial invasiva (PAI e a pressão arterial não invasiva (PANI em cães após diferentes eventos de hipotensão. Foram utilizados 15 cães adultos, distribuídos aleatoriamente em três grupos (G com cinco animais cada, submetidos aos seguintes eventos hipotensores: GI - cloridrato de xilazina a 2%, GII - choque hipovolêmico agudo e GIII - veneno da serpente Bothrops moojeni. Os animais, avaliados durante 30 minutos após o início do evento hipotensor, foram tratados com cloridrato de ioimbina (GI, amido hidroxietílico a 6% (GII e cetoprofeno (GIII e reavaliados por mais 30 minutos. Somente os animais do GII apresentaram redução da PVP após o evento hipotensor e aumento, 25 minutos após tratamento. Os cães dos grupos II e III mostraram redução da PVC após o evento hipotensor, e somente os animais do GII exibiram discreto aumento cinco minutos imediatamente após o tratamento. Houve diminuição da PAI e PANI nos dos grupos II e III após o evento hipotensor, com recuperação gradativa imediata, após o tratamento, somente da PAI.The peripheral venous pressure (PVP, the central venous pressure (CVP, the invasive (IAP and non-invasive blood pressure (NIAP in dogs submitted to different hypotensive events were studied. Fifteen adult mongrel dogs were randomly divided in three groups with five animals each, and submitted to hypotensive event as follow: GI - xylazine chloride 2%, GII - acute hypovolemic shock and GIII - snake venom (Bothrops moojeni. All animals were evaluated for 30 minutes after starting hypotensive event, treated with yoimbine chloride (GI, colloid hetastarch 6% (GII and ketoprofen (GIII and reevaluated for more 30 minutes. Only the group II dogs showed PVP decrease after hypotensive event, and increase 25 minutes after treatment. In animals of groups II and III, the CVP decreased after hypotensive event and only in GII

  10. Investigation of effect of blood pressure and heart rate changes in different positions (lying and sitting on hypotension incidence rate after spinal anesthesia in patients undergoing caesarean section

    Directory of Open Access Journals (Sweden)

    Nahid Manouchehrian

    2016-07-01

    Full Text Available Due to the relatively high prevalence of hypotension (20% -40% after spinal anesthesia as well as the adverse effects of hypotension on mother and baby, it is better to prevent hypotension as much as possible. Therefore, this study is aimed to determine the relationship between postural blood pressure and heart rate changes and hypotension incidence rate after spinal anesthesia in cesarean section.63 women aging18 to 45years old with fullterm pregnancy, who were candidate for caesarean section with spinal anesthesia, entered the study. Afterwards, the diastolic, systolic, and mean arterial pressures as well as the heart rate (pulse in different positions (sitting, lying, and left lateral were measured. After spinal anesthesia, the patients' blood pressure was measured and recorded every minute until the10thmin, then every 3 minute until the15thmin, and then every 5 minute until the end of cesarean section. Data analysis was performed using SPSS (ver. 19 software, descriptive statistics, one-way ANOVA, and post hoc Bonferroni test. In this study, the hypotension incidence rate was 30% and the orthostatic variation rate of the systolic blood pressure in more than half of the people was between 4.39 to 13.49psi, which showed the highest variation compared to the diastolic pressure, mean arterial blood pressure (or: mean arterial pressure [MAP], and heart(pulse. Considering the correlation coefficient of 0.27, the systolic blood pressure in the lateral position has the highest relationship with the incidence of hypotension. The postural systolic blood pressure changes in patients prior to the spinal anesthesia can be a predictive factor for the post-spinal hypotension incidence.

  11. Space Flight Orthostatic Intolerance Protection

    Science.gov (United States)

    Luty, Wei

    2009-01-01

    This paper summarizes investigations conducted on different orthostatic intolerance protection garments. This paper emphasizes on the engineering and operational aspects of the project. The current Shuttle pneumatic Anti-G Suit or AGS at 25 mmHg (0.5 psi) and customized medical mechanical compressive garments (20-30 mmHg) were tested on human subjects. The test process is presented. The preliminary results conclude that mechanical compressive garments can ameliorate orthostatic hypotension in hypovolemic subjects. A mechanical compressive garment is light, small and works without external pressure gas source; however the current garment design does not provide an adjustment to compensate for the loss of mass and size in the lower torso during long term space missions. It is also difficult to don. Compression garments that do not include an abdominal component are less effective countermeasures than garments which do. An early investigation conducted by the Human Adaptation and Countermeasures Division at Johnson Space Center (JSC) has shown there is no significant difference between the protection function of the AGS (at 77 mmHg or 1.5 psi) and the Russian anti-g suit, Kentavr (at 25 mmHg or 0.5 psi). Although both garments successfully countered hypovolemia-induced orthostatic intolerance, the Kentavr provided protection by using lower levels of compression pressure. This more recent study with a lower AGS pressure shows that pressures at 20-30 mmHg is acceptable but protection function is not as effective as higher pressure. In addition, a questionnaire survey with flight crewmembers who used both AGS and Kentavr during different missions was also performed.

  12. Clinical significance of orthostatic dizziness in the diagnosis of benign paroxysmal positional vertigo and orthostatic intolerance.

    Science.gov (United States)

    Jeon, Eun-Ju; Park, Yong-Soo; Park, Shi-Nae; Park, Kyoung-Ho; Kim, Dong-Hyun; Nam, In-Chul; Chang, Ki-Hong

    2013-01-01

    Orthostatic dizziness (OD) and positional dizziness (PD) are considerably common conditions in dizziness clinic, whereas those two conditions are not clearly separated. We aimed to evaluate the clinical significance of simple OD and OD combined with PD for the diagnosis of benign paroxysmal positional vertigo (BPPV) and orthostatic intolerance (OI). Patients presenting with OD (n=102) were divided into two groups according to their symptoms: group PO, presenting with PD as well as OD; group O, presenting with OD. A thorough medical history, physical examination, and vestibular function tests were performed to identify the etiology of the dizziness. Orthostatic vital sign measurement (OVSM) was used to diagnose OI. The majority of patients were in group PO (87.3%). BPPV was the most common cause of OD for entire patients (36.3%) and group PO (37.1%), while OI was most common etiology for group O (38.5%). Total of 17 (16.7%) OI patients were identified by OVSM test. Orthostatic hypotension (n=10) was most frequently found, followed by orthostatic hypertension (n=5), and orthostatic tachycardia (n=2). Group O showed significantly higher percentage (38.5%) of OI than group PO (13.5%) (P=0.039). It is suggested that orthostatic testing such as OVSM or head-up tilt table test should be performed as an initial work up for the patients with simple OD. Positional tests for BPPV should be considered as an essential diagnostic test for patients with OD, even though their dizziness is not associated with PD. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. Perioperative care of an adolescent with postural orthostatic tachycardia syndrome

    Directory of Open Access Journals (Sweden)

    Kernan Scott

    2010-01-01

    Full Text Available Postural orthostatic tachycardia syndrome (POTS is a disorder characterized by postural tachycardia in combination with orthostatic symptoms without associated hypotension. Symptoms include light-headedness, palpitations, fatigue, confusion, and anxiety, which are brought on by assuming the upright position and usually relieved by sitting or lying down. Given the associated autonomic dysfunction that occurs with POTS, various perioperative concerns must be considered when providing anesthetic care for such patients. We present an adolescent with POTS who required anesthetic care during posterior spinal fusion for the treatment of scoliosis. The potential perioperative implications of this syndrome are discussed.

  14. Suspension Trauma / Orthostatic Intolerance

    Science.gov (United States)

    ... Suspension Trauma/Orthostatic Intolerance Safety and Health Information Bulletin SHIB 03-24-2004, updated 2011 This Safety ... the harness, the environmental conditions, and the worker's psychological state all may increase the onset and severity ...

  15. Implication of altered autonomic control for orthostatic tolerance in SCI.

    Science.gov (United States)

    Wecht, Jill Maria; Bauman, William A

    2018-01-01

    Neural output from the sympathetic and parasympathetic branches of the autonomic nervous system (ANS) are integrated to appropriately control cardiovascular responses during routine activities of daily living including orthostatic positioning. Sympathetic control of the upper extremity vasculature and the heart arises from the thoracic cord between T1 and T5, whereas splanchnic bed and lower extremity vasculature receive sympathetic neural input from the lower cord between segments T5 and L2. Although the vasculature is not directly innervated by the parasympathetic nervous system, the SA node is innervated by post-ganglionic vagal nerve fibers via cranial nerve X. Segmental differences in sympathetic cardiovascular innervation highlight the effect of lesion level on orthostatic cardiovascular control following spinal cord injury (SCI). Due to impaired sympathetic cardiovascular control, many individuals with SCI, particularly those with lesions above T6, are prone to orthostatic hypotension (OH) and orthostatic intolerance (OI). Symptomatic OH, which may result in OI, is a consequence of episodic reductions in cerebral perfusion pressure and the symptoms may include: dizziness, lightheadedness, nausea, blurred vision, ringing in the ears, headache and syncope. However, many, if not most, individuals with SCI who experience persistent and episodic hypotension and OH do not report symptoms of cerebral hypoperfusion and therefore do not raise clinical concern. This review will discuss the mechanism underlying OH and OI following SCI, and will review our knowledge to date regarding the prevalence, consequences and possible treatment options for these conditions in the SCI population. Published by Elsevier B.V.

  16. Individual Differences in the Temporal Profile of Cardiovascular Responses to Head Down Tilt and Orthostatic Stress with and Without Fluid Loading

    Science.gov (United States)

    Cowings, Patricia; Toscano, William; Kanis, Dionisios; Gebreyesus, Fiyore

    2013-01-01

    Susceptibility of healthy astronauts to orthostatic hypotension and presyncope is exacerbated upon return from spaceflight. Hypo-volemia is suspected to play an important role in cardiovascular deconditioning following exposure to spaceflight, which may lead to increased peripheral resistance, attenuated arterial baroreflex, and changes in cardiac function. The effect of altered gravity during space flight and planetary transition on human cardiovascular function is of critical importance to maintenance of astronaut health and safety. A promising countermeasure for post-flight orthostatic intolerance is fluid loading used to restore loss fluid volume by giving crew salt tablets and water prior to re-entry. Eight men and eight women will be tested during two, 6-hour exposures to 6o HDT: 1) fluid loading, 2) no fluid loading. Before and immediately after each HDT, subjects will perform a stand test to assess their orthostatic tolerance. Physiological measures (e.g., ECG, blood pressure, peripheral blood volume) will be continuously monitored while echocardiography measures are recorded at 30-minute intervals during HDT and stand tests. Preliminary results (N=4) clearly show individual differences in responses to this countermeasure and the time course of physiological changes induced by HDT.

  17. Cardiovascular profile in postural orthostatic tachycardia syndrome and Ehlers-Danlos syndrome type III.

    Science.gov (United States)

    Cheng, Jem L; Au, Jason S; Guzman, Juan C; Morillo, Carlos A; MacDonald, Maureen J

    2017-04-01

    The cardiovascular profile of postural orthostatic tachycardia syndrome + Ehlers-Danlos syndrome hypermobility type (POTS + EDSIII) has not been described, despite suggestions that it plays a role in orthostatic intolerance. We studied nine individuals diagnosed with POTS + EDSIII and found that the arterial stiffness and cardiac profiles of patients with POTS + EDSIII were comparable to those of age- and sex-matched controls, suggesting an alternate explanation for orthostatic intolerance.

  18. Dynamic cerebral autoregulation is unrelated to decrease in external carotid artery blood flow during acute hypotension in healthy young men

    DEFF Research Database (Denmark)

    Ogoh, Shigehiko; Sørensen, Henrik; Hirasawa, Ai

    2016-01-01

    men. Both ICA (mean ± SD; by 17 ± 8%, P = 0.005) and ECA (by 37 ± 15%, P 5 s) than for the ECA blood flow (17 ± 5 s; P = 0.019). The ICA blood flow recovery...... from hypoperfusion was delayed with prazosin (17 ± 4 s versus control 9 ± 5 s, P = 0.006), whereas ECA recovery remained unchanged (P = 0.313) despite a similar reduction in mean arterial pressure (−20 ± 4 mmHg versus control −23 ± 7 mmHg, P = 0.148). These findings suggest that α1-receptor blockade...

  19. Secondary Intracranial Hypotension: A Case Report

    Directory of Open Access Journals (Sweden)

    Pinar Gundogan Bozdag

    2014-04-01

    Full Text Available Intracranial hypotension is a clinical condition that characterized by postural (orthostatic headache and low pressure. It apperas with cerebrospinal fluid leak which occurs spontaneous or depending on the secondary attempts. 31 years old female patient which has diagnosis of acute appendicitis and underwent appendectomy under spinal anesthesia. postoperative 5.day she admitted with a postural headache, diplopia. Patient was treated with conservative methods after diagnosed with magnetic resonance imaging. We aim to asses an encountered complication after spinal anesthesia which widely applied for surgical procedures with imaging findings and literature.

  20. Hypocapnia and cerebral hypoperfusion in orthostatic intolerance.

    Science.gov (United States)

    Novak, V; Spies, J M; Novak, P; McPhee, B R; Rummans, T A; Low, P A

    1998-09-01

    Orthostatic and other stresses trigger tachycardia associated with symptoms of tremulousness, shortness of breath, dizziness, blurred vision, and, often, syncope. It has been suggested that paradoxical cerebral vasoconstriction during head-up tilt might be present in patients with orthostatic intolerance. We chose to study middle cerebral artery (MCA) blood flow velocity (BFV) and cerebral vasoregulation during tilt in patients with orthostatic intolerance (OI). Beat-to-beat BFV from the MCA, heart rate, CO2, blood pressure (BP), and respiration were measured in 30 patients with OI (25 women and 5 men; age range, 21 to 44 years; mean age, 31.3+/-1.2 years) and 17 control subjects (13 women and 4 men; age range, 20 to 41 years; mean age, 30+/-1.6 years); ages were not statistically different. These indices were monitored during supine rest and head-up tilt (HUT). We compared spontaneous breathing and hyperventilation and evaluated the effect of CO2 rebreathing in these 2 positions. The OI group had higher supine heart rates (Presponse to HUT, OI patients underwent a greater heart rate increment (Ppressure (Pdifferent between control subjects and patients with OI. Cerebral vasoconstriction occurs in OI during orthostasis, which is primarily due to hyperventilation, causing significant hypocapnia. Hypocapnia and symptoms of orthostatic hypertension are reversible by CO2 rebreathing.

  1. Multiple System Atrophy with Orthostatic Hypotension (Shy-Drager Syndrome)

    Science.gov (United States)

    ... the onset of symptoms. A problem with the respiratory system is the most common cause of death. x ... the onset of symptoms. A problem with the respiratory system is the most common cause of death. View ...

  2. Effects of imipramine of the orthostatic changes in blood pressure, heart rate and plasma catecholamines

    DEFF Research Database (Denmark)

    Nielsen, J R; Johansen, Torben; Arentoft, A

    1983-01-01

    The effect of imipramine on the orthostatic changes in heart rate, blood pressure and plasma catecholamines were examined in six healthy male subjects on two occasions on high sodium balance (Na+ excretion greater than 120 mmol per day) and on low sodium balance (Na+ excretion less than 110 mmol...... per day), respectively. Orthostatic tests were carried out before and 2 h after ingestion of 150 mg imipramine hydrochloride. Imipramine caused a moderate increase in supine systolic blood pressure, and a pronounced increase in the rise in heart rate, when the subjects assumed erect position....... The orthostatic drop in systolic blood pressure was in most cases only moderately increased after ingestion of imipramine, but in three subjects pronounced orthostatic hypotension developed when the sodium balance was low, whereas no clinical symptoms were seen in the same subjects when tested after imipramine...

  3. Risk of Orthostatic Intolerance During Re-Exposure to Gravity

    Science.gov (United States)

    Platts, Steven; Stenger, Michael B.; Lee, Stuart M. C.; Westby, Christian M.; Phillips, Tiffany R.; Arzeno, Natalia M.; Johnston, Smith; Mulugeta, Lealem

    2015-01-01

    Post-spaceflight orthostatic intolerance remains a significant concern to NASA. In Space Shuttle missions, astronauts wore anti-gravity suits and liquid cooling garments to protect against orthostatic intolerance during re-entry and landing, but in-flight exercise and the end-of-mission fluid loading failed to protect approximately 30% of Shuttle astronauts when these garments were not worn. The severity of the problem appears to be increased after long-duration space flight. Five of six US astronauts could not complete a 10-minutes upright-posture tilt testing on landing day following 4-5 month stays aboard the Mir space station. The majority of these astronauts had experienced no problems of orthostatic intolerance following their shorter Shuttle flights. More recently, four of six US astronauts could not complete a tilt test on landing day following approximately 6 month stays on the International Space Station. Similar observations were made in the Soviet and Russian space programs, such that some cosmonauts wear the Russian compression garments (Kentavr) up to 4 days after landing. Future exploration missions, such as those to Mars or Near Earth Objects, will be long duration, and astronauts will be landing on planetary bodies with no ground-support teams. The occurrence of severe orthostatic hypotension could threaten the astronauts' health and safety and success of the mission.

  4. Hypocapnia and cerebral hypoperfusion in orthostatic intolerance

    Science.gov (United States)

    Novak, V.; Spies, J. M.; Novak, P.; McPhee, B. R.; Rummans, T. A.; Low, P. A.

    1998-01-01

    BACKGROUND AND PURPOSE: Orthostatic and other stresses trigger tachycardia associated with symptoms of tremulousness, shortness of breath, dizziness, blurred vision, and, often, syncope. It has been suggested that paradoxical cerebral vasoconstriction during head-up tilt might be present in patients with orthostatic intolerance. We chose to study middle cerebral artery (MCA) blood flow velocity (BFV) and cerebral vasoregulation during tilt in patients with orthostatic intolerance (OI). METHODS: Beat-to-beat BFV from the MCA, heart rate, CO2, blood pressure (BP), and respiration were measured in 30 patients with OI (25 women and 5 men; age range, 21 to 44 years; mean age, 31.3+/-1.2 years) and 17 control subjects (13 women and 4 men; age range, 20 to 41 years; mean age, 30+/-1.6 years); ages were not statistically different. These indices were monitored during supine rest and head-up tilt (HUT). We compared spontaneous breathing and hyperventilation and evaluated the effect of CO2 rebreathing in these 2 positions. RESULTS: The OI group had higher supine heart rates (Pfailed to show an increment. Among the cerebrovascular indices, all BFVs (systolic, diastolic, and mean) decreased significantly more, and cerebrovascular resistance (CVR) was increased in OI patients (Pindices were improved within 2 minutes of CO2 rebreathing. The relationships between CO2 and BFV and heart rate were well described by linear regressions, and the slope was not different between control subjects and patients with OI. CONCLUSIONS: Cerebral vasoconstriction occurs in OI during orthostasis, which is primarily due to hyperventilation, causing significant hypocapnia. Hypocapnia and symptoms of orthostatic hypertension are reversible by CO2 rebreathing.

  5. Slower lower limb blood pooling in young women with orthostatic intolerance.

    Science.gov (United States)

    Lindenberger, Marcus; Länne, Toste

    2015-01-01

    .0007). Orthostatic intolerant women elicited blunted arterial vasoconstriction at low-grade LBNP, activating only cardiopulmonary baroreceptors, while orthostatic tolerant women responded with apparent vasoconstriction (P intolerance in women. Mobilization of venous capacitance blood from the peripheral to the central circulation was both slower and decreased; furthermore, reduced cardiopulmonary baroreceptor sensitivity was found in women who developed orthostatic intolerance. Further studies including women who experience syncope in daily life are needed. © 2014 The Authors. Experimental Physiology © 2014 The Physiological Society.

  6. Changes in arterial blood pressure induced by passive leg raising predict hypotension during the induction of sedation in critically ill patients without severe cardiac dysfunction.

    Science.gov (United States)

    Yu, Tao; Pan, Chun; Guo, Feng-mei; Yang, Yi; Qiu, Hai-bo

    2013-07-01

    Hypotension due to the induction of sedation with dexmedetomidine infusion may be harmful in critically ill patients. Changes in pulse pressure induced by the passive leg raising test (PLR-ΔPP) as marker of fluid responsiveness, assessed prior to sedation, may predict hemodynamic changes. The present study was to investigate the power of the PLR test in critically ill patients in predicting hypotension induced by the induction of dexmedetomidine sedation. Fluid responsiveness was estimated by a passive leg raising (PLR) test before dexmedetomidine sedation. Patients were assigned to either the "Nonresponders" or "Responders" group according to their hemodynamic responses to the PLR test ("Nonresponders", PLR-ΔPP pressure, heart rate (HR), and central venous pressure (CVP) were measured at each phase of the study procedure. Hemodynamic fluctuations during the use of dexmedetomidine sedation were recorded and compared between the two groups. Fifty patients had a median (25% - 75% interquartile range) of 71 (61 - 78) years old were studied. At baseline, 39 of the 50 patients were "Nonresponders" and 11 were "Responders". Following dexmedetomidine sedation, patients classified as "Responders" had a significantly greater systolic blood pressure decrease during the induction of dexmedetomidine sedation than the "Nonresponders" ((-26.3 ± 6.8)% vs. -11.8 ± 8.5)%, P blood pressure. Finally, PLR-ΔPP was positively correlated with changes in systolic blood pressure (PLR-ΔSBP) (r(2) = 0.576; P AUC for PLR-ΔPP was 0.84 (95%CI 0.71 - 0.93). PLR-ΔPP predicted hypotension with a sensitivity of 73% and a specificity of 92%. The fluid responsiveness assessment pre-sedation was found to predict blood pressure fluctuation during the induction of dexmedetomidine sedation. The PLR test conducted prior to sedation may be a useful tool to identify patients with a high risk of hemodynamic events and may be used to indicate the need for prophylactic treatment.

  7. Lack of causal association between spontaneous intracranial hypotension and cranial cerebrospinal fluid leaks.

    Science.gov (United States)

    Schievink, Wouter I; Schwartz, Marc S; Maya, M Marcel; Moser, Franklin G; Rozen, Todd D

    2012-04-01

    Spontaneous intracranial hypotension is an important cause of headaches and an underlying spinal CSF leak can be demonstrated in most patients. Whether CSF leaks at the level of the skull base can cause spontaneous intracranial hypotension remains a matter of controversy. The authors' aim was to examine the frequency of skull base CSF leaks as the cause of spontaneous intracranial hypotension. Demographic, clinical, and radiological data were collected from a consecutive group of patients evaluated for spontaneous intracranial hypotension during a 9-year period. Among 273 patients who met the diagnostic criteria for spontaneous intracranial hypotension and 42 who did not, not a single instance of CSF leak at the skull base was encountered. Clear nasal drainage was reported by 41 patients, but a diagnosis of CSF rhinorrhea could not be established. Four patients underwent exploratory surgery for presumed CSF rhinorrhea. In addition, the authors treated 3 patients who had a postoperative CSF leak at the skull base following the resection of a cerebellopontine angle tumor and developed orthostatic headaches; spinal imaging, however, demonstrated the presence of a spinal source of CSF leakage in all 3 patients. There is no evidence for an association between spontaneous intracranial hypotension and CSF leaks at the level of the skull base. Moreover, the authors' study suggests that a spinal source for CSF leakage should even be suspected in patients with orthostatic headaches who have a documented skull base CSF leak.

  8. Radionuclide cisternography: a prudent investigation in diagnosing spontaneous intracranial hypotension

    International Nuclear Information System (INIS)

    Sehgal, Aditi Khurana; Sethi, Ravinder Singh; Namgyal, Padma A.; Raghavan, Samudrala

    2013-01-01

    Spontaneous intracranial hypotension (SIH) is a cause of new persistent headache, which disappears on recumbence and reappears in sitting/standing position (orthostatic headache). We present a case of orthostatic headache, where the patient was suspected to have SIH and was subjected to radionuclide cisternography (RNC) using 99m Technetium Diethylenetriaminepenta acetic acid for confirmation of diagnosis. After due consent from the patient, the radiotracer was injected intra-thecally and serial images were acquired until 24 h. The direct and indirect evidences of Cerebrospinal fluid (CSF) leakage, which were revealed in our study, provided objective evidence to the clinical diagnosis. RNC is an important investigation in diagnosing SIH and also identifying the site of CSF leak, which may aid the management. (author)

  9. How do pediatric anesthesiologists define intraoperative hypotension?

    Science.gov (United States)

    Nafiu, Olubukola O; Voepel-Lewis, Terri; Morris, Michelle; Chimbira, Wilson T; Malviya, Shobha; Reynolds, Paul I; Tremper, Kevin K

    2009-11-01

    Although blood pressure (BP) monitoring is a recommended standard of care by the ASA, and pediatric anesthesiologists routinely monitor the BP of their patients and when appropriate treat deviations from 'normal', there is no robust definition of hypotension in any of the pediatric anesthesia texts or journals. Consequently, what constitutes hypotension in pediatric anesthesia is currently unknown. We designed a questionnaire-based survey of pediatric anesthesiologists to determine the BP ranges and thresholds used to define intraoperative hypotension (IOH). Members of the Society of Pediatric Anesthesia (SPA) and the Association of Paediatric Anaesthetists (APA) of Great Britain and Ireland were contacted through e-mail to participate in this survey. We asked a few demographic questions and five questions about specific definitions of hypotension for different age groups of patients undergoing inguinal herniorraphy, a common pediatric surgical procedure. The overall response rate was 56% (483/860), of which 76% were SPA members. Majority of the respondents (72%) work in academic institutions, while 8.9% work in institutions with fewer than 1000 annual pediatric surgical caseload. About 76% of respondents indicated that a 20-30% reduction in baseline systolic blood pressure (SBP) indicates significant hypotension in children under anesthesia. Most responders (86.7%) indicated that they use mean arterial pressure or SBP (72%) to define IOH. The mean SBP values for hypotension quoted by SPA members was about 5-7% lower across all pediatric age groups compared to values quoted by APA members (P = 0.001 for all age groups). There is great variability in the BP parameters used and the threshold used for defining and treating IOH among pediatric anesthesiologists. The majority of respondents considered a 20-30% reduction from baseline in SBP as indicative of significant hypotension. Lack of a consensus definition for a common clinical condition like IOH could have

  10. The changing face of orthostatic and neurocardiogenic syncope with age.

    LENUS (Irish Health Repository)

    Cooke, J

    2012-01-31

    AIM: Reports of the outcomes of syncope assessment across a broad spectrum of ages in a single population are scarce. It is our objective to chart the varying prevalence of orthostatic and neurocardiogenic syncope (NCS) as a patient ages. METHODS: This was a retrospective study. All consecutive patients referred to a tertiary referral syncope unit over a decade were included. Patients were referred with recurrent falls or orthostatic intolerance. Tilt tests and carotid sinus massage (CSM) were performed in accordance with best practice guidelines. RESULTS: A total of 3002 patients were included (1451 short tilt, 127 active stand, 1042 CSM and 382 prolonged tilt). Ages ranged from 11 to 91 years with a median (IQR) of 75 (62-81) years. There were 1914 females; 1088 males. Orthostatic hypotension (OH) was the most commonly observed abnormality (test positivity of 60.3%). Those with OH had a median (IQR) age of 78 (71-83) years. Symptomatic patients were significantly younger than asymptomatic (P = 0.03). NCS demonstrated a bimodal age distribution. Of 194 patients with carotid sinus hypersensitivity, the median age (IQR) was 77 (68-82) years. Those with vasovagal syncope (n = 80) had a median (IQR) age of 30 (19-44) years. There were 57 patients with isolated postural orthostatic tachycardia syndrome. Of the total patients, 75% were female. They had a median (IQR) age of 23 (17-29) years. CONCLUSION: We have confirmed, in a single population, a changing pattern in the aetiology of syncope as a person ages. The burden of disease is greatest in the elderly.

  11. Aging augments renal vasoconstrictor response to orthostatic stress in humans.

    Science.gov (United States)

    Clark, Christine M; Monahan, Kevin D; Drew, Rachel C

    2015-12-15

    The ability of the human body to maintain arterial blood pressure (BP) during orthostatic stress is determined by several reflex neural mechanisms. Renal vasoconstriction progressively increases during graded elevations in lower body negative pressure (LBNP). This sympathetically mediated response redistributes blood flow to the systemic circulation to maintain BP. However, how healthy aging affects the renal vasoconstrictor response to LBNP is unknown. Therefore, 10 young (25 ± 1 yr; means ± SE) and 10 older (66 ± 2 yr) subjects underwent graded LBNP (-15 and -30 mmHg) while beat-to-beat renal blood flow velocity (RBFV; Doppler ultrasound), arterial BP (Finometer), and heart rate (HR; electrocardiogram) were recorded. Renal vascular resistance (RVR), an index of renal vasoconstriction, was calculated as mean BP/RBFV. All baseline cardiovascular variables were similar between groups, except diastolic BP was higher in older subjects (P aging augments the renal vasoconstrictor response to orthostatic stress in humans. Copyright © 2015 the American Physiological Society.

  12. Intracranial hypotension - a look beyond “bilateral subdural hematomas”

    International Nuclear Information System (INIS)

    Penev, B.

    2015-01-01

    Full text: The intracranial hypotension (ICH) is a disorder due to spontaneous or iatrogenic CSF leak and a low intracranial pressure. The clinical presentation is characterized by drug resistant orthostatic headache, nausea, vomiting, dizziness, neck pain and etc. The intracranial hypotension is defined as a benign disorder and the treatment is predominantly conservative. Due to this fact it is very important to differentiate this entity from subdural hematomas and hygromas which are treated surgically. Magnetic resonance imaging has revolutionized the diagnosis of ICH. Nowadays there are a lot of clinical and imaging features of this disorder. Regardless of clinical varieties and atypical forms, MRI gives enough information for the correct or probable diagnosis in the vast majority of the cases. The initial imaging resemblance with posttraumatic subdural hematomas and hygromas can result in giving the wrong diagnosis and therefore performing unneeded surgical interventions. the aim of this presentation is to discuss the contemporary criteria, algorithm and imaging features of ICH

  13. [Effects of midodrine on symptomatic hypotension during hemodialysis].

    Science.gov (United States)

    Cotera, Alejandro; Alvo, Miriam; Sanhueza, María Eugenia; Elgueta, Leticia; Gormaz, Juan Pablo; Ibáñez, Carlos; Cuadra, Cristián

    2002-09-01

    Hypotension occurs in 20% of hemodialysis procedures. To study the effects of midodrine on hypotension during hemodialysis. Ten patients on chronic hemodialysis and with a history of hypotension during the procedure, were studied. They received midodrine 10 mg per os or placebo during 5 dialytic procedures each, in a double blind cross over design. Blood pressure levels prior to dialysis were similar during the midodrine or placebo administration periods. During dialysis, systolic blood pressure fell 19.3 +/- 28 mmHg with midodrine and 23.4 +/- 28 mmHg with placebo. Diastolic blood pressure fell 7.3 +/- 11.5 mmHg with midodrine and 11.1 +/- 12 mmHg with placebo. The reduction in median arterial pressure was also less pronounced with midodrine. Midodrine lessens the fall in arterial pressure during hemodialysis, in patients with symptomatic hypotension.

  14. Dystonia Associated with Idiopathic Slow Orthostatic Tremor

    Directory of Open Access Journals (Sweden)

    Christopher Kobylecki

    2016-02-01

    Full Text Available Background: We aimed to characterize the clinical and electrophysiological features of patients with slow orthostatic tremor.Case Report: The clinical and neurophysiological data of patients referred for lower limb tremor on standing were reviewed. Patients with symptomatic or primary orthostatic tremor were excluded. Eight patients were identified with idiopathic slow 4–8 Hz orthostatic tremor, which was associated with tremor and dystonia in cervical and upper limb musculature. Coherence analysis in two patients showed findings different to those seen in primary orthostatic tremor.Discussion: Slow orthostatic tremor may be associated with dystonia and dystonic tremor.

  15. The impact of arm position on the measurement of orthostatic blood pressure.

    Science.gov (United States)

    Guss, David A; Abdelnur, Diego; Hemingway, Thomas J

    2008-05-01

    Blood pressure is a standard vital sign in patients evaluated in an Emergency Department. The American Heart Association has recommended a preferred position of the arm and cuff when measuring blood pressure. There is no formal recommendation for arm position when measuring orthostatic blood pressure. The objective of this study was to assess the impact of different arm positions on the measurement of postural changes in blood pressure. This was a prospective, unblinded, convenience study involving Emergency Department patients with complaints unrelated to cardiovascular instability. Repeated blood pressure measurements were obtained using an automatic non-invasive device with each subject in a supine and standing position and with the arm parallel and perpendicular to the torso. Orthostatic hypotension was defined as a difference of >or= 20 mm Hg systolic or >or= 10 mm Hg diastolic when subtracting standing from supine measurements. There were four comparisons made: group W, arm perpendicular supine and standing; group X, arm parallel supine and standing; group Y, arm parallel supine and perpendicular standing; and group Z, arm perpendicular supine and parallel standing. There were 100 patients enrolled, 55 men, mean age 44 years. Four blood pressure measurements were obtained on each patient. The percentage of patients meeting orthostatic hypotension criteria in each group was: W systolic 6% (95% CI 1%, 11%), diastolic 4% (95% CI 0%, 8%), X systolic 8% (95% CI 3%, 13%), diastolic 9% (95% CI 3%, 13%), Y systolic 19% (95% CI 11%, 27%), diastolic 30% (95% CI 21%, 39%), Z systolic 2% (95% CI 0%, 5%), diastolic 2% (95% CI 0%, 5%). Comparison of Group Y vs. X, Z, and W was statistically significant (p postural changes in blood pressure. The combination of the arm parallel when supine and perpendicular when standing may significantly overestimate the orthostatic change. Arm position should be held constant in supine and standing positions when assessing for orthostatic

  16. Errata Corrige. Orthostatic Reactivity in Patients with Ischemic Stroke in the Chronic Period. http://dx.doi.org/10.3889/oamjms.2015.090.

    Science.gov (United States)

    Vasileva, Danche; Lubenova, Daniela; Mihova, Marija; Grigorova-Petrova, Kristin; Dimitrova, Antoaneta

    2015-09-15

    This study aims to trace the influence of specialized kinesitherapeutic methodology (SKTM) on orthostatic reactivity in patients with ischemic stroke in the chronic period (ISChP). An active orthostatic test is used for the evaluation of the orthostatic reactions. The arterial blood pressure and heart rate were defined in the 10 minutes of supine position, before and after 1, 5 and 10 minutes of active upright position. The orthostatic autoregulation is evaluated four times - at the beginning of the study, on the 10th day, on the 1st month and three months after the start of the KT. The classification by Thulesius was used to separate the patients into two groups depending on the type of their orthostatic reactivity. At the beginning of the study of infringements symptomatic type orthostatic reactivity (SOR) was observed in 24 patients and hypertensive type orthostatic reactivity (HOR) was observed in the remaining 32 patients. Once applied SKTM establish improvement of orthostatic autoregulation for the groups SOR and HOR at the 10th day and the 1st month with a level of significance p <0.05. The applied specialized kinesitherapeutic methodology continued later as an adapted exercise program at home, has significantly improved the orthostatic reactivity in patients with orthostatic dysregulation due to the ISChP.

  17. Endothelin role in the orthostatic stress Papel da endotelina no estresse ortostático

    Directory of Open Access Journals (Sweden)

    Marli Cardoso Martins Pinge

    2008-10-01

    Full Text Available Orthostasis adoption causes hemodynamic changes. Hydrostatic opposition to the venous return, venous return reduction and cardiac output decrease act as stimuli and generate compensatory mechanisms. The central nervous system adjusts the autonomic sympathetic and parasympathetic activity. The autonomous nervous system causes a tonic and reflexive influence on the main variables of the cardiovascular system and, together with hormonal components, extends the adaptation capacity in face of postural changes. Any difficulties in this compensatory mechanism that prevents it from functioning properly may result in hypotension response failure, what, on its turn, can lead to cerebral hypoperfusion, hypoxia and loss of consciousness. Blood pressure maintenance at normal levels is important for the internal medium homeosthasis. Baroreflex plays an important role in the cardiovascular control in the short-term in the adaptation of the orthostatic stress, preventing excessive blood pressure alterations. During the orthostatic stress, neuroendocrinal changes also occur as alteration in endothelin plasma levels. Endothelin, a peptide formed by 21 amino acids, shows a powerful vasoconstrictor action. It also demonstrates that its levels in the blood are increased in response to an orthostatic stress. However, although endothelin-1 levels increase in response to an acute postural stress, its role in cardiovascular homeosthasis and its relation in the release of other hormones are still controversial and quite unknown in humans in vivo. A adoção da ortostase promove alterações hemodinâmicas. A oposição hidrostática ao retorno venoso, a redução do retorno venoso e a diminuição do débito cardíaco atua como estímulos e geram mecanismos compensatórios. O sistema nervoso central ajusta a atividade autonômica simpática e parassimpática. O sistema nervoso autônomo influencia tônica e reflexamente as principais variáveis do sistema cardiovascular

  18. Sympathetic dysfunction in vasovagal syncope and the postural orthostatic tachycardia syndrome

    Directory of Open Access Journals (Sweden)

    Elisabeth eLambert

    2014-07-01

    Full Text Available Orthostatic intolerance is the inability to tolerate the upright posture and is relieved by recumbence. It most commonly affects young women and has a major impact on quality of life and psychosocial well being. Several forms of orthostatic intolerance have been described. The most common one is the recurrent vasovagal syncope (VVS phenotype which presents as a transient and abrupt loss of consciousness and postural tone that is followed by rapid recovery. Another common type of orthostatic intolerance is the postural orthostatic tachycardia syndrome (POTS which is characterized by an excessive rise in heart rate upon standing and is associated with symptoms of presyncope such as light-headedness, fatigue, palpitations and nausea. Maintenance of arterial pressure under condition of reduced central blood volume during the orthostasis is accomplished in large part through sympathetic efferent nerve traffic to the peripheral vasculature. Therefore sympathetic nervous system (SNS dysfunction is high on the list of possible contributors to the pathophysiology of orthostatic intolerance. Investigations into the role of the SNS in orthostatic intolerance have yielded mixed results. This review outlines the current knowledge of the function of the SNS in both VVS and POTS.

  19. [Cardiovascular resistance to orthostatic stress in athletes after aerobic exercise].

    Science.gov (United States)

    Mel'nikov, A A; Popov, S G; Vikulov, A D

    2014-01-01

    In the paper cardiovascular resistance to orthostatic stress in the athletes in the two-hour recovery period after prolonged aerobic exercise was investigated. The reaction of the cardiac (stroke volume and cardiac output) and peripheral blood volumes in the lower and upper limbs, abdominal and neck regions in response to the tilt-test before and during two hours after exercise (30 min, heart rate = 156 +/- 8 beats/min) was determined by impedance method: It is found that: (1) at baseline distribution of blood flow in favor of the neck-region in response to the tilt-test, in spite of the decrease in cardiac output, was more efficient in athletes, that was due to a large decrease in blood flow to the lower extremities, and increased blood flow in the neck region; (2) after exercise it was established symptoms of potential orthostatic intolerance: postural hypotension and tachycardia, reduced peripheral pulse blood volume, expressed in a standing position, and reduced effectiveness of the distribution of blood flow in the direction of the neck region; (3) the abilityto effectively distribute blood flow in favor of the neck region in athletes after exercise remained elevated, which was due to a large decrease in blood flow in the abdominal region at the beginning, and in the lower limbs at the end of the recovery period.

  20. Paradoxical hypotension during dobutamine infusion for myocardial perfusion scintigraphy

    International Nuclear Information System (INIS)

    Erguen, E.L.; Caner, B.; Atalar, E.; Karanfil, A.; Tokgoezoglu, L.

    1998-01-01

    test, hypotension response to dobutamine is not always a marker for coronary artery disease. (orig.) [de

  1. Acute fluid ingestion in the treatment of orthostatic intolerance - important implications for daily practice.

    Science.gov (United States)

    Z'Graggen, W J; Hess, C W; Humm, A M

    2010-11-01

    Rapid water ingestion improves orthostatic intolerance (OI) in multiple system atrophy (MSA) and postural tachycardia syndrome (PoTS). We compared haemodynamic changes after water and clear soup intake, the latter being a common treatment strategy for OI in daily practice. Seven MSA and seven PoTS patients underwent head-up tilt (HUT) without fluid intake and 30 min after drinking 450 ml of water and clear soup, respectively. All patients suffered from moderate to severe OI because of neurogenic orthostatic hypotension (OH) and excessive orthostatic heart rate (HR) increase, respectively. Beat-to-beat cardiovascular indices were measured non-invasively. In MSA, HUT had to be terminated prematurely in 2/7 patients after water, but in 6/7 after clear soup. At 3 min of HUT, there was an increase in blood pressure of 15.7(8.2)/8.3(2.3) mmHg after water, but a decrease of 11.6(18.9)/8.1(9.2) mmHg after clear soup (P clear soup. The attenuation of excessive orthostatic HR increase did not differ significantly after water and clear soup drinking. In MSA, clear soup cannot substitute water for eliciting a pressor effect, but even worsens OI after rapid ingestion. In PoTS, acute water and clear soup intake both result in improvement of OI. These findings cannot solely be explained by difference in osmolarity but may reflect some degree of superimposed postprandial hypotension in widespread autonomic failure in MSA compared to the mild and limited autonomic dysfunction in PoTS. © 2010 The Author(s). Journal compilation © 2010 EFNS.

  2. Role of the cerebellum and the vestibular apparatus in regulation of orthostatic reflexes in the cat

    Science.gov (United States)

    Doba, N.; Reis, D. J.

    1974-01-01

    The contribution of the fastigial nucleus and the vestibular nerves (eighth cranial nerves) to the orthostatic reflexes in anesthetized, paralyzed cats was studied. Bilateral lesions of the rostral fastigial nucleus resulted in impairment of the reflex changes in blood pressure, femoral arterial flow, and resistance evoked by head-up tilting to 30 deg or 60 deg. The rostral fastigial nucleus, which might be triggered by the vestibular apparatus, appears to participate in concert with the baroreceptors in the initiation and possibly the maintenance of the orthostatic reflexes.

  3. Alanine increases blood pressure during hypotension

    Science.gov (United States)

    Conlay, L. A.; Maher, T. J.; Wurtman, R. J.

    1990-01-01

    The effect of L-alanine administration on blood pressure (BP) during haemorrhagic shock was investigated using anesthetized rats whose left carotid arteries were cannulated for BP measurement, blood removal, and drug administration. It was found that L-alanine, in doses of 10, 25, 50, 100, and 200 mg/kg, increased the systolic BP of hypotensive rats by 38 to 80 percent (while 100 mg/kg pyruvate increased BP by only 9.4 mmhg, not significantly different from saline). The results suggest that L-alanine might influence cardiovascular function.

  4. Low cerebral blood flow in hypotensive perinatal distress

    DEFF Research Database (Denmark)

    Lou, H C; Lassen, N A; Friis-Hansen, B

    1977-01-01

    was used for the cerebral blood flow measurements. The study confirmed that perinatal distress may be associated with low arterial blood pressure, and it was shown that cerebral blood flow is very low, 20 ml/100 g/min or less, in hypotensive perinatal distress. It is concluded that cerebral ischaemia plays...... a crucial role in the development of perinatal hypoxic brain injury....

  5. Orthostatic Intolerance and Postural Orthostatic Tachycardia Syndrome in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome, Hypermobility Type: Neurovegetative Dysregulation or Autonomic Failure?

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    Claudia Celletti

    2017-01-01

    Full Text Available Background. Joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type (JHS/EDS-HT, is a hereditary connective tissue disorder mainly characterized by generalized joint hypermobility, skin texture abnormalities, and visceral and vascular dysfunctions, also comprising symptoms of autonomic dysfunction. This study aims to further evaluate cardiovascular autonomic involvement in JHS/EDS-HT by a battery of functional tests. Methods. The response to cardiovascular reflex tests comprising deep breathing, Valsalva maneuver, 30/15 ratio, handgrip test, and head-up tilt test was studied in 35 JHS/EDS-HT adults. Heart rate and blood pressure variability was also investigated by spectral analysis in comparison to age and sex healthy matched group. Results. Valsalva ratio was normal in all patients, but 37.2% of them were not able to finish the test. At tilt, 48.6% patients showed postural orthostatic tachycardia, 31.4% orthostatic intolerance, 20% normal results. Only one patient had orthostatic hypotension. Spectral analysis showed significant higher baroreflex sensitivity values at rest compared to controls. Conclusions. This study confirms the abnormal cardiovascular autonomic profile in adults with JHS/EDS-HT and found the higher baroreflex sensitivity as a potential disease marker and clue for future research.

  6. Orthostatic Intolerance and Postural Orthostatic Tachycardia Syndrome in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome, Hypermobility Type: Neurovegetative Dysregulation or Autonomic Failure?

    Science.gov (United States)

    Celletti, Claudia; Camerota, Filippo; Castori, Marco; Censi, Federica; Gioffrè, Laura; Calcagnini, Giovanni; Strano, Stefano

    2017-01-01

    Background . Joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type (JHS/EDS-HT), is a hereditary connective tissue disorder mainly characterized by generalized joint hypermobility, skin texture abnormalities, and visceral and vascular dysfunctions, also comprising symptoms of autonomic dysfunction. This study aims to further evaluate cardiovascular autonomic involvement in JHS/EDS-HT by a battery of functional tests. Methods . The response to cardiovascular reflex tests comprising deep breathing, Valsalva maneuver, 30/15 ratio, handgrip test, and head-up tilt test was studied in 35 JHS/EDS-HT adults. Heart rate and blood pressure variability was also investigated by spectral analysis in comparison to age and sex healthy matched group. Results . Valsalva ratio was normal in all patients, but 37.2% of them were not able to finish the test. At tilt, 48.6% patients showed postural orthostatic tachycardia, 31.4% orthostatic intolerance, 20% normal results. Only one patient had orthostatic hypotension. Spectral analysis showed significant higher baroreflex sensitivity values at rest compared to controls. Conclusions. This study confirms the abnormal cardiovascular autonomic profile in adults with JHS/EDS-HT and found the higher baroreflex sensitivity as a potential disease marker and clue for future research.

  7. Spontaneous intracranial hypotension

    International Nuclear Information System (INIS)

    Cardwell, C.; Cox, I.; Baldey, A.

    2002-01-01

    Full text: A 49-year old female presented with severe postural headache with no history of trauma. A Computed Tomography (CT) study of the brain demonstrated abnormal meningeal enhancement raising the possibility of leptomeningeal metastases. The patient was then referred to Magnetic Resonance Imaging (MRI) which demonstrated diffuse smooth dural enhancement with ancillary findings characteristic of spontaneous intracranial hypotension. The patient was then referred to Nuclear Medicine to confirm the diagnosis and localise the presumed leak 400MBq of 99mTc DTPA was injected via lumbar puncture into the L3-L4 subarachnoid space Posterior images of the spine were taken with a GE XRT single head gamma camera at 1 and 4 hours post administration of radionuclide. Images demonstrated abnormal early arrival of radionuclide in the kidneys and bladder at 1 hour and abnormal leak of tracer was demonstrate at the level of the first thoracic vertebra on the right side at 4 hours. This confirmed CSF leak at this level. Consequently the patient underwent a blood patch and her symptoms resolved. Spontaneous Intracranial Hypotension is a syndrome often unrecognised presenting with symptoms including severe postural headache neck stiffness nausea vomiting tinnitus and vertigo. The diagnosis is frequently suspected from findings on MRI, but Nuclear Medicine CSF imaging provides a readily available and cost effective method for confirming the diagnosis, and for making the diagnosis in patients who are unsuitable for or do not have access to MRI. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  8. Spontaneous intracranial hypotension

    Energy Technology Data Exchange (ETDEWEB)

    Cardwell, C; Cox, I; Baldey, A [St. F.X. Cabrini Hospital, VIC (Australia). Departments of Nuclear Medicine and Magnetic Resonance Imaging

    2002-07-01

    Full text: A 49-year old female presented with severe postural headache with no history of trauma. A Computed Tomography (CT) study of the brain demonstrated abnormal meningeal enhancement raising the possibility of leptomeningeal metastases. The patient was then referred to Magnetic Resonance Imaging (MRI) which demonstrated diffuse smooth dural enhancement with ancillary findings characteristic of spontaneous intracranial hypotension. The patient was then referred to Nuclear Medicine to confirm the diagnosis and localise the presumed leak 400MBq of 99mTc DTPA was injected via lumbar puncture into the L3-L4 subarachnoid space Posterior images of the spine were taken with a GE XRT single head gamma camera at 1 and 4 hours post administration of radionuclide. Images demonstrated abnormal early arrival of radionuclide in the kidneys and bladder at 1 hour and abnormal leak of tracer was demonstrate at the level of the first thoracic vertebra on the right side at 4 hours. This confirmed CSF leak at this level. Consequently the patient underwent a blood patch and her symptoms resolved. Spontaneous Intracranial Hypotension is a syndrome often unrecognised presenting with symptoms including severe postural headache neck stiffness nausea vomiting tinnitus and vertigo. The diagnosis is frequently suspected from findings on MRI, but Nuclear Medicine CSF imaging provides a readily available and cost effective method for confirming the diagnosis, and for making the diagnosis in patients who are unsuitable for or do not have access to MRI. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc.

  9. Perfusion index as a predictor of hypotension following propofol induction - A prospective observational study

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    Sripada G Mehandale

    2017-01-01

    Full Text Available Background and Aims: Hypotension during propofol induction is a common problem. Perfusion index (PI, an indicator of systemic vascular resistance, is said to be predictive of hypotension following subarachnoid block. We hypothesised that PI can predict hypotension following propofol induction and a cut-off value beyond which hypotension is more common can be determined. Methods: Fifty adults belonging to the American Society of Anesthesiologists' physical status I/II undergoing elective surgery under general anaesthesia were enrolled for this prospective, observational study. PI, heart rate, blood pressure (BP and oxygen saturation were recorded every minute from baseline to 10 min following induction of anaesthesia with a titrated dose of propofol, and after endotracheal intubation. Hypotension was defined as fall in systolic BP (SBP by >30% of baseline or mean arterial pressure (MAP to <60 mm Hg. Severe hypotension (MAP of <55 mm Hg was treated. Results: Within first 5-min after induction, the incidence of hypotension with SBP and MAP criteria was 30% and 42%, respectively, and that of severe hypotension, 22%. Baseline PI <1.05 predicted incidence of hypotension at 5 min with sensitivity 93%, specificity 71%, positive predictive value (PPV 68% and negative predictive value (NPV 98%. The area under the ROC curve (AUC was 0.816, 95% confidence interval (0.699–0.933, P < 0.001 Conclusion: Perfusion index could predict hypotension following propofol induction, especially before endotracheal intubation, and had a very high negative predictive value.

  10. Intracranial hypotension and hypertension in children and adolescents.

    Science.gov (United States)

    Ozge, Aynur; Bolay, Hayrunnisa

    2014-07-01

    The specific aim of this review is to report the features of intracranial pressure changes [spontaneous intracranial hypotension (SIH) and idiopathic intracranial hypertension (IIH)] in children and adolescents, with emphasis on the presentation, diagnosis, and treatment modalities. Headache associated with intracranial pressure changes are relatively rare and less known in children and adolescents. SIH is a specific syndrome involving reduced intracranial pressure with orthostatic headache, frequently encountered connective tissue disorders, and a good prognosis with medical management, initial epidural blood patching, and sometimes further interventions may be required. IIH is an uncommon condition in children and different from the disease in adults, not only with respect to clinical features (likely to present with strabismus and stiff neck rather than headache or pulsatile tinnitus) but also different in outcome. Consequently, specific ICP changes of pediatric ages required specific attention both of exact diagnosis and entire management.

  11. Spontaneous Intracranial Hypotension

    International Nuclear Information System (INIS)

    Joash, Dr.

    2015-01-01

    Epidemiology is not only rare but an important cause of new daily persistent headaches among young & middle age individuals. The Etiology & Pathogenesis is generally caused by spinal CSF leak. Precise cause remains largely unknown, underlying structural weakness of spinal meninges is suspected. There are several MR Signs of Intracranial Hypotension that include:- diffuse pachymeningeal (dural) enhancement; bilateral subdural, effusion/hematomas; Downward displacement of brain; enlargement of pituitary gland; Engorgement of dural venous sinuses; prominence of spinal epidural venous plexus and Venous sinus thrombosis & isolated cortical vein thrombosis. The sum of volumes of intracranial blood, CSF & cerebral tissue must remain constant in an intact cranium. Treatment in Many cases can be resolved spontaneously or by use Conservative approach that include bed rest, oral hydration, caffeine intake and use of abdominal binder. Imaging Modalities for Detection of CSF leakage include CT myelography, Radioisotope cisternography, MR myelography, MR imaging and Intrathecal Gd-enhanced MR

  12. Crisis management during anaesthesia: hypotension.

    Science.gov (United States)

    Morris, R W; Watterson, L M; Westhorpe, R N; Webb, R K

    2005-06-01

    Hypotension is commonly encountered in association with anaesthesia and surgery. Uncorrected and sustained it puts the brain, heart, kidneys, and the fetus in pregnancy at risk of permanent or even fatal damage. Its recognition and correction is time critical, especially in patients with pre-existing disease that compromises organ perfusion. To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK", supplemented by a specific sub-algorithm for hypotension, in the management of hypotension when it occurs in association with anaesthesia. Reports of hypotension during anaesthesia were extracted and studied from the first 4000 incidents reported to the Australian Incident Monitoring Study (AIMS). The potential performance of the COVER ABCD algorithm and the sub-algorithm for hypotension was compared with the actual management as reported by the anaesthetist involved. There were 438 reports that mentioned hypotension, cardiovascular collapse, or cardiac arrest. In 17% of reports more than one cause was attributed and 550 causative events were identified overall. The most common causes identified were drugs (26%), regional anaesthesia (14%), and hypovolaemia (9%). Concomitant changes were reported in heart rate or rhythm in 39% and oxygen saturation or ventilation in 21% of reports. Cardiac arrest was documented in 25% of reports. As hypotension was frequently associated with abnormalities of other vital signs, it could not always be adequately addressed by a single algorithm. The sub-algorithm for hypotension is adequate when hypotension occurs in association with sinus tachycardia. However, when it occurs in association with bradycardia, non-sinus tachycardia, desaturation or signs of anaphylaxis or other problems, the sub-algorithm for hypotension recommends cross referencing to other relevant sub-algorithms. It was considered that, correctly applied, the core algorithm COVER ABCD would have diagnosed 18% of cases and led to resolution in

  13. Efedrina versus fenilefrina: prevenção de hipotensão arterial durante anestesia raquídea para cesariana e efeitos sobre o feto Efedrina versus fenilefrina: prevención de hipotensión arterial durante anestesia raquidea para cesárea y efectos sobre el feto Ephedrine versus phenylephrine: prevention of hypotension during spinal block for cesarean section and effects on the fetus

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    Edno Magalhães

    2009-02-01

    evaluar así sus efectos colaterales y las alteraciones fetales. MÉTODO: Sesenta pacientes, sometidas a la anestesia raquídea con bupivacaína y sufentanil para cesárea, se dividieron aleatoriamente en dos grupos para recibir, profilácticamente, efedrina (Grupo E, n = 30, dosis = 10mg o fenilefrina (Grupo F, n = 30, dosis = 80 µg. Hipotensión arterial (presión arterial menor o igual a un 80% de la medida basal fue tratada con bolo de vasoconstrictor con un 50% de la dosis inicial. Se evaluaron: incidencia de hipotensión arterial, hipertensión arterial reactiva, bradicardia y vómitos, puntuación de Apgar en el 1° y 5° minutos y gasometría del cordón umbilical. RESULTADOS: La dosis promedio de efedrina fue 14,8 mg (± 3,8 y 186,7 µg (± 52,9 de fenilefrina. Los grupos fueron similares en cuanto a los parámetros demográficos y a la incidencia de vómitos, bradicardia e hipertensión arterial reactiva. La incidencia de hipotensión arterial fue de un 70% en el Grupo E y un 93% en el Grupo F (p BACKGROUND AND OBJECTIVES: Hypotension during spinal block for cesarean section is secondary to the sympathetic blockade and aorto-caval compression by the uterus and it can be deleterious to both the fetus and the mother. Ephedrine and phenylephrine improve venous return after sympathetic blockade during the spinal block. The objective of this study was to compare the efficacy of ephedrine and phenylephrine in the prevention and treatment of maternal hypotension during spinal block and to evaluate their side effects and fetal changes. METHODS: Sixty patients undergoing spinal block with bupivacaine and sufentanil for cesarean section were randomly divided in two groups to receive prophylactic ephedrine (Group E, n = 30, dose = 10 mg or phenylephrine (Group P, n = 30, dose = 80 µg. Hypotension (blood pressure equal or lower than 80% of baseline values was treated with bolus administration of the vasoconstrictor at 50% of the initial dose. The incidence of hypotension

  14. Orthostatic intolerance: potential pathophysiology and therapy.

    Science.gov (United States)

    Lu, Chih-Cherng; Tseng, Ching-Jiunn; Tang, Hung-Shang; Tung, Che-Se

    2004-09-30

    Orthostatic intolerance affects an estimated 1 in 500 persons and causes a wide range of disabilities. After essential hypertension, it is the most frequently encountered dysautonomia, accounting for the majority of patients referred to centers specializing in autonomic disorders. Patients are typically young females with symptoms such as dizziness, visual changes, head and neck discomfort, poor concentration, fatigue, palpitations, tremulousness, anxiety, and, in some cases, syncope. Syncope is the most hazardous symptom of orthostatic intolerance, presumably occurring because of impaired cerebral perfusion and in part to compensatory autonomic mechanisms. The etiology of this syndrome is still unclear but is heterogeneous. Orthostatic intolerance used to be characterized by an overall enhancement of noradrenergic tone at rest in some patients and by a patchy dysautonomia of postganglionic sympathetic fibers with a compensatory cardiac sympathetic activation in others. However, recent advances in molecular genetics are improving our understanding of orthostatic intolerance, such as several genetic diseases (such as Ehler-Danlos syndrome and norepinephrine transporter deficiency) presenting with symptoms typical of orthostatic intolerance. Future work will include investigation of genetic functional mutations underlying interindividual differences in autonomic cardiovascular control, body fluid regulation, and vascular regulation in orthostatic intolerance patients. The goal of this review article is to describe recent advances in understanding the pathophysiological mechanisms of orthostatic intolerance and their clinical significance.

  15. Modeling baroreflex regulation of heart rate during orthostatic stress

    DEFF Research Database (Denmark)

    Olufsen, Mette; Tran, Hien T.; Ottesen, Johnny T.

    2006-01-01

    . The model uses blood pressure measured in the finger as an input to model heart rate dynamics in response to changes in baroreceptor nerve firing rate, sympathetic and parasympathetic responses, vestibulo-sympathetic reflex, and concentrations of norepinephrine and acetylcholine. We formulate an inverse...... in healthy and hypertensive elderly people the hysteresis loop shifts to higher blood pressure values and its area is diminished. Finally, for hypertensive elderly people the hysteresis loop is generally not closed indicating that during postural change from sitting to standing, the blood pressure resettles......During orthostatic stress, arterial and cardiopulmonary baroreflexes play a key role in maintaining arterial pressure by regulating heart rate. This study, presents a mathematical model that can predict the dynamics of heart rate regulation in response to postural change from sitting to standing...

  16. Four faces of baroreflex failure: hypertensive crisis, volatile hypertension, orthostatic tachycardia, and malignant vagotonia

    Science.gov (United States)

    Ketch, Terry; Biaggioni, Italo; Robertson, RoseMarie; Robertson, David

    2002-01-01

    BACKGROUND: The baroreflex normally serves to buffer blood pressure against excessive rise or fall. Baroreflex failure occurs when afferent baroreceptive nerves or their central connections become impaired. In baroreflex failure, there is loss of buffering ability, and wide excursions of pressure and heart rate occur. Such excursions may derive from endogenous factors such as stress or drowsiness, which result in quite high and quite low pressures, respectively. They may also derive from exogenous factors such as drugs or environmental influences. METHODS AND RESULTS: Impairment of the baroreflex may produce an unusually broad spectrum of clinical presentations; with acute baroreflex failure, a hypertensive crisis is the most common presentation. Over succeeding days to weeks, or in the absence of an acute event, volatile hypertension with periods of hypotension occurs and may continue for many years, usually with some attenuation of pressor surges and greater prominence of depressor valleys during long-term follow-up. With incomplete loss of baroreflex afferents, a mild syndrome of orthostatic tachycardia or orthostatic intolerance may appear. Finally, if the baroreflex failure occurs without concomitant destruction of the parasympathetic efferent vagal fibers, a resting state may lead to malignant vagotonia with severe bradycardia and hypotension and episodes of sinus arrest. CONCLUSIONS: Although baroreflex failure is not the most common cause of the above conditions, correct differentiation from other cardiovascular disorders is important, because therapy of baroreflex failure requires specific strategies, which may lead to successful control.

  17. A Case Report and Review of Postural Orthostatic Tachycardia Syndrome in Pregnancy

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    Brianna Lide

    2015-04-01

    Full Text Available Purpose - Postural orthostatic tachycardia syndrome (POTS is a form of orthostatic intolerance characterized by an increased heart rate upon transition from supine to standing, and head-up tilt without orthostatic hypotension. Its etiology is multifactorial, and no clear cause has been identified. Common symptoms include light-headedness, blurred vision, weakness, cognitive difficulties, and fatigue and are often accompanied by palpitations, shortness of breath, syncope, or gastrointestinal symptoms. Management includes volume expansion, physical counter maneuvers, and pharmacological agents such as fludrocortisone, midodrine, propranolol, and pyridostigmine. The course of POTS in pregnancy is variable and POTS has not been directly implicated in any adverse outcomes for the mother or fetus. Methods - Two cases of POTS in pregnancy are presented, along with a review of the literature for reports of POTS in pregnancy. Results - Along with our 2 cases, 10 other case reports were identified and included. Conclusion - The course of POTS in pregnancy is variable, and not directly linked to increase perinatal morbidity or mortality. Women can safely undergo regional anesthesia, and vaginal delivery with close monitoring of hemodynamic changes.

  18. A Case Report and Review of Postural Orthostatic Tachycardia Syndrome in Pregnancy.

    Science.gov (United States)

    Lide, Brianna; Haeri, Sina

    2015-04-01

    Purpose Postural orthostatic tachycardia syndrome (POTS) is a form of orthostatic intolerance characterized by an increased heart rate upon transition from supine to standing, and head-up tilt without orthostatic hypotension. Its etiology is multifactorial, and no clear cause has been identified. Common symptoms include light-headedness, blurred vision, weakness, cognitive difficulties, and fatigue and are often accompanied by palpitations, shortness of breath, syncope, or gastrointestinal symptoms. Management includes volume expansion, physical counter maneuvers, and pharmacological agents such as fludrocortisone, midodrine, propranolol, and pyridostigmine. The course of POTS in pregnancy is variable and POTS has not been directly implicated in any adverse outcomes for the mother or fetus. Methods Two cases of POTS in pregnancy are presented, along with a review of the literature for reports of POTS in pregnancy. Results Along with our 2 cases, 10 other case reports were identified and included. Conclusion The course of POTS in pregnancy is variable, and not directly linked to increase perinatal morbidity or mortality. Women can safely undergo regional anesthesia, and vaginal delivery with close monitoring of hemodynamic changes.

  19. Hipotensão arterial em cirurgia de revascularização do miocárdio: influência dos inibidores da enzima conversora de angiotensina Hipotensión arterial en cirugía de revascularización del miocardio: influencia de los inhibidores de la enzima conversora de angiotensina Arterial hypotension in myocardial revascularization surgery: influence of angiotensin-converting enzyme inhibitors

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    Míriam Gomes Jordão

    2002-04-01

    incidencia de hipotensión arterial en la inducción anestésica, necesitando, con mayor frecuencia, de drogas para mantener la presión arterial sistémica en niveles adecuados.BACKGROUND AND OBJECTIVES: Angiotensin-converting enzyme inhibitors (ACEI are widely used in hypertension and heart failure. Their prolonged use may lead to hemodynamic instability and hypotension during anesthetic induction. This study aimed at comparing the incidence of hypotension in patients chronically treated and non treated with ACEI, submitted to anesthesia for myocardial revascularization. METHODS: Participated in this study 50 patients, physical status ASA II, III and IV, who were distributed in two groups: Group 1 - patients treated with ACEI for more than two months. Group 2 - patients not treated with ACEI. Parameters evaluated were mean blood pressure (MBP, heart rate (HR, and analysis of the ST segment in D II and V5. Systemic vascular resistance was determined during CPB. RESULTS: The incidence of arterial hypotension in anesthetized patients under ACEI was higher than in the control group in several anesthetic moments, but was predominant during anesthetic induction. This group needed dopamine for longer periods. From the 26 patients previously treated with ACEI, 23% needed drugs to correct hypotension from induction to CPB, and 19.1% in other anesthetic periods, totaling 42.3%. No control group patient needed drug infusion to increase systemic blood pressure, from induction to CPB. However, 21% of patients in this group needed dopamine or araminol in one or more anesthetic moments. CONCLUSIONS: In our study, patients treated whit ACEI for prolonged periods had a higher incidence of hypotension on anesthetic induction, requiring more drugs to maintain systemic pressure in adequate levels.

  20. Sinking Brain: Unusual Cause of Orthostatic Headache

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    Raina R

    2015-04-01

    Full Text Available We report a case presenting with an orthostatic headache. Brain magnetic resonance imaging (MRI revealed typical pachymeningeal enhancement. CT myelography revealed leakage at the thoracic level. Patient was successfully treated by lumbar epidural blood patch (EBP.

  1. Orthostatic stability with intravenous levodopa

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    Shan H. Siddiqi

    2015-08-01

    Full Text Available Intravenous levodopa has been used in a multitude of research studies due to its more predictable pharmacokinetics compared to the oral form, which is used frequently as a treatment for Parkinson’s disease (PD. Levodopa is the precursor for dopamine, and intravenous dopamine would strongly affect vascular tone, but peripheral decarboxylase inhibitors are intended to block such effects. Pulse and blood pressure, with orthostatic changes, were recorded before and after intravenous levodopa or placebo—after oral carbidopa—in 13 adults with a chronic tic disorder and 16 tic-free adult control subjects. Levodopa caused no statistically or clinically significant changes in blood pressure or pulse. These data add to previous data that support the safety of i.v. levodopa when given with adequate peripheral inhibition of DOPA decarboxylase.

  2. Estudo comparativo entre efedrina e etilefrina como vasopressor para correção da hipotensão arterial materna em cesarianas eletivas com raquianestesia Estudio comparativo entre efedrina y etilefrina como vasopresor para correción de la hipotensión materna en cesáreas electivas con raquianestesia Ephedrine and etilefrine as vasopressor to correct maternal arterial hypotension during elective cesarean section under spinal anesthesia. Comparative study

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    Sérgio D. Belzarena

    2006-06-01

    grupos iguales. Todas recibieron raquianestesia con bupivacaína, fentanil y morfina. Se les midió la presión arterial no invasiva y la frecuencia cardiaca. Los recién nacidos fueron evaluados con el índice de Apgar. La incidencia de hipotensión arterial, la cantidad de vasopresor necesaria para corrección y los efectos adversos fueron registrados. RESULTADOS: Ocurrió hipotensión arterial materna con frecuencia en los dos grupos, siendo un 68% del grupo etilefrina y un 63% del grupo efedrina. En la mayoría de las embrazadas, se corrigió con la primera dosis del vasopresor, sin diferencia entre los grupos (66% etilefrina, 58% efedrina. La hipotensión arterial necesitó dos o más dosis de vasopresor para ser corregida o se registró hipertensión reactiva en pocas pacientes (un 24% y un 10% del grupo etilefrina y 34% y 8% del grupo efedrina, respectivamente, sin diferencia estadística significativa. No hubo diferencia en los efectos adversos y en las pruebas de los recién nacidos. CONCLUSIONES: Con el método de administración empleado y con las dosis de vasopresor seleccionadas no hubo diferencia entre la efedrina y la etilefrina cuando se utilizaron para corregir la hipotensión arterial materna en cesáreas con raquianestesia.BACKGROUND AND OBJECTIVES: Ephedrine is the most popular vasopressor for obstetrics and etilefrine is widely used in regional anesthesia. This study aimed at comparing ephedrine and etilefrine to correct maternal arterial hypotension during elective Cesarean section under spinal anesthesia. METHODS: Participated in this study 120 pregnant patients who were randomly distributed in two equal groups. All patients received spinal anesthesia with bupivacaine, fentanyl and morphine. Noninvasive blood pressure and heart rate were monitored. Neonates were evaluated by the Apgar score. The incidence of hypotension, the amount of vasopressor needed to correct it and adverse effects were recorded. RESULTS: Maternal hypotension was similar in

  3. Effects of head-down-tilt bed rest on cerebral hemodynamics during orthostatic stress

    Science.gov (United States)

    Zhang, R.; Zuckerman, J. H.; Pawelczyk, J. A.; Levine, B. D.; Blomqvist, C. G. (Principal Investigator)

    1997-01-01

    Our aim was to determine whether the adaptation to simulated microgravity (microG) impairs regulation of cerebral blood flow (CBF) during orthostatic stress and contributes to orthostatic intolerance. Twelve healthy subjects (aged 24 +/- 5 yr) underwent 2 wk of -6 degrees head-down-tilt (HDT) bed rest to simulate hemodynamic changes that occur when humans are exposed to microG. CBF velocity in the middle cerebral artery (transcranial Doppler), blood pressure, cardiac output (acetylene rebreathing), and forearm blood flow were measured at each level of a ramped protocol of lower body negative pressure (LBNP; -15, -30, and -40 mmHg x 5 min, -50 mmHg x 3 min, then -10 mmHg every 3 min to presyncope) before and after bed rest. Orthostatic tolerance was assessed by using the cumulative stress index (CSI; mmHg x minutes) for the LBNP protocol. After bed rest, each individual's orthostatic tolerance was reduced, with the group CSI decreased by 24% associated with greater decreases in cardiac output and greater increases in systemic vascular resistance at each level of LBNP. Before bed rest, mean CBF velocity decreased by 14, 10, and 45% at -40 mmHg, -50 mmHg, and maximal LBNP, respectively. After bed rest, mean velocity decreased by 16% at -30 mmHg and by 21, 35, and 39% at -40 mmHg, -50 mmHg, and maximal LBNP, respectively. Compared with pre-bed rest, post-bed-rest mean velocity was less by 11, 10, and 21% at -30, -40, and -50 mmHg, respectively. However, there was no significant difference at maximal LBNP. We conclude that cerebral autoregulation during orthostatic stress is impaired by adaptation to simulated microG as evidenced by an earlier and greater fall in CBF velocity during LBNP. We speculate that impairment of cerebral autoregulation may contribute to the reduced orthostatic tolerance after bed rest.

  4. Risk factors for vascular dementia: Hypotension as a key point

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    Rita Moretti

    2008-04-01

    Full Text Available Rita Moretti, Paola Torre, Rodolfo M Antonello, Davide Manganaro, Cristina Vilotti, Gilberto PizzolatoDepartment of Internal Medicine and Clinical Neurology University of Trieste, ItalyAbstract: Physiologically, the cerebral autoregulation system allows maintenance of constant cerebral blood flow over a wide range of blood pressure. In old people, there is a progressive reshape of cerebral autoregulation from a sigmoid curve to a straight line. This implies that any abrupt change in blood pressure will result in a rapid and significant change in cerebral blood flow. Hypertension has often been observed to be a risk factor for vascular dementia (VaD and sometimes for Alzheimer disease although not always. Indeed, high blood pressure may accelerate cerebral white matter lesions, but white matter lesions have been found to be facilitated by excessive fall in blood pressure, including orthostatic dysregulation and postprandial hypotension. Many recent studies observed among other data, that there was a correlation between systolic pressure reduction and cognitive decline in women, which was not accounted for by other factors. Baseline blood pressure level was not significantly related to cognitive decline with initial good cognition. Some researchers speculate that blood pressure reduction might be an early change of the dementing process. The most confounding factor is that low pressure by itself might be a predictor of death; nevertheless, the effect of low blood pressure on cognition is underestimated because of a survival bias. Another explanation is that clinically unrecognized vascular lesions in the brain or atherosclerosis are responsible for both cognitive decline and blood pressure reduction. We discuss the entire process, and try to define a possible mechanism that is able to explain the dynamic by which hypotension might be related to dementia.Keywords: vascular dementia, hypotension, low blood pressure, alzheimer disease

  5. Autogenic-Feedback Training: A Potential Treatment for Orthostatic Intolerance in Aerospace Crews

    Science.gov (United States)

    Cowings, P. S.; Toscano, W. B.; Miller, N. E.; Pickering, T. G.; Shapiro, D.; Stevenson, J.; Maloney, S.; Knapp, J.

    1994-01-01

    Postflight orthostatic intolerance has been identified as a serious biomedical problem associated with long-duration exposure to microgravity in space. High priority has been given to the development of countermeasures for this disorder that are both effective and practical. A considerable body of clinical research has demonstrated that people can be taught to increase their own blood pressure voluntarily, and that this is an effective treatment for chronic orthostatic intolerance in paralyzed patients. The current pilot study was designed to examine the feasibility of adding training in control of blood pressure to an existing preflight training program designed to facilitate astronaut adaptation to microgravity. Using an operant conditioning procedure, autogenic-feedback training (AFT), three men and two women participated in four to nine training (15-30-minute) sessions. At the end of training, the average increase in systolic and diastolic pressure, as well as mean arterial pressures, that the subjects made ranged between 20 and 50 mm Hg under both supine and 45 deg head-up tilt conditions. These findings indicate that AFT may be a useful alternative treatment or supplement to existing approaches for preventing postflight orthostatic intolerance. Furthermore, the use of operant conditioning methods for training cardiovascular responses may contribute to the general understanding of the mechanisms of orthostatic intolerance.

  6. Autogenic-feedback training: A potential treatment for post-flight orthostatic intolerance in aerospace crews

    Science.gov (United States)

    Cowings, Patricia S.; Toscano, William B.; Miller, Neil E.; Pickering, Thomas G.; Shapiro, David

    1993-01-01

    Postflight orthostatic intolerance was identified as a serious biomedical problem associated with long duration exposure to microgravity in space. High priority was given to the development of countermeasures for this disorder which are both effective and practical. A considerable body of clinical research demonstrated that people can be taught to increase their own blood pressure voluntarily and that this is an effective treatment for chronic orthostatic intolerance in paralyzed patients. The present pilot study was designed to examine the feasibility of adding training in control of blood pressure to an existing preflight training program designed to facilitate astronaut adaptation to microgravity. Using an operant conditioning procedure, Autogenic-Feedback Training (AFT), three men and two women participated in four to nine (15-30 training sessions). At the end of training, the average increase in systolic and diastolic pressure, as well as mean arterial pressures that the subjects made, ranged between 20 and 5O mmHg under both supine and 45 deg head-up tilt conditions. These findings suggest that AFT may be a useful alternative treatment or supplement to existing approaches for preventing postflight orthostatic intolerance. Further, the use of operant conditioning methods for training cardiovascular responses may contribute to the general understanding of the mechanisms of orthostatic intolerance.

  7. Interaction of mianserin and some hypotensive drugs in Wistar rats.

    Science.gov (United States)

    Górska, Dorota; Andrzejczak, Dariusz

    2004-01-01

    Mianserin is thought to exert little effect on the cardiovascular system. In fact its safety in comparison with tricyclic drugs is high. Various experiments gave varying results as for the influence of the drug on arterial blood pressure in people and animals. Therefore, a study was undertaken in Wistar rats to evaluate interactions of mianserin administered intraperitoneally as a single dose, and for 21 days with 3 hypotensive drugs showing different mechanism of action (propranolol, enalapril, prazosine). The systolic, diastolic and mean blood pressure was measured with a LETICA apparatus. The results of the study revealed that administration of mianserin in normotensive rats leads to a short-term decrease in blood pressure and significantly enhanced the hypotensive effect of prazosine. Repeated doses of mianserin lead to a temporary increase in blood pressure after 2 weeks of administration. Single and repeated administration of mianserin did not change the hypotensive effect of propranolol and enalapril. Three-week therapy with mianserin significantly enhanced the hypotensive effect of prazosine.

  8. Central Methysergide Prevents Renal Sympathoinhibition and Bradycardia during Hypotensive Hemorrhage

    Science.gov (United States)

    Veelken, Roland; Johnson, Kim; Scrogin, Karie E.

    1998-01-01

    Central methysergide prevents renal sympathoinhibition and bradycardia during hypotensive hemorrhage. Mean arterial pressure (MAP), heart rate (HR), and renal sympathetic nerve activity (RSNA) were measured in conscious rats during either hemorrhage or cardiopulmonary receptor stimulation with phenylbiguanide (PBG) after intracerebroventricular injection of the 5-HT1/5-HT2-receptor antagonist, methysergide (40 microg). Progressive hemorrhage caused an initial rise (109 +/- 33%) followed by a fall in RSNA (-60 +/- 7%) and a fall in HR (-126 +/- 7 beats/min). Methysergide delayed the hypotension and prevented both the sympathoinhibitory and bradycardic responses to hemorrhage. Systemic 5-HT3-receptor blockade did not influence responses to hemorrhage. The PBG infusion caused transient depressor(-25 +/- 6 mmHg), bradycardic (-176 +/- 40 beats/min), and renal sympathostimulatory (182 +/-47% baseline) responses that were not affected by central methysergide (-20 +/- 6 mmHg, -162 +/- 18 beats/min, 227 +/- 46% baseline). These data indicate that a central serotonergic receptor-mediated component contributes to the sympathoinhibitory and bradycardic responses to hypotensive hemorrhage in conscious rats. Furthermore, the same central 5-HT-receptor populations involved in reflex responses to hypotensive hemorrhage probably do not mediate the sympathoinhibitory response to cardiopulmonary chemosensitive 5-HT3 receptors.

  9. Characterizing Orthostatic Tremor Using a Smartphone Application.

    Science.gov (United States)

    Balachandar, Arjun; Fasano, Alfonso

    2017-01-01

    Orthostatic tremor is one of the few tremor conditions requiring an electromyogram for definitive diagnosis since leg tremor might not be visible to the naked eye. An iOS application (iSeismometer, ObjectGraph LLC, New York) using an Apple iPhone 5 (Cupertino, CA, USA) inserted into the patient's sock detected a tremor with a frequency of 16.4 Hz on both legs. The rapid and straightforward accelerometer-based recordings accomplished in this patient demonstrate the ease with which quantitative analysis of orthostatic tremor can be conducted and, importantly, demonstrates the potential application of this approach in the assessment of any lower limb tremor.

  10. Orthostatic hypertension: profile of a Nigerian population ...

    African Journals Online (AJOL)

    Background: The aim of this study was to determine the prevalence, age, sex distribution and blood pressure (BP) pattern of patients with orthostatic hypertension in a cohort of hypertensives. Method: A total of 179 patients on follow-up treatment in a hypertension clinic were assessed for age, sex and BP in the seated ...

  11. Hypotensive Response Magnitude and Duration in Hypertensives: Continuous and Interval Exercise

    Directory of Open Access Journals (Sweden)

    Raphael Santos Teodoro de Carvalho

    2015-03-01

    Full Text Available Background: Although exercise training is known to promote post-exercise hypotension, there is currently no consistent argument about the effects of manipulating its various components (intensity, duration, rest periods, types of exercise, training methods on the magnitude and duration of hypotensive response. Objective: To compare the effect of continuous and interval exercises on hypotensive response magnitude and duration in hypertensive patients by using ambulatory blood pressure monitoring (ABPM. Methods: The sample consisted of 20 elderly hypertensives. Each participant underwent three ABPM sessions: one control ABPM, without exercise; one ABPM after continuous exercise; and one ABPM after interval exercise. Systolic blood pressure (SBP, diastolic blood pressure (DBP, mean arterial pressure (MAP, heart rate (HR and double product (DP were monitored to check post-exercise hypotension and for comparison between each ABPM. Results: ABPM after continuous exercise and after interval exercise showed post-exercise hypotension and a significant reduction (p < 0.05 in SBP, DBP, MAP and DP for 20 hours as compared with control ABPM. Comparing ABPM after continuous and ABPM after interval exercise, a significant reduction (p < 0.05 in SBP, DBP, MAP and DP was observed in the latter. Conclusion: Continuous and interval exercise trainings promote post-exercise hypotension with reduction in SBP, DBP, MAP and DP in the 20 hours following exercise. Interval exercise training causes greater post-exercise hypotension and lower cardiovascular overload as compared with continuous exercise.

  12. Hypotensive response magnitude and duration in hypertensives: continuous and interval exercise.

    Science.gov (United States)

    Carvalho, Raphael Santos Teodoro de; Pires, Cássio Mascarenhas Robert; Junqueira, Gustavo Cardoso; Freitas, Dayana; Marchi-Alves, Leila Maria

    2015-03-01

    Although exercise training is known to promote post-exercise hypotension, there is currently no consistent argument about the effects of manipulating its various components (intensity, duration, rest periods, types of exercise, training methods) on the magnitude and duration of hypotensive response. To compare the effect of continuous and interval exercises on hypotensive response magnitude and duration in hypertensive patients by using ambulatory blood pressure monitoring (ABPM). The sample consisted of 20 elderly hypertensives. Each participant underwent three ABPM sessions: one control ABPM, without exercise; one ABPM after continuous exercise; and one ABPM after interval exercise. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and double product (DP) were monitored to check post-exercise hypotension and for comparison between each ABPM. ABPM after continuous exercise and after interval exercise showed post-exercise hypotension and a significant reduction (p ABPM. Comparing ABPM after continuous and ABPM after interval exercise, a significant reduction (p < 0.05) in SBP, DBP, MAP and DP was observed in the latter. Continuous and interval exercise trainings promote post-exercise hypotension with reduction in SBP, DBP, MAP and DP in the 20 hours following exercise. Interval exercise training causes greater post-exercise hypotension and lower cardiovascular overload as compared with continuous exercise.

  13. Cerebro-retinal ischemia after bilateral occlusion of internal carotid artery

    International Nuclear Information System (INIS)

    Bogousslavsky, J.; Regli, F.

    1985-01-01

    Six patients with occlusion of internal carotid arteries (ICAs) were prospectively followed during a mean period of 14 months. Prior to demonstration of occlusions, four patients suffered a mild stroke, and three isolated transient ischemic attacks (TIAs) or amaurosis fugax. All patients remained alive and with an unchanged functional ability. During follow-up, one patient suffered amaurosis fugax and TIAs followed by a mild stroke, three suffered isolated TIAs or amaurosis fugax, two suffered reversible cerebro-retinal ischemia of more than 24 hours, and one remained symptomfree. In three cases, delayed cerebro-retinal ischemia distal to one of the occluded ICAs was systematically triggered by orthostatic, cardiogenic or iatrogenic hypotension, and resolved after adequate medical treatment or restoration of a functional collateral circulation by endarterectomy of a tightly stenosed ipsilateral external carotid artery (ECA), suggesting hemodynamic phenomena. In three cases, micro-emboli originating from a stump or an ulcerated ipsilateral common carotid artery and migrating through well-developed ECA collateral channels explained delayed episodes of ipsilateral TIAs or amaurosis fugax, which disappeared in two cases after adequate anticoagulant therepy was introduced. Bilateral occlusion of ICA may be a relatively benign condition, if the patients are carefully controlled and treated. (orig.)

  14. Decreased splenic enhancement on CT in traumatized hypotensive patients

    International Nuclear Information System (INIS)

    Berland, L.L.; VanDyke, J.A.

    1985-01-01

    Three patients with transient episodes of hypotension following blunt abdominal trauma incurred in motor vehicle accidents were examined by computed tomography within 6 hours of injury. None of the patients had splenic injury evident on autopsy, surgery, or clinical follow-up study (one case each), nor did they have other characteristic features of splenic infarction. However, in each case the spleen was less enhanced than the liver, leading to an erroneous impression in one patient that the splenic artery had been disrupted. Physiologic studies have shown that splenic perfusion decreases with sympathetic stimulation; this may have been the cause of the diminished enhancement. Decreased splenic enhancement should be interpreted cautiously in traumatized hypotensive patients

  15. Decreased splenic enhancement on CT in traumatized hypotensive patients

    Energy Technology Data Exchange (ETDEWEB)

    Berland, L.L.; VanDyke, J.A.

    1985-08-01

    Three patients with transient episodes of hypotension following blunt abdominal trauma incurred in motor vehicle accidents were examined by computed tomography within 6 hours of injury. None of the patients had splenic injury evident on autopsy, surgery, or clinical follow-up study (one case each), nor did they have other characteristic features of splenic infarction. However, in each case the spleen was less enhanced than the liver, leading to an erroneous impression in one patient that the splenic artery had been disrupted. Physiologic studies have shown that splenic perfusion decreases with sympathetic stimulation; this may have been the cause of the diminished enhancement. Decreased splenic enhancement should be interpreted cautiously in traumatized hypotensive patients.

  16. Potential contribution of diabetes mellitus to orthostatic blood pressure fall and conversion of mild cognitive impairment to dementia

    Directory of Open Access Journals (Sweden)

    Muratli S

    2016-01-01

    Full Text Available Sevilay Muratli,1 Fatih Tufan,1 Ozlem Soyluk,2 Gulistan Bahat,1 Mehmet Akif Karan1 1Department of Geriatrics, 2Department of Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, TurkeyWe read the article “Orthostatic blood pressure in people with mild cognitive impairment predicts conversion to dementia” by Hayakawa et al1 with interest. It is well-known that many individuals with mild cognitive impairment (MCI progress to dementia.2 However, we do not exactly know which risk factors increase this risk and to what extent. Hypertension is a risk factor for Alzheimer’s disease and vascular dementia. However, the findings of this study make us consider hypotension as a new risk factor for dementia. Furthermore, a recently published 6-year prospective general population cohort study suggested that not only orthostatic hypotension (OH, but also symptoms of OH seemed to be risk factors for cognitive decline.3 Notably, in the study by Elmstahl et al3, hypertension and diabetes mellitus (DM were more common in subjects with dementia. We would like to make some comments on this well-designed study.

  17. Abnormal norepinephrine clearance and adrenergic receptor sensitivity in idiopathic orthostatic intolerance

    Science.gov (United States)

    Jacob, G.; Shannon, J. R.; Costa, F.; Furlan, R.; Biaggioni, I.; Mosqueda-Garcia, R.; Robertson, R. M.; Robertson, D.

    1999-01-01

    BACKGROUND: Chronic orthostatic intolerance (OI) is characterized by symptoms of inadequate cerebral perfusion with standing, in the absence of significant orthostatic hypotension. A heart rate increase of >/=30 bpm is typical. Possible underlying pathophysiologies include hypovolemia, partial dysautonomia, or a primary hyperadrenergic state. We tested the hypothesis that patients with OI have functional abnormalities in autonomic neurons regulating cardiovascular responses. METHODS AND RESULTS: Thirteen patients with chronic OI and 10 control subjects underwent a battery of autonomic tests. Systemic norepinephrine (NE) kinetics were determined with the patients supine and standing before and after tyramine administration. In addition, baroreflex sensitivity, hemodynamic responses to bolus injections of adrenergic agonists, and intrinsic heart rate were determined. Resting supine NE spillover and clearance were similar in both groups. With standing, patients had a greater decrease in NE clearance than control subjects (55+/-5% versus 30+/-7%, Pheart rate 25 bpm was lower in patients than in control subjects (0.5+/-0.05 versus 1.0+/-0.1 microg, Pheart rate was similar in both groups. CONCLUSIONS: The decreased NE clearance with standing, resistance to the NE-releasing effect of tyramine, and increased sensitivity to adrenergic agonists demonstrate dramatically disordered sympathetic cardiovascular regulation in patients with chronic OI.

  18. Modeling human orthostatic responses on the Moon and on Mars.

    Science.gov (United States)

    Beck, Paula; Tank, Jens; Gauger, Peter; Beck, Luis E J; Zirngibl, Hubert; Jordan, Jens; Limper, Ulrich

    2018-04-26

    Since manned missions to the Moon and Mars are planned, we conducted active standing tests with lunar, Martian, terrestrial, and 1.8 loads of inertial resistance (+G z ) modeled through defined parabolic flight maneuvers. We hypothesized that the cardiovascular response to active standing is proportional to the +G z load. During partial-+G z parabolic flights, 14 healthy test subjects performed active stand-up maneuvers under 1 +G z , lunar (0.16 +G z ), Martian (0.38 +G z ), and hyper inertial resistance (1.8 +G z ) while heart rate and finger blood pressure were continuously monitored. We quantified amplitudes and timing of orthostatic response immediately following standing up. The maximum early heart rate increase was 21 (SD ± 10) bpm with lunar, 23 (± 11) bpm with Martian, 34 (± 17) bpm with terrestrial +G z , and 40 (± 11) bpm hyper +G z . The time to maximum heart rate increased gradually with increasing loads of inertial resistance. The transient blood pressure reduction was most pronounced with hyper +G z but did not differ significantly between lunar and Martian +G z . The mean arterial pressure nadir was reached significantly later with Martian and lunar compared to 1 +G z . Paradoxically, the time for blood pressure to recover was shortest with terrestrial +G z . While load of inertial resistance directly affects the magnitude of the transient blood pressure reduction and heart rate response to active standing, blood pressure stabilization is most rapidly attained during terrestrial +G z . The observation might suggest that the human cardiovascular system is tuned to cope with orthostatic stress on earth.

  19. Mechanisms of Orthostatic Tolerance Improvement Following Artificial Gravity Exposure Differ Between Men and Women

    Science.gov (United States)

    Evans, J. M.; Stenger, M. B.; Ferguson, C. R.; Ribiero, L. C.; Zhang, Q.; Moore, F. B.; Serrador, J.; Smith, J. D.; Knapp, C. F.

    2014-01-01

    We recently determined that a short exposure to artificial gravity (AG) improved the orthostatic tolerance limit (OTL) of cardiovascularly deconditioned subjects. We now seek to determine the mechanisms of that improvement in these hypovolemic men and women. Methods. We determined the orthostatic tolerance limit (OTL) of 9 men and 8 women following a 90 min exposure to AG compared to 90 min of head down bed rest (HDBR). In both cases (21 days apart), subjects were made hypovolemic (low salt diet plus 20 mg intravenous furosemide). Orthostatic tolerance was determined from a combination of head up tilt and increasing lower body negative pressure until presyncope. Mean values and correlations with OTL were determined for heart rate, blood pressure, stroke volume, cardiac output and peripheral resistance (Finometer), cerebral artery blood velocity (DWL), partial pressure of carbon dioxide (Novametrics) and body segmental impedance (UFI THRIM) were measured during supine baseline, during OTL to presyncope and during supine recovery Results. Orthostatic tolerance of these hypovolemic subjects was significantly greater on the day of AG exposure than on the HDBR day. Regression of OTL on these variables identified significant relationships on the HDBR day that were not evident on the AG day: resting TPR correlated positively while resting cerebral flow correlated negatively with OTL. On both days, women's resting stroke volume correlated positively with orthostatic tolerance. Higher group mean values of stroke volume and cerebral artery flow and lower values of blood pressure, peripheral vascular and cerebrovascular resistance both at control and during OTL testing were observed on the AG day. Even though regression of OTL on resting stroke volume was significant only in women, presyncopal stroke volume reached the same level on each day of study for both men and women while the OTL test lasted 30% longer in men and 22% longer in women. Cerebral artery flow appeared to

  20. Low cerebral blood flow in hypotensive perinatal distress

    International Nuclear Information System (INIS)

    Lou, H.C.; Lassen, N.A.; Friis-Hansen, B.

    1977-01-01

    Hypoxic brain injury is the most important neurological problem in the neonatal period and accounts for more neurological deficits in children than any other lesion. The neurological deficits are notably mental retardation, epilepsy and cerebral palsy. The pathogenesis has hitherto been poorly understood. Arterial hypoxia has been taken as the obvious mechanism but this does not fully explain the patho-anatomical findings. In the present investigation we have examined the arterial blood pressure and the cerebral blood flow in eight infants a few hours after birth. The 133Xe clearance technique was used for the cerebral blood flow measurements. The study confirmed that perinatal distress may be associated with low arterial blood pressure, and it was shown that cerebral blood flow is very low, 20 ml/100 g/min or less, in hypotensive perinatal distress. It is concluded that cerebral ischaemia plays a crucial role in the development of perinatal hypoxic brain injury. (author)

  1. Endurance exercise training in orthostatic intolerance: a randomized, controlled trial.

    Science.gov (United States)

    Winker, Robert; Barth, Alfred; Bidmon, Daniela; Ponocny, Ivo; Weber, Michael; Mayr, Otmar; Robertson, David; Diedrich, André; Maier, Richard; Pilger, Alex; Haber, Paul; Rüdiger, Hugo W

    2005-03-01

    Orthostatic intolerance is a syndrome characterized by chronic orthostatic symptoms of light-headedness, fatigue, nausea, orthostatic tachycardia, and aggravated norepinephrine levels while standing. The aim of this study was to assess the protective effect of exercise endurance training on orthostatic symptoms and to examine its usefulness in the treatment of orthostatic intolerance. 2768 military recruits were screened for orthostatic intolerance by questionnaire. Tilt-table testing identified 36 cases of orthostatic intolerance out of the 2768 soldiers. Subsequently, 31 of these subjects with orthostatic intolerance entered a randomized, controlled trial. The patients were allocated randomly to either a "training" (3 months jogging) or a "control" group. The influence of exercise training on orthostatic intolerance was assessed by determination of questionnaire scores and tilt-table testing before and after intervention. After training, only 6 individuals of 16 still had orthostatic intolerance compared with 10 of 11 in the control group. The Fisher exact test showed a highly significant difference in diagnosis between the 2 groups (P=0.008) at the end of the study. Analysis of the questionnaire-score showed significant interaction between time and group (P=0.001). The trained subjects showed an improvement in the average symptom score from 1.79+/-0.4 to 1.04+/-0.4, whereas the control subjects showed no significant change in average symptom score (2.09+/-0.6 and 2.14+/-0.5, respectively). Our data demonstrate that endurance exercise training leads to an improvement of symptoms in the majority of patients with orthostatic intolerance. Therefore, we suggest that endurance training should be considered in the treatment of orthostatic intolerance patients.

  2. Characterizing Orthostatic Tremor Using a Smartphone Application

    Directory of Open Access Journals (Sweden)

    Arjun Balachandar

    2017-07-01

    Full Text Available Background: Orthostatic tremor is one of the few tremor conditions requiring an electromyogram for definitive diagnosis since leg tremor might not be visible to the naked eye.Phenomenology Shown: An iOS application (iSeismometer, ObjectGraph LLC, New York using an Apple iPhone 5 (Cupertino, CA, USA inserted into the patient’s sock detected a tremor with a frequency of 16.4 Hz on both legs.Educational Value: The rapid and straightforward accelerometer-based recordings accomplished in this patient demonstrate the ease with which quantitative analysis of orthostatic tremor can be conducted and, importantly, demonstrates the potential application of this approach in the assessment of any lower limb tremor. 

  3. Disabling Orthostatic Headache after Penetrating Stonemason Pencil Injury to the Sacral Region

    Directory of Open Access Journals (Sweden)

    Carlo Brembilla

    2015-01-01

    Full Text Available Penetrating injuries to the spine, although less common than motor vehicle accidents and falls, are important causes of injury to the spinal cord. They are essentially of two varieties: gunshot or stab wounds. Gunshot injuries to the spine are more commonly described. Stab wounds are usually inflicted by knife or other sharp objects. Rarer objects causing incidental spinal injuries include glass fragments, wood pieces, chopsticks, nailguns, and injection needles. Just few cases of penetrating vertebral injuries caused by pencil are described. The current case concerns a 42-year-old man with an accidental penetrating stonemason pencil injury into the vertebral canal without neurological deficit. After the self-removal of the foreign object the patient complained of a disabling orthostatic headache. The early identification and treatment of the intracranial hypotension due to the posttraumatic cerebrospinal fluid (CSF sacral fistulae were mandatory to avoid further neurological complications. In the current literature acute pattern of intracranial hypotension immediately after a penetrating injury of the vertebral column has never been reported.

  4. The duration of hypotension determines the evolution of bacteremia-induced acute kidney injury in the intensive care unit.

    Directory of Open Access Journals (Sweden)

    Karin Janssen van Doorn

    Full Text Available BACKGROUND: Exploration of the impact of severe hypotension on the evolution of acute kidney injury in septic patients. METHODS AND RESULTS: We reviewed the hemodynamic parameters of 137 adults with septic shock and proven blood stream infection in the ICU. Severe hypotension was defined as a mean arterial blood pressure (MAP ≤65 mmHg. The influence of the duration of severe hypotension on the evolution of acute kidney injury was evaluated according to the RIFLE classification, with day 0 defined as the day of a positive blood stream infection. After bloodstream infection, the probability for a patient to be in Failure was significantly higher than before blood stream infection (OR = 1.94, p = 0.0276. Patients have a significantly higher risk of evolving to Failure if the duration of severe hypotension is longer (OR = 1.02 for each 10 minutes increase in duration of a MAP <65 mmHg, p = 0.0472. A cut-off of at least 51 minutes of severe hypotension (<65 mmHg or at least 5.5 periods of severe hypotension within 1 day identified patients with increased risk to evolve to Failure. CONCLUSIONS: There is a significant influence of both the duration and the number of periods of severe hypotension on the evolution to Failure. Blood stream infection has a significantly negative effect on the relationship between severe hypotension and Failure.

  5. Caloric restriction decreases orthostatic tolerance independently from 6° head-down bedrest.

    Directory of Open Access Journals (Sweden)

    John P Florian

    Full Text Available Astronauts consume fewer calories during spaceflight and return to earth with an increased risk of orthostatic intolerance. Whether a caloric deficiency modifies orthostatic responses is not understood. Thus, we determined the effects of a hypocaloric diet (25% caloric restriction during 6° head down bedrest (an analog of spaceflight on autonomic neural control during lower body negative pressure (LBNP. Nine healthy young men completed a randomized crossover bedrest study, consisting of four (2 weeks each interventions (normocaloric bedrest, normocaloric ambulatory, hypocaloric bedrest, hypocaloric ambulatory, each separated by 5 months. Muscle sympathetic nerve activity (MSNA was recorded at baseline following normocaloric and hypocaloric interventions. Heart rate (HR and arterial pressure were recorded before, during, and after 3 consecutive stages (7 min each of LBNP (-15, -30, -45 mmHg. Caloric and posture effects during LBNP were compared using two-way ANOVA with repeated measures. There was a strong trend toward reduced basal MSNA following caloric restriction alone (normcaloric vs. hypocaloric: 22±3 vs. 14±4 burst/min, p = 0.06. Compared to the normocaloric ambulatory, both bedrest and caloric restriction were associated with lower systolic blood pressure during LBNP (p<0.01; however, HR responses were directionally opposite (i.e., increase with bedrest, decrease with caloric restriction. Survival analysis revealed a significant reduction in orthostatic tolerance following caloric restriction (normocaloric finishers: 12/16; hypocaloric finishers: 6/16; χ2, p = 0.03. Caloric restriction modifies autonomic responses to LBNP, which may decrease orthostatic tolerance after spaceflight.

  6. Influence of mianserin on the activity of some hypotensive drugs in spontaneously hypertensive rats.

    Science.gov (United States)

    Górska, Dorota; Andrzejczak, Dariusz

    2003-01-01

    Mianserin might be an alternative drug in patients with depression accompanied by hypertension because of its effectiveness and lack of side effects in the circulatory system. However, a few studies reported in literature show influence of the drug on blood pressure. We investigate interactions between mianserin and commonly used hypotensive drugs (propranolol, enalapril and prazosin) in spontaneously hypertensive rats (SHR). The experiments were performed in two experimental designs: a single administration of both mianserin and a hypotensive drug, and repeated administration of mianserin with a single administration of a hypotensive drug. Arterial blood pressure was measured by bloodless method with manometer made by LETICA. A single administration of mianserin caused a statistically significant decrease in systolic, diastolic and mean blood pressure in the 60th minute of observation and intensified hypotensive effect of prazosin. However, long-term administration of mianserin in SHR rats had no significant influence on arterial blood pressure. Chronic and single administration of mianserin with propranolol or enalapril did not influence the circulatory system. A long-term administration of mianserin intensified the hypotensive effect of prazosin. This interaction might suggest possibility of dangerous complications in the treatment of humans with this drug combination.

  7. Permissive hypotension in the extremely low birthweight infant with signs of good perfusion.

    LENUS (Irish Health Repository)

    Dempsey, E M

    2012-01-31

    INTRODUCTION: Many practitioners routinely treat infants whose mean arterial blood pressure in mm Hg is less than their gestational age in weeks (GA). OBJECTIVE: To assess the effectiveness of utilising a combined approach of clinical signs, metabolic acidosis and absolute blood pressure (BP) values when deciding to treat hypotension in the extremely low birthweight (ELBW) infant. METHODS: Retrospective cohort study of all live born ELBW infants admitted to our neonatal intensive care unit over a 4-year period. Patients were grouped as either normotensive (BP never less than GA), hypotensive and not treated (BPhypotension) and hypotensive treated (BPhypotensive (mean BP in mm Hg less than GA in weeks). Treated patients had lower birth weight and GA, and significantly lower blood pressure at 6, 12, 18 and 24 h. Normotensive patients and patients designated as having permissive hypotension had similar outcomes. Mean blood pressure in the permissive group increased from 26 mm Hg at 6 h to 31 mm Hg at 24 h. In a logistic regression model, treated hypotension is independently associated with mortality, odds ratio 8.0 (95% CI 2.3 to 28, p<0.001). CONCLUSIONS: Blood pressure spontaneously improves in ELBW infants during the first 24 h. Infants hypotensive on GA criteria but with clinical evidence of good perfusion had as good an outcome as normotensive patients. Treated low blood pressure was associated with adverse outcome.

  8. Normal Reactions to Orthostatic Stress in Rett Syndrome

    Science.gov (United States)

    Larsson, Gunilla; Julu, Peter O. O.; Engerstrom, Ingegerd Witt; Sandlund, Marlene; Lindstrom, Britta

    2013-01-01

    The aim of this study was to investigate orthostatic reactions in females with Rett syndrome (RTT), and also whether the severity of the syndrome had an impact on autonomic reactions. Based on signs of impaired function of the central autonomic system found in RTT, it could be suspected that orthostatic reactions were affected. The orthostatic…

  9. Spontaneous Intracranial Hypotension Treated with a Targeted CT-Guided Epidural Blood Patch

    Directory of Open Access Journals (Sweden)

    Inês Correia

    2016-01-01

    Full Text Available Spontaneous intracranial hypotension (SIH is an important cause of new daily persistent headache. It is thought to be due to spontaneous spinal cerebrospinal fluid (CSF leaks, which probably have a multifactorial etiology. The classic manifestation of SIH is an orthostatic headache, but other neurological symptoms may be present. An epidural blood patch is thought to be the most effective treatment, but a blind infusion may be ineffective. We describe the case of a young man who developed an acute severe headache, with pain worsening when assuming an upright posture and relief gained with recumbency. No history of previous headache, recent cranial or cervical trauma, or invasive procedures was reported. Magnetic resonance imaging showed pachymeningeal enhancement and other features consistent with SIH and pointed towards a cervical CSF leak site. After failure of conservative treatment, a targeted computer tomography-guided EBP was performed, with complete recovery.

  10. Spontan cerebrospinalvæskelækage kan give intrakraniel hypotension

    DEFF Research Database (Denmark)

    Christiansen, Ingelise

    2015-01-01

    Spontaneous intracranial hypotension (SIH) is often misinterpreted as migraine or tension headache. This type of headache is, however, orthostatic and resolves in supine position. CT scan/MRI of the brain has characteristic findings, enhancement of the pachymeninges and bilateral hygroma....... An extreme situation of a 70-year-old woman with sagging midbrain is described in this case report. Although this type of headache may be caused by a dural fistula with spinal fluid leak it is not necessary to locate the lesion with myelografi/MR. Timely treatment with an epidural blood patch at any lumbal...... level could prevent potentially life-threatening complications and the headache resolved within hours/few days....

  11. The long-term outcome of orthostatic tremor.

    Science.gov (United States)

    Ganos, Christos; Maugest, Lucie; Apartis, Emmanuelle; Gasca-Salas, Carmen; Cáceres-Redondo, María T; Erro, Roberto; Navalpotro-Gómez, Irene; Batla, Amit; Antelmi, Elena; Degos, Bertrand; Roze, Emmanuel; Welter, Marie-Laure; Mestre, Tiago; Palomar, Francisco J; Isayama, Reina; Chen, Robert; Cordivari, Carla; Mir, Pablo; Lang, Anthony E; Fox, Susan H; Bhatia, Kailash P; Vidailhet, Marie

    2016-02-01

    Orthostatic tremor is a rare condition characterised by high-frequency tremor that appears on standing. Although the essential clinical features of orthostatic tremor are well established, little is known about the natural progression of the disorder. We report the long-term outcome based on the largest multicentre cohort of patients with orthostatic tremor. Clinical information of 68 patients with clinical and electrophysiological diagnosis of orthostatic tremor and a minimum follow-up of 5 years is presented. There was a clear female preponderance (76.5%) with a mean age of onset at 54 years. Median follow-up was 6 years (range 5-25). On diagnosis, 86.8% of patients presented with isolated orthostatic tremor and 13.2% had additional neurological features. At follow-up, seven patients who initially had isolated orthostatic tremor later developed further neurological signs. A total 79.4% of patients reported worsening of orthostatic tremor symptoms. These patients had significantly longer symptom duration than those without reported worsening (median 15.5 vs 10.5 years, respectively; p=0.005). There was no change in orthostatic tremor frequency over time. Structural imaging was largely unremarkable and dopaminergic neuroimaging (DaTSCAN) was normal in 18/19 cases. Pharmacological treatments were disappointing. Two patients were treated surgically and showed improvement. Orthostatic tremor is a progressive disorder with increased disability although tremor frequency is unchanged over time. In most cases, orthostatic tremor represents an isolated syndrome. Drug treatments are unsatisfactory but surgery may hold promise. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  12. Sympathovagal response to orthostatism in overt and in subclinical hyperthyroidism.

    Science.gov (United States)

    Goichot, B; Brandenberger, G; Vinzio, S; Perrin, A E; Geny, B; Schlienger, J L; Simon, C

    2004-04-01

    Heart rate variability (HRV) is a measure of the physiological variation of R-R intervals, reflecting the sympathovagal balance. In both overt and subclinical hyperthyroidism, a relative increase in sympathetic activity has been demonstrated, mainly due to a decrease in vagal activity. The modifications of HRV during orthostatism in normal subjects resemble those seen in hyperthyroidism. We have studied the response of 19 patients with overt hyperthyroidism and 12 with subclinical hyperthyroidism during orthostatism using HRV and compared the results to those of 32 healthy controls. In the three groups, the R-R intervals decreased in the same proportion after orthostatism. The low frequency power (LF)/[LF + high frequency power (HF)] ratio, which reflects the sympathetic tone, also increased in the same proportion in the three groups. However, the mechanisms of the modulation of the sympathovagal balance during orthostatism were different among the three groups. In controls, the relative increase of sympathetic tone after orthostatism was due principally to a decrease in vagal tone (reflected by decreased power in the HF band), while in overt hyperthyroidism, where the power in the HF band was already minimal in the lying position, there was a clear increase in the LF band power during orthostatism. The results were intermediate in the subclinical hyperthyroidism group, reflecting a continuum of effects of the thyroid hormone excess on the autonomic nervous system. Our study shows that despite an apparent normal cardiovascular adaptation to orthostatism in hyperthyroidism, the modulation of the autonomic nervous system is profoundly modified.

  13. Standing orthostatic blood pressure measurements cannot be replaced by sitting measurements.

    Science.gov (United States)

    Breeuwsma, Anna C; Hartog, Laura C; Kamper, Adriaan M; Groenier, Klaas H; Bilo, Henk Jg; Kleefstra, Nanne; Van Hateren, Kornelis Jj

    2017-08-01

    As many elderly patients are not able to stand for several minutes, sitting orthostatic blood pressure (BP) measurements are sometimes used as an alternative. We aimed to investigate the difference in BP response and orthostatic hypotension (OH) prevalence between the standard postural change to the sitting and the standing position in a cross-sectional observational study. BP was measured with a continuous BP measurement device during two postural changes, from supine to the sitting and from supine to the standing position. Linear mixed models were used to investigate the differences in changes (Δ) of systolic BP (SBP) and diastolic BP (DBP) between the two postural changes. The prevalence and the positive and negative proportions of agreement of OH were calculated of the two postural changes. One hundred and four patients with a mean age of 69 years were included. ΔSBP was significantly larger in the standing position compared with the sitting between 0 and 44 s. ΔDBP was significantly larger in the sitting position compared with the standing 75-224 s after postural change. The prevalence of OH was 66.3% (95% confidence interval (CI) 57.2, 75.4) in the standing position and 67.3% (95% CI 58.3, 76.3) in the sitting position. The positive proportion of agreement was 74.8% and the negative proportion of agreement was 49.3%. A clear difference was seen in BP response between the two postural changes. Although no significant difference in prevalence of OH was observed, the positive and negative proportion of agreement of the prevalence of OH were poor to moderate, which indicates a different outcome between both postural changes.

  14. Subclinical decelerations during developing hypotension in preterm fetal sheep after acute on chronic lipopolysaccharide exposure

    Science.gov (United States)

    Lear, Christopher A.; Davidson, Joanne O.; Galinsky, Robert; Yuill, Caroline A.; Wassink, Guido; Booth, Lindsea C.; Drury, Paul P.; Bennet, Laura; Gunn, Alistair J.

    2015-01-01

    Subclinical (shallow) heart rate decelerations occur during neonatal sepsis, but there is limited information on their relationship with hypotension or whether they occur before birth. We examined whether subclinical decelerations, a fall in fetal heart rate (FHR) that remained above 100 bpm, were associated with hypotension in preterm fetal sheep exposed to lipopolysaccharide (LPS). Chronically-instrumented fetal sheep at 0.7 gestation received continuous low-dose LPS infusions (n = 15, 100 ng/kg over 24 h, followed by 250 ng/kg/24 h for 96 h) or saline (n = 8). Boluses of 1 μg LPS or saline were given at 48 and 72 h. FHR variability (FHRV) was calculated, and sample asymmetry was used to assess the severity and frequency of decelerations. Low-dose LPS infusion did not affect FHR. After the first LPS bolus, 7 fetuses remained normotensive, while 8 developed hypotension (a fall in mean arterial blood pressure of ≥5 mmHg). Developing hypotension was associated with subclinical decelerations, with a corresponding increase in sample asymmetry and FHRV (p < 0.05). The second LPS bolus was associated with similar but attenuated changes in FHR and blood pressure (p < 0.05). In conclusion, subclinical decelerations are not consistently seen during prenatal exposure to LPS, but may be a useful marker of developing inflammation-related hypotension before birth. PMID:26537688

  15. Acarbose improved severe postprandial hypotension in a patient with diabetes mellitus.

    Science.gov (United States)

    Sasaki, E; Goda, K; Nagata, K; Kitaoka, H; Ohsawa, N; Hanafusa, T

    2001-01-01

    Postprandial hypotension (PPH) is defined as a decrease of systolic blood pressure by more than 20 mmHg after meals. Severe PPH is a troublesome diabetic complication, which has no established means of treatment. We encountered a patient who had diabetes mellitus complicated by severe PPH and attempted to treat this problem using several medications (octreotide, midodrine hydrochloride, and acarbose). A 58-year-old male with diabetic triopathy complained of orthostatic dizziness and vertigo after meals. The blood pressure was monitored for 24 h with an ambulatory blood pressure monitor, revealing that the systolic blood pressure decreased markedly after breakfast and dinner by 45 and 50 mmHg, respectively. PPH was not improved by a subcutaneous injection of octreotide. Administration of midodrine hydrochloride reduced the frequency of hypotensive episodes from twice to once daily, but the magnitude of the postprandial fall in blood pressure was still around 30 mmHg. After the patient started to receive acarbose therapy, the postprandial fall in blood pressure was diminished to 18 mmHg and his symptoms largely disappeared. For the treatment of PPH in diabetic patients, our experience suggests that it may be appropriate to try first on alpha-glucosidase inhibitor like acarbose.

  16. Orthostatic change in blood pressure and incidence of atrial fibrillation: results from a bi-ethnic population based study.

    Directory of Open Access Journals (Sweden)

    Sunil K Agarwal

    Full Text Available Autonomic fluctuations are associated with the initiation and possibly maintenance of atrial fibrillation (AF. However, little is known about the relationship between orthostatic blood pressure change, a common manifestation of autonomic dysfunction, and incident AF.We examined whether supine-to-standing changes in systolic blood pressure (SBP are associated with incident AF in 12,071 African American and white men and women aged 45-64 years, enrolled in the Atherosclerosis Risks in Communities (ARIC study. Orthostatic hypotension (OH was defined as a supine-standing drop in SBP by ≥20 mmHg or diastolic blood pressure by ≥10 mmHg. AF cases were identified based on study scheduled 12-lead ECG, hospital discharge ICD codes, and death certificates through 2009.OH was seen in 603 (5% at baseline. During an average follow-up of 18.1 years, 1438 (11.9% study participants developed AF. Incident AF occurred more commonly among those with OH than those without, a rate of 9.3 vs. 6.3 per 1000 person years, (p<0.001. The age, gender, and race adjusted hazard ratio (95%CI of AF among those with OH compared to those without was 1.62 (1.34, 2.14. This association was attenuated after adjustment for common AF risk factors to HR 1.40 (1.15, 1.71, a strength similar to that of diabetes or hypertension with AF in the same model. A non-linear relationship between orthostatic change in SBP and incident AF was present after multivariable adjustment.OH is associated with higher AF incidence. Whether interventions that decrease OH can reduce AF risk remains unknown.

  17. Renal function after prolonged hypotensive anesthesia and surgery in dogs with reduced renal mass.

    Science.gov (United States)

    Stone, E A; Rawlings, C A; Finco, D R; Crowell, W A

    1981-10-01

    The effect of prolonged hypotensive anesthesia and surgery on renal function was studied in 8 dogs with decreased renal mass. Renal mass was reduced by unilateral nephrectomy and ligation of 4 of the 6 terminal renal artery branches of the opposite kidney. One week after reduction in renal mass, the dogs were azotemic with a serum urea nitrogen (SUN) value of 65.8 +/- 11.5 mg/dl. Glomerular filtration rate, as estimated by 14C-inulin clearance, was 0.66 +/- 0.19 ml/kg of body weight/hour. A mean arterial pressure of less than 75 mm of Hg was maintained for 4 hours in dogs given 2.3 +/- 0.7% halothane. An exploratory laparotomy lasting 1 hour was performed. The day after the hypotensive episode, 3 dogs began vomiting, became dehydrated, and had SUN values greater than 100 mg/dl. The SUN values returned to base-line values after the dogs were rehydrated. Eight days after the hypotensive episode, 14C-inulin clearance decreased 15.2 +/- 8.2% (P less than 0.005) compared with base-line clearance values. Light microscopic and electron microscopic observations of the kidneys did not demonstrate acute renal failure. Prolonged hypotensive anesthesia can cause a decrease in renal function, and may cause prerenal uremia and/or acute renal failure.

  18. Vasorelaxing Action of the Kynurenine Metabolite, Xanthurenic Acid: The Missing Link in Endotoxin-Induced Hypotension?

    Directory of Open Access Journals (Sweden)

    Carmine Vecchione

    2017-05-01

    Full Text Available The kynurenine pathway of tryptophan metabolism is activated by pro-inflammatory cytokines. L-kynurenine, an upstream metabolite of the pathway, acts as a putative endothelium-derived relaxing factor, and has been hypothesized to play a causative role in the pathophysiology of inflammation-induced hypotension. Here, we show that xanthurenic acid (XA, the transamination product of 3-hydroxykynurenine, is more efficacious than L-kynurenine in causing relaxation of a resistance artery, but fails to relax pre-contracted aortic rings. In the mesenteric artery, XA enhanced activating phosphorylation of endothelial nitric oxide synthase (NOS, and the relaxing action of XA was abrogated by pharmacological inhibition of NOS and endothelial-derived hyperpolarizing factor. Systemic injection of XA reduced blood pressure in mice, and serum levels of XA increased by several fold in response to a pulse with the endotoxin, lipopolysaccharide (LPS. LPS-induced hypotension in mice was prevented by pre-treatment with the kynurenine monooxygenase (KMO inhibitor, Ro-618048, which lowered serum levels of XA but enhanced serum levels of L-kynurenine. UPF 648, another KMO inhibitor, could also abrogate LPS-induced hypotension. Our data identify XA as a novel vasoactive compound and suggest that formation of XA is a key event in the pathophysiology of inflammation-induced hypotension.

  19. Orthostatic Dysregulation during Postural Change on the Dental Chair and Intraoperative Monitoring by Heart Rate Variability Analysis

    Directory of Open Access Journals (Sweden)

    Yukihiro Momota

    2014-01-01

    Full Text Available This is the first case report of orthostatic dysregulation (OD manifested during postural change on the dental chair and intraoperatively monitored by heart rate variability (HRV analysis. OD-associated autonomic dysfunction is induced by postural changes and easily leads to disturbance in circulatory dynamics; however, most dental practices have not yet realized the importance of managing OD. We measured autonomic activity in a patient with OD during dental therapy and assessed the clinical significance of HRV analysis for OD. The patient was a 17-year-old Japanese female. She was diagnosed with impacted wisdom teeth and had no previous history of a distinct systemic disease. A surgical procedure to extract the teeth was safely performed under both local anesthesia and sedation with nitrous oxide and midazolam. After the surgery, her postural change to sitting induced orthostatic hypotension. HRV variables showed parasympathetic dominance due to the upright position. Subsequently, her posture was returned to supine, and atropine sulfate administration for the immediate treatment of OD returned her blood pressure to normal levels. HRV variables showed relative sympathetic dominance due to an atropine-derived parasympathetic blockade. HRV analysis revealed OD-associated autonomic dysfunction and should become a standard tool for safe and secure dental management of OD.

  20. Autonomic control of heart rate during orthostasis and the importance of orthostatic-tachycardia in the snake Python molurus.

    Science.gov (United States)

    Armelin, Vinicius Araújo; da Silva Braga, Victor Hugo; Abe, Augusto Shinya; Rantin, Francisco Tadeu; Florindo, Luiz Henrique

    2014-10-01

    Orthostasis dramatically influences the hemodynamics of terrestrial vertebrates, especially large and elongated animals such as snakes. When these animals assume a vertical orientation, gravity tends to reduce venous return, cardiac filling, cardiac output and blood pressure to the anterior regions of the body. The hypotension triggers physiological responses, which generally include vasomotor adjustments and tachycardia to normalize blood pressure. While some studies have focused on understanding the regulation of these vasomotor adjustments in ectothermic vertebrates, little is known about regulation and the importance of heart rate in these animals during orthostasis. We acquired heart rate and carotid pulse pressure (P PC) in pythons in their horizontal position, and during 30 and 60° inclinations while the animals were either untreated (control) or upon muscarinic cholinoceptor blockade and a double autonomic blockade. Double autonomic blockade completely eradicated the orthostatic-tachycardia, and without this adjustment, the P PC reduction caused by the tilts became higher than that which was observed in untreated animals. On the other hand, post-inclinatory vasomotor adjustments appeared to be of negligible importance in counterbalancing the hemodynamic effects of gravity. Finally, calculations of cardiac autonomic tones at each position revealed that the orthostatic-tachycardia is almost completely elicited by a withdrawal of vagal drive.

  1. Noninvasive beat-to-beat finger arterial pressure monitoring during orthostasis : a comprehensive review of normal and abnormal responses at different ages

    NARCIS (Netherlands)

    van Wijnen, V K; Finucane, C; Harms, M P M; Nolan, H; Freeman, R L; Westerhof, B. E.; Kenny, R A; Ter Maaten, J C; Wieling, W

    2017-01-01

    Over the past 30years, noninvasive beat-to-beat blood pressure (BP) monitoring has provided great insight into cardiovascular autonomic regulation during standing. Although traditional sphygmomanometric measurement of BP may be sufficient for detection of sustained orthostatic hypotension, it fails

  2. Orthostatic intolerance and the cardiovascular response to early postoperative mobilization

    DEFF Research Database (Denmark)

    Bundgaard-Nielsen, M; Jørgensen, Christoffer Calov; Jørgensen, T B

    2009-01-01

    BACKGROUND: A key element in enhanced postoperative recovery is early mobilization which, however, may be hindered by orthostatic intolerance, that is, an inability to sit or stand because of symptoms of cerebral hypoperfusion as intolerable dizziness, nausea and vomiting, feeling of heat...... of orthostatic intolerance. In contrast, 8 (50%) and 2 (12%) patients were orthostatic intolerant at 6 and approximately 22 h after surgery, respectively. Before surgery, SAP, DAP, and TPR increased (P0.05) and Scv(O2) decreased (P... the preoperative evaluation (P>0.05). CONCLUSIONS: The early postoperative postural cardiovascular response is impaired after radical prostatectomy with a risk of orthostatic intolerance, limiting early postoperative mobilization. The pathogenic mechanisms include both impaired TPR and CO responses....

  3. Nimodipine-induced hypotension but not nitroglycerin-induced hypotension preserves long- and short-term memory in adult mice.

    Science.gov (United States)

    Haile, Michael; Galoyan, Samuel; Li, Yong-Sheng; Cohen, Barry H; Quartermain, David; Blanck, Thomas; Bekker, Alex

    2012-05-01

    Acute hypotension may be implicated in cognitive dysfunction. L-type calcium channel blockers in the setting of hypoxia are protective of learning and memory. We tested the hypothesis that hypotension induced by nimodipine (NIMO) and nicardipine (NICA) would be protective of long- and short-term memory compared to hypotension induced by nitroglycerin (NTG). Forty Swiss-Webster mice (30 to 35 g, 6 to 8 weeks) were randomized into 4 groups for i.p. injection immediately after passive avoidance (PA) learning on day 0: (1) NTG (30 mg/kg); (2) NICA (40 mg/kg); (3) NIMO (40 mg/kg); and (4) saline. PA training latencies (seconds) were recorded for entry from a suspended platform into a Plexiglas tube where a shock (0.3 mA; 2-second duration) was automatically delivered. On day 2 latencies were recorded during a testing trial during which no shock was delivered. Latencies >900 seconds were assigned this value. Lower testing latency is indicative of an impairment of long-term associative memory. Forty-nine additional mice were randomized into similar groups for object recognition testing (ORT) and given i.p. injections on day 0. ORT measures short-term memory by exploiting the tendency of mice to prefer novel objects where a familiar object is present. On day 5 during training, 2 identical objects were placed in a circular arena and mice explored both for 15 minutes. A testing trial was conducted 1 hour later for 3 minutes after a novel object replaced a familiar one. Mice with intact memory spend about 65% of the time exploring the novel object. Mice with impaired memory devote equal time to each object. Recognition index (RI) is defined as the ratio of time spent exploring the novel object to time spent exploring both objects was the measure of memory. Mean arterial blood pressure (MAP), cerebral bloodflow, and body and brain oxygenation (PO(2)) studies were done in separate groups of mice to determine the dosages for matched degrees of hypotension and the physiological

  4. Corticosteroids for treating hypotension in preterm infants.

    Science.gov (United States)

    Ibrahim, Hafis; Sinha, Ian P; Subhedar, Nimish V

    2011-12-07

    Systemic hypotension is a relatively common complication of preterm birth and is associated with periventricular haemorrhage, periventricular white matter injury and adverse neurodevelopmental outcome. Corticosteroid treatment has been used as an alternative or an adjunct to conventional treatment with volume expansion and vasopressor/inotropic therapy. To determine the effectiveness and safety of corticosteroids used either as primary treatment of hypotension or for the treatment of refractory hypotension in preterm infants. Randomized or quasi-randomised controlled trials were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2011), MEDLINE (1996 to Jan 2011), EMBASE (1974 to Jan 2011), CINAHL (1981 to 2011), reference lists of published papers and abstracts from the Pediatric Academic Societies and the European Society for Pediatric Research meetings published in Pediatric Research (1995 to 2011). We included all randomised or quasi-randomised controlled trials investigating the effect of corticosteroid therapy in the treatment of hypotension in preterm infants (babies with hypotension resistant to inotropes/pressors and volume therapy. We included studies comparing oral/intravenous corticosteroids with placebo, other drugs used for providing cardiovascular support or no therapy in this review. Methodological quality of eligible studies was assessed according to the methods used for minimising selection bias, performance bias, attrition bias and detection bias. Studies that evaluated corticosteroids (1) as primary treatment for hypotension or (2) for refractory hypotension unresponsive to prior use of inotropes/pressors and volume therapy, were analysed using separate comparisons. Data were analysed using the standard methods of the Neonatal Review Group using Rev Man 5.1.2. Treatment effect was analysed using relative risk, risk reduction, number needed to treat for categorical outcomes and

  5. A review of postural orthostatic tachycardia syndrome.

    LENUS (Irish Health Repository)

    Carew, Sheila

    2012-01-31

    A 21-year-old female reports an 18-month history of light-headedness on standing. This is often associated with palpitations and a feeling of intense anxiety. She has had two black-outs in the past 12 months. She is not taking any regular medications. Her supine blood pressure was 126\\/84 mmHg with a heart rate of 76 bpm, and her upright blood pressure was 122\\/80 mmHg with a heart rate of 114 bpm. A full system examination was otherwise normal. She had a 12-lead electrocardiogram performed which was unremarkable. She was referred for head-up tilt testing. She was symptomatic during the test and lost consciousness at 16 min. Figure 1 summarizes her blood pressure and heart rate response to tilting. A diagnosis of postural orthostatic tachycardia syndrome with overlapping vasovagal syncope was made.

  6. Postural Orthostatic Tachycardia Syndrome (POTS) in Denmark

    DEFF Research Database (Denmark)

    Brinth, Louise; Pors, Kirsten; Spahic, Jasmina Medic

    2018-01-01

    " 1997-2014 was retrieved from PubMed and related to yearly POTS incidence. RESULTS: Eight-hundred-and-seventy-five tests with suspected POTS were thoroughly evaluated. The reclassification of test results yielded 243 POTS diagnoses (age, 27.0 ± 11.8 years). An increase in total number of POTS diagnoses...... was observed but the proportion of POTS-positive tests per year was relatively constant (≈2-3%) except for the period 2013-2014 (≈7%). The increase in POTS diagnoses was preceded by an increase in number of POTS-related papers in PubMed. CONCLUSION: The proportion of POTS diagnoses among patients investigated...... for suspected syncope and/or orthostatic intolerance was relatively constant 1997-2012. The growing number of POTS-related publications in PubMed preceded the steep increase in diagnostic rate of POTS observed after 2012....

  7. [131I] Hippuran renography in the detection of orthostatic hypertension

    International Nuclear Information System (INIS)

    Clorius, J.H.; Kjelle-Schweigler, M.; Ostertag, H.; Moehring, K.

    1978-01-01

    Scintigrams in prone and standing positions were done in 11 hypertensive women. All had nephroptosis with ventral rotation. On the basis of the renograms, seven patients were identified as suffering from orthostatic hypertension. Nephropexy resulted in normalization of blood pressure in six of the seven patients and normalization of the renograms of all seven. We believe that sequence scintigrams in prone and standing positions offer a simple method of identifying patients with orthostatic hypertension

  8. Orthostatic Intolerance in Older Persons: Etiology and Countermeasures

    Directory of Open Access Journals (Sweden)

    Nandu Goswami

    2017-11-01

    Full Text Available Orthostatic challenge produced by upright posture may lead to syncope if the cardiovascular system is unable to maintain adequate brain perfusion. This review outlines orthostatic intolerance related to the aging process, long-term bedrest confinement, drugs, and disease. Aging-associated illness or injury due to falls often leads to hospitalization. Older patients spend up to 83% of hospital admission lying in bed and thus the consequences of bedrest confinement such as physiological deconditioning, functional decline, and orthostatic intolerance represent a central challenge in the care of the vulnerable older population. This review examines current scientific knowledge regarding orthostatic intolerance and how it comes about and provides a framework for understanding of (patho- physiological concepts of cardiovascular (in- stability in ambulatory and bedrest confined senior citizens as well as in individuals with disease conditions [e.g., orthostatic intolerance in patients with diabetes mellitus, multiple sclerosis, Parkinson's, spinal cord injury (SCI] or those on multiple medications (polypharmacy. Understanding these aspects, along with cardio-postural interactions, is particularly important as blood pressure destabilization leading to orthostatic intolerance affects 3–4% of the general population, and in 4 out of 10 cases the exact cause remains elusive. Reviewed also are countermeasures to orthostatic intolerance such as exercise, water drinking, mental arithmetic, cognitive training, and respiration training in SCI patients. We speculate that optimally applied countermeasures such as mental challenge maintain sympathetic activity, and improve venous return, stroke volume, and consequently, blood pressure during upright standing. Finally, this paper emphasizes the importance of an active life style in old age and why early re-mobilization following bedrest confinement or bedrest is crucial in preventing orthostatic intolerance, falls

  9. ORTHO-LBNP: A new apparatus for assessing autocontrol mechanisms of the heart-vessel system in pilots undergoing training in conditions of ischemic hypoxia and orthostatic stress

    Science.gov (United States)

    Truszczynski, Olaf; Skibniewski, Franciszek; Dziuda, Lukasz; Gacek, Adam; Krej, Mariusz; Sobotnicki, Aleksander; Rajchel, Jan; Bylinka, Marek; Burek, Michal

    The authors present a new system for examining the behaviour of the human body and cerebral circulation in conditions of ischemic hypoxia and orthostatic stress that can cause orthostatic hypotension. Ischemic hypoxia affects mainly pilots of highly manoeuvrable aircraft, where long-lasting G forces not seldom reach 6-8 +Gz and can exceed the gravitational acceleration by ten times or more. Additionally, pilots are subjected to orthostatic hypotension in which abnormally low blood pressure is caused by pressure adjustment disorder and decreased stroke volume when changing body position rapidly. For several decades, these effects have been deeply investigated using human centrifuges or lower body negative pressure (LBNP) chambers. The latter method involves significantly less financial resources to carry out experiments and training, whereas the effects exerted on pilots, and the results of the training can be comparable. A group of researchers from the Military Institute of Aviation Medicine, Warszawa, Poland, and the Institute of Medical Technology and Equipment ITAM, Zabrze, Poland, are developing the innovative ORTHO-LBNP device based on the cradle principle and the LBNP method. The system will be implemented in a modern programme for training cadets of the Polish Air Force Academy, Dęblin, Poland. Together with other equipment such as a high-G centrifuge, pressure chambers, flight and spatial disorientation simulators as well as gymnastic training equipment for pilots (GTEP), the ORTHO-LBNP apparatus will be an element of the selection system of candidates for aviation. It is expected that the experimental studies will result in developing new indicators providing an objective assessment, whether examined persons possess the traits necessary for performing tasks related to the job of a pilot. It is highly probable that those indicators can be incorporated into routine checks for pilots, which in turn, can lead to improving the safety of flight operations and

  10. Refractory hypotension due to Rogaine® (minoxidil) ingestion managed with midodrine.

    Science.gov (United States)

    Garrard, Alexander; Wood, Adam; Sollee, Dawn; Aaronson, Patrick

    2011-12-01

    Minoxidil (Rogaine®) is a direct vasodilator that can cause significant toxicity when ingested. We report a case of ingestion of topical minoxidil [Rogaine® (Johnson & Johnson Healthcare Products, Division of McNeil-PPC, Inc)] resulting in refractory hypotension that was successfully managed with the oral α (1) agonist midodrine. A 48-year-old male who ingested an eight ounce bottle of Rogaine® presented to the emergency department. The patient presented with a blood pressure of 57/45 mmHg and a pulse of 84 beats per minute. The patient received IV fluids and multiple vasopressors to maintain an adequate mean arterial pressure. Midodrine, an oral α (1) vasopressor, was added 10 hours post ingestion and was able to maintain an adequate mean arterial pressure. Over the next two days, midodrine was titrated down as his blood pressure returned to baseline. Midodrine may serve as an additional option to treat toxicant induced hypotension.

  11. Differential effects of beta-adrenoceptor partial agonists in patients with postural hypotension

    DEFF Research Database (Denmark)

    Mehlsen, J; Stadeager, C; Trap-Jensen, J

    1993-01-01

    patients with postural hypotension of different aetiologies. Blood pressure, heart rate and stroke volume were measured in the supine and head-up tilted positions. Left ventricular ejection fraction (LVEF) was measured in the supine position, and vascular resistance, left ventricular volume, and left.......min-1 and LVEF from 0.57 to 0.52, and reduced mean arterial blood pressure from 103 mm Hg to 93 mm Hg. Xamoterol showed beta-adrenoceptor agonistic effects in the supine position through increments in heart rate from 72 to 90 beats.min-1 and LVEF from 0.58 to 0.66, and raised mean arterial blood...... pressure from 108 to 123 mm Hg. It is concluded that the degree of agonist activity of a beta-adrenergic agent is of importance if it is given to a patient with postural hypotension....

  12. Aerobic Exercise Training Improves Orthostatic Tolerance in Aging Humans.

    Science.gov (United States)

    Xu, Diqun; Wang, Hong; Chen, Shande; Ross, Sarah; Liu, Howe; Olivencia-Yurvati, Albert; Raven, Peter B; Shi, Xiangrong

    2017-04-01

    This study was designed to test the hypothesis that aerobic exercise training of the elderly will increase aerobic fitness without compromising orthostatic tolerance (OT). Eight healthy sedentary volunteers (67.0 ± 1.7 yr old, four women) participated in 1 yr of endurance exercise training (stationary bicycle and/or treadmill) program at the individuals' 65%-75% of HRpeak. Peak O2 uptake (V˙O2peak) and HRpeak were determined by a maximal exercise stress test using a bicycle ergometer. Carotid baroreceptor reflex (CBR) control of HR and mean arterial pressure (MAP) were assessed by a neck pressure-neck suction protocol. Each subject's maximal gain (Gmax), or sensitivity, of the CBR function curves were derived from fitting their reflex HR and MAP responses to the corresponding neck pressure-neck suction stimuli using a logistic function curve. The subjects' OT was assessed using lower-body negative pressure (LBNP) graded to -50 mm Hg; the sum of the product of LBNP intensity and time (mm Hg·min) was calculated as the cumulative stress index. Training increased V˙O2peak (before vs after: 22.8 ± 0.92 vs 27.9 ± 1.33 mL·min·kg, P stress index was increased from 767 ± 68 mm Hg·min pretraining to 946 ± 44 mm Hg·min posttraining (P Aerobic exercise training improved the aerobic fitness and OT in elderly subjects. An improved OT is likely associated with an enhanced CBR function that has been reset to better maintain cerebral perfusion and cerebral tissue oxygenation during LBNP.

  13. Orthognathic surgery with or without induced hypotension.

    Science.gov (United States)

    Carlos, E; Monnazzi, M S; Castiglia, Y M M; Gabrielli, M F R; Passeri, L A; Guimarães, N C

    2014-05-01

    This study involved a retrospective evaluation of patients subjected to surgery for dentofacial deformities treated without induced controlled hypotension (group I, n=50) and a prospective evaluation of patients who were subjected to surgery under hypotensive general anaesthesia (group II, n=50). No statistical differences were found between the study groups with regard to the duration of surgery. However, there were statistically significant differences in the need for blood transfusion and the occurrence of bradycardia during the maxillary down-fracture. Hypotensive anaesthesia decreased the need for a blood transfusion and the occurrence of bradycardia, and is therefore considered highly beneficial for patients undergoing orthognathic surgery. Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  14. Peculiarities of psychological, clinical and instrumental indicators in children with vegetative dysfunction and hypotension under the influence of innovative psychocorrective program

    Directory of Open Access Journals (Sweden)

    I.O. Mitjurjajeva

    2017-03-01

    Full Text Available Background. To study the features of psychological state, clinical and instrumental parameters in children with vegetative dysfunction (VD and hypotension influenced by comprehensive treatment with the inclusion of the innovative psychocorrective program with elements of music therapy, visual art therapy and gelotology. Materials and methods. The study included 57 patients with VD and hypotension aged 12 to 17 years, 37 of them received psychotherapy with innovative program “Our drugs — music, laughter, creativity” in comprehensive treatment, 20 children (control group received basic treatment without psychological assistance. General clinical, laboratory, instrumental and psychodiagnostic studies were performed both in main and control groups. Results. Using innovative psychocorrective program in children with VD and hypotension as a part of comprehensive treatment contributed to the improvement of clinical and instrumental data: number of cases with autonomic influences on the heart reduced (from 22.1 to 5.25 %, р < 0.05, orthostatic test autonomic provision was normalized in 40.5 % of children, psychological state improvement was observed in 74.1 % of cases. Conclusions. Innovative psychocorrective program with elements of music therapy, visual art therapy and gelotology can be recommended as a part of comprehensive treatment of children with VD and hypotension in hospital environment and in future psychological support of patients.

  15. Simulated stand tests and centrifuge training to prevent orthostatic intolerance on Earth, moon, and Mars.

    Science.gov (United States)

    Coats, Brandon W; Sharp, M Keith

    2010-03-01

    One proposed method to overcome postflight orthostatic intolerance is for astronauts to undergo inflight centrifugation. Cardiovascular responses were compared between centrifuge and gravitational conditions using a seven-compartment cardiovascular model. Vascular resistance, heart rate, and stroke volume values were adopted from literature, while compartmental volumes and compliances were derived from impedance plethysmography of subjects (n=8) riding on a centrifuge. Three different models were developed to represent the typical male subject who completed a 10-min postflight stand test ("male finisher"), "non-finishing male" and "female" (all non-finishers). A sensitivity analysis found that both cardiac output and arterial pressure were most sensitive to total blood volume. Simulated stand tests showed that female astronauts were more susceptible to orthostatic intolerance due to lower initial blood pressure and higher pressure threshold for presyncope. Rates of blood volume loss by capillary filtration were found to be equivalent in female and male non-finishers, but four times smaller in male finishers. For equivalent times to presyncope during centrifugation as those during constant gravity, lower G forces at the level of the heart were required. Centrifuge G levels to match other cardiovascular parameters varied depending on the parameter, centrifuge arm length, and the gravity level being matched.

  16. Skin cooling maintains cerebral blood flow velocity and orthostatic tolerance during tilting in heated humans

    Science.gov (United States)

    Wilson, Thad E.; Cui, Jian; Zhang, Rong; Witkowski, Sarah; Crandall, Craig G.

    2002-01-01

    Orthostatic tolerance is reduced in the heat-stressed human. The purpose of this project was to identify whether skin-surface cooling improves orthostatic tolerance. Nine subjects were exposed to 10 min of 60 degrees head-up tilting in each of four conditions: normothermia (NT-tilt), heat stress (HT-tilt), normothermia plus skin-surface cooling 1 min before and throughout tilting (NT-tilt(cool)), and heat stress plus skin-surface cooling 1 min before and throughout tilting (HT-tilt(cool)). Heating and cooling were accomplished by perfusing 46 and 15 degrees C water, respectively, though a tube-lined suit worn by each subject. During HT-tilt, four of nine subjects developed presyncopal symptoms resulting in the termination of the tilt test. In contrast, no subject experienced presyncopal symptoms during NT-tilt, NT-tilt(cool), or HT-tilt(cool). During the HT-tilt procedure, mean arterial blood pressure (MAP) and cerebral blood flow velocity (CBFV) decreased. However, during HT-tilt(cool), MAP, total peripheral resistance, and CBFV were significantly greater relative to HT-tilt (all P heat-stressed humans.

  17. Genetics and molecular biology of hypotension

    Science.gov (United States)

    Robertson, D.

    1994-01-01

    Major strides in the molecular biology of essential hypertension are currently underway. This has tended to obscure the fact that a number of inherited disorders associated with low blood pressure exist and that these diseases may have milder and underrecognized phenotypes that contribute importantly to blood pressure variation in the general population. This review highlights some of the gene products that, if abnormal, could cause hypotension in some individuals. Diseases due to abnormalities in the catecholamine enzymes are discussed in detail. It is likely that genetic abnormalities with hypotensive phenotypes will be as interesting and diverse as those that give rise to hypertensive disorders.

  18. Graded Association Between Kidney Function and Impaired Orthostatic Blood Pressure Stabilization in Older Adults.

    Science.gov (United States)

    Canney, Mark; O'Connell, Matthew D L; Sexton, Donal J; O'Leary, Neil; Kenny, Rose Anne; Little, Mark A; O'Seaghdha, Conall M

    2017-05-04

    Impaired orthostatic blood pressure (BP) stabilization is highly prevalent in older adults and is a predictor of end-organ injury, falls, and mortality. We sought to characterize the relationship between postural BP responses and the kidney. We performed a cross-sectional analysis of 4204 participants from The Irish Longitudinal Study on Ageing, a national cohort of community-dwelling adults aged ≥50 years. Beat-to-beat systolic and diastolic BP were measured during a 2-minute active stand test. The primary predictor was cystatin C estimated glomerular filtration rate (eGFR) categorized as follows (mL/min per 1.73 m 2 ): ≥90 (reference, n=1414); 75 to 89 (n=1379); 60 to 74 (n=942); 45 to 59 (n=337); postural BP response merits further study in kidney disease as a potential means of identifying those at risk of hypotension-related events. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  19. Cardiac Organ Damage and Arterial Stiffness in Autonomic Failure: Comparison With Essential Hypertension.

    Science.gov (United States)

    Milazzo, Valeria; Maule, Simona; Di Stefano, Cristina; Tosello, Francesco; Totaro, Silvia; Veglio, Franco; Milan, Alberto

    2015-12-01

    Autonomic failure (AF) is characterized by orthostatic hypotension, supine hypertension, and increased blood pressure (BP) variability. AF patients develop cardiac organ damage, similarly to essential hypertension (EH), and have higher arterial stiffness than healthy controls. Determinants of cardiovascular organ damage in AF are not well known: both BP variability and mean BP values may be involved. The aim of the study was to evaluate cardiac organ damage, arterial stiffness, and central hemodynamics in AF, compared with EH subjects with similar 24-hour BP and a group of healthy controls, and to evaluate determinants of target organ damage in patients with AF. Twenty-seven patients with primary AF were studied (mean age, 65.7±11.2 years) using transthoracic echocardiography, carotid-femoral pulse wave velocity, central hemodynamics, and 24-hour ambulatory BP monitoring. They were compared with 27 EH subjects matched for age, sex, and 24-hour mean BP and with 27 healthy controls. AF and EH had similar left ventricular mass (101.6±33.3 versus 97.7±28.1 g/m(2), P=0.59) and carotid-femoral pulse wave velocity (9.3±1.8 versus 9.2±3.0 m/s, P=0.93); both parameters were significantly lower in healthy controls (Phypertensive heart disease and increased arterial stiffness, similar to EH with comparable mean BP values. Twenty-four-hour and nighttime systolic BP were determinants of cardiovascular damage, independent of BP variability. © 2015 American Heart Association, Inc.

  20. Predicting spinal hypotension during Caesarean section

    African Journals Online (AJOL)

    There is a significant body of recent work which has looked at the haemodynamic changes which occur under spinal anaesthesia and the effects of various treatment regimens on these changes. It has long been held that the dominant mechanism of hypotension in the patient for Caesarean section is caval compression.9.

  1. Hypotensive Anesthesia Is Associated With Shortened Length of Hospital Stay Following Orthognathic Surgery.

    Science.gov (United States)

    Ettinger, Kyle S; Yildirim, Yavuz; Weingarten, Toby N; Van Ess, James M; Viozzi, Christopher F; Arce, Kevin

    2016-01-01

    To evaluate the impact of induced hypotensive anesthesia on length of hospital stay (LOS) for patients undergoing maxillary Le Fort I osteotomy in isolation or in combination with mandibular orthognathic surgery. A retrospective cohort study design was implemented and patients undergoing a Le Fort I osteotomy as a component of orthognathic surgery at the Mayo Clinic from 2010 through 2014 were identified. The primary predictor variable was the presence of induced hypotensive anesthesia during orthognathic surgery. Hypotensive anesthesia was defined as at least 10 consecutive minutes of a mean arterial pressure no higher than 60 mmHg documented within the anesthetic record. The primary outcome variable was LOS in hours after completion of orthognathic surgery. The secondary outcome variable was the duration of surgery in hours. Multiple covariates also abstracted included patient age, patient gender, American Society of Anesthesiologists score, complexity of surgical procedure, and volume of intraoperative fluids administered during surgery. Univariable and multivariable models were developed to evaluate associations between the primary predictor variable and covariates relative to the primary and secondary outcome variables. A total of 117 patients were identified undergoing Le Fort I orthognathic surgery in isolation or in combination with mandibular surgery. Induced hypotensive anesthesia was significantly associated with shortened LOS (odds ratio [OR] = 0.33; 95% confidence interval [CI], 0.12-0.88; P = .026) relative to patients with normotensive regimens. This association between hypotensive anesthesia and LOS remained statistically significant in a subgroup analysis of 47 patients in whom isolated Le Fort I surgery was performed (OR = 0.13; 95% CI, 0.03-0.62; P = .010). Induced hypotensive anesthesia was not statistically associated with shorter duration of surgery. Induced hypotensive anesthesia represents a potential factor that minimizes

  2. Hydrocortisone administration for the treatment of refractory hypotension in critically ill newborns.

    Science.gov (United States)

    Baker, C F W; Barks, J D E; Engmann, C; Vazquez, D M; Neal, C R; Schumacher, R E; Bhatt-Mehta, V

    2008-06-01

    The purpose of this observation was to evaluate the safety and efficacy of hydrocortisone (HC) for the treatment of refractory hypotension in term and preterm infants. A secondary purpose was to determine the utility of serum cortisol concentrations in predicting the response to treatment. This is a retrospective observational study of 117 infants treated with a standardized HC protocol for refractory hypotension. Refractory hypotension was defined as a mean arterial pressure (MAP) less than the gestational age (GA) despite a total inotrope dose of 20 microg per kg per min. Baseline serum cortisol concentrations were determined prior to treatment with stress dose HC. Treatment with HC increased the MAP at 2, 6, 12 and 24 h after initiation, decreased the total inotrope dose at 6, 12 and 24 h, and was associated with resolution of oliguria. There was no correlation between the pretreatment baseline cortisol concentration and GA, birth weight or the response to treatment. The incidence of grades III to IV intraventricular hemorrhage, periventricular leukomalacia, bacterial or fungal sepsis and spontaneous intestinal perforation (SIP) after HC treatment was similar to institutional historic controls prior to institution of this standardized HC protocol. HC treatment was associated with a rapid resolution of cardiovascular compromise. The incidence of significant side effects was similar to that in previously published reports, including a comparable incidence of SIP. On the basis of our results, measuring baseline serum cortisol concentration to guide the management of refractory hypotension is unwarranted.

  3. Aortic stiffness and hypotension episodes are associated with impaired cognitive function in older subjects with subjective complaints of memory loss.

    Science.gov (United States)

    Scuteri, Angelo; Tesauro, Manfredi; Guglini, Letizia; Lauro, Davide; Fini, Massimo; Di Daniele, Nicola

    2013-11-20

    Though CV risk factors and markers of arterial aging are recognized risky for cognition, no study has simultaneously investigated the impact of multiple cardiac, arterial (large and small vessels), and hemodynamic parameters on cognitive function in older subjects. Two hundred eighty older subjects with subjective complaints of memory loss and no previous stroke (mean age 78.3 ± 6.3 years) were studied. Global cognitive function was evaluated with the Mini-Mental State Examination (MMSE). Cognitive impairment was defined as a MMSE cognitive function-controlling for age, sex, education, depression, traditional CV risk factors, and medications. LV mass was no longer associated with cognition in multiple regression. Older subjects with stiffer arteries or episodes of hypotension presented a 4-fold and an 11-fold, respectively, greater odds for progression from normal cognitive function to cognitive impairment. A synergistic effect between PWV, WML, and hypotension was observed: the occurrence of any two of PWV, WML, or hypotension was accompanied by lower MMSE; in the presence of all three factors, a further significant decline in cognitive function was observed. Systemic hemodynamic parameters (higher PWV and hypotension) together with cerebral microvascular damage (WML) are significantly associated with poorer cognitive function and may identify older subjects with subjective complaints of memory loss at higher risk of cognitive decline. © 2013.

  4. Orthostatic intolerance during early mobilization after fast-track hip arthroplasty

    DEFF Research Database (Denmark)

    Jans, O; Bundgaard-Nielsen, M; Solgaard, S

    2012-01-01

    has not been established after THA. This study evaluated the cardiovascular response and tissue oxygenation to mobilization before and after surgery in relation to OI in fast-track THA patients. METHODS: /st>OI and the cardiovascular response to standing were evaluated with a standardized mobilization......BACKGROUND: /st>Early postoperative mobilization is a cornerstone in fast-track total hip arthroplasty (THA), but postoperative orthostatic intolerance (OI) may delay early recovery or lead to fainting, falls, and prosthesis dislocation or fracture. However, the prevalence and pathophysiology of OI...... protocol, before, 6, and 24 h after surgery in 26 patients undergoing THA with spinal anaesthesia and an opioid-sparing analgesic regime. Haemoglobin, fluid balance, and opioid use were recorded. Systolic (SAP) and diastolic (DAP) arterial pressure, heart rate (HR), stroke volume (SV), cardiac output (CO...

  5. Evaluation of risk of falls and orthostatic hypotension in older, long-term topical beta-blocker users

    NARCIS (Netherlands)

    Ramdas, Wishal D.; van der Velde, Nathalie; van der Cammen, Tischa J. M.; Wolfs, Roger C. W.

    2009-01-01

    Falls are a serious problem in the elderly, and have recently been described as cardiovascular-mediated side effects of beta-blocker eye drops. Therefore, we investigated the possible association between the long-term use of beta-blockers, prostaglandins and their combinations in eye drops, and

  6. Evaluation of risk of falls and orthostatic hypotension in older, long-term topical beta-blocker users

    NARCIS (Netherlands)

    W.D. Ramdas (Wishal); N. van der Velde (Nathalie); T.J.M. van der Cammen (Tischa); R.C.W. Wolfs (Roger)

    2009-01-01

    textabstractBackground: Falls are a serious problem in the elderly, and have recently been described as cardiovascular-mediated side effects of beta-blocker eye drops. Therefore, we investigated the possible association between the long-term use of beta-blockers, prostaglandins and their

  7. Influência do uso crônico dos inibidores da enzima conversora da angiotensina na hipotensão arterial após indução anestésica: é necessário suspender esse fármaco no pré-operatório? Influencia del uso crónico de los inhibidores de la enzima conversora de la angiotensina en la hipotensión arterial después de la inducción anestésica: ¿es necesario suspender ese fármaco en el preoperatorio? Influence of angiotensin-converting enzyme inhibitors on hypotension after anesthetic induction: is the preoperative discontinuation of this drug necessary?

    Directory of Open Access Journals (Sweden)

    Verônica Vieira da Costa

    2009-12-01

    anestesia. Como controles fueron seleccionados pacientes de la misma franja etaria y sexo, sometidos a la intervención quirúrgica en el mismo período de los casos y que no presentaron hipotensión arterial. Las variables de interés fueron las siguientes: edad, sexo, porte quirúrgico, diagnóstico previo de hipertensión arterial sistémica (HAS, uso de IECA, estado físico (ASA, sangramiento en el intraoperatorio, técnica anestésica y tiempo quirúrgico. RESULTADOS: Cuarenta pacientes presentaron hipotensión arterial, en un total de 2.179 operaciones. De ellos, 20 usaron IECA el día de la operación. El grupo control estuvo compuesto por 171 pacientes, de los cuales 11 usaron IECA. En el análisis univariado, se encontró una asociación entre la hipotensión arterial y la edad avanzada (p BACKGROUND AND OBJECTIVES: The discontinuation of drugs such as angiotensin-converting enzyme inhibitors (ACE inhibitors has been suggested based on reports of hypotension during anesthesia. This may imply on a higher risk of intraoperative hypertensive peaks with deleterious consequences for the patient. The objective of the present study was to evaluate the influence of the preoperative use of ACE inhibitors on the development of hypotension during anesthesia. METHODS: This is a case-controlled study of patients who developed hypotension after anesthetic induction. The control group was composed of patients of the same age and gender who underwent surgeries during the same period and who did not develop hypotension. Parameters of interest included: age, gender, size of the surgery, prior diagnosis of hypertension, use of ACE inhibitors, physical status (ASA, intraoperative bleeding, anesthetic technique, and duration of the surgery. RESULTS: In 2,179 surgeries, 40 patients developed hypotension. Twenty of those patients used ACEIs on the day of the surgery. The control group was composed by 171 patients, 11 of which used ACE inhibitors. Univariate analysis showed an association

  8. In vivo hypotensive effect and in vitro inhibitory activity of some Cyperaceae species

    Directory of Open Access Journals (Sweden)

    Monica Lacerda Lopes Martins

    2013-12-01

    Full Text Available In 1820, French naturalist August Saint Hillaire, during a visit in Espírito Santo (ES, a state in southeastern Brazil, reported a popular use of Cyperaceae species as antidote to snake bites. The plant may even have a hypotensive effect, though it was never properly researched. The in vitro inhibitory of the angiotensin converting enzyme (ACE activity of eigth ethanolic extracts of Cyperaceae was evaluated by colorimetric assay. Total phenolic and flavonoids were determined using colorimetric assay. The hypotensive effect of the active specie (Rhychonospora exaltata, ERE and the in vivo ACE assay was measured in vivo using male Wistar Kyoto (ERE, 0.01-100mg/kg, with acetylcholine (ACh as positive control (5 µg/kg, i.v.. The evaluation of ACE in vivo inhibitory effect was performed comparing the mean arterial pressure before and after ERE (10 mg/kg in animals which received injection of angiotensin I (ANG I; 0,03, 03 and 300 µg/kg, i.v.. Captopril (30 mg/kg was used as positive control. Bulbostylis capillaris (86.89 ± 15.20% and ERE (74.89 ± 11.95%, ERE were considered active in the in vitro ACE inhibition assay, at 100 µg/mL concentration. ACh lead to a hypotensive effect before and after ERE's curve (-40±5% and -41±3%. ERE showed a dose-dependent hypotensive effect and a in vivo ACE inhibitory effect. Cyperaceae species showed an inhibitory activity of ACE, in vitro, as well as high content of total phenolic and flavonoids. ERE exhibited an inhibitory effect on both in vitro and in vivo ACE. The selection of species used in popular medicine as antidotes, along with the in vitro assay of ACE inhibition, might be a biomonitoring method for the screening of new medicinal plants with hypotensive properties.

  9. Severe bradycardia and prolonged hypotension in ciguatera.

    Science.gov (United States)

    Chan, Thomas Yan Keung

    2013-06-01

    Ciguatera results when ciguatoxin-contaminated coral reef fish from tropical or subtropical waters are consumed. The clinical features that present in affected persons are mainly gastrointestinal, neurological, general, and much less commonly, cardiovascular. We report the case of a 50-year-old man who developed the characteristic combination of acute gastrointestinal and neurological symptoms after the consumption of an unidentified coral reef fish head. In addition to those symptoms, he developed dizziness, severe bradycardia (46 bpm) and prolonged hypotension, which required the administration of intravenous atropine and over three days of intravenous fluid replacement with dopamine infusion. Patients with ciguatera can develop severe bradycardia and prolonged hypotension. Physicians should recognise the possible cardiovascular complications of ciguatera and promptly initiate treatment with intravenous atropine, intravenous fluid replacement and inotropic therapy if such complications are observed.

  10. Effect of hypotension and carbon dioxide changes in an improved genuine closed cranial window rat model

    DEFF Research Database (Denmark)

    Petersen, K A; Dyrby, Lone; Williamson, D

    2005-01-01

    The genuine closed cranial window model, in which the thinned parietal bone constitutes the covering of the preparation, has contributed to a better understanding of the pathophysiological mechanisms in migraine. In its present form, only measurements of the middle meningeal artery (MMA) are perf......The genuine closed cranial window model, in which the thinned parietal bone constitutes the covering of the preparation, has contributed to a better understanding of the pathophysiological mechanisms in migraine. In its present form, only measurements of the middle meningeal artery (MMA......) are performed. The aim of this study was, in addition, to measure pial artery/arteriole (PA) diameter and cortical cerebral blood flux in the same cranial window. The model was evaluated by studying the effects of hypotension and changes in arterial carbon dioxide pressure (PaCO2), because these parameters......-induced hypotension (-64+/-0.8 mmHg) caused an increase of MMA diameter of 11.8+/-8.4%, PA diameter of 61.2+/-7.7% and a decrease in LCBF(Flux) of -36.4+/-2.5%. The decrease in blood pressure did not significantly change the MMA (P=0.38); however, the PA diameter and the LCBF(Flux) were affected (P

  11. Aerobic capacity, orthostatic tolerance, and exercise perceptions at discharge from inpatient spinal cord injury rehabilitation.

    Science.gov (United States)

    Pelletier, Chelsea A; Jones, Graham; Latimer-Cheung, Amy E; Warburton, Darren E; Hicks, Audrey L

    2013-10-01

    To describe physical capacity, autonomic function, and perceptions of exercise among adults with subacute spinal cord injury (SCI). Cross-sectional. Two inpatient SCI rehabilitation programs in Canada. Participants (N=41; mean age ± SD, 38.9 ± 13.7y) with tetraplegia (TP; n=19), high paraplegia (HP; n=8), or low paraplegia (LP; n=14) completing inpatient SCI rehabilitation (mean ± SD, 112.9 ± 52.5d postinjury). Not applicable. Peak exercise capacity was determined by an arm ergometry test. As a measure of autonomic function, orthostatic tolerance was assessed by a passive sit-up test. Self-efficacy for exercise postdischarge was evaluated by a questionnaire. There was a significant difference in peak oxygen consumption and heart rate between participants with TP (11.2 ± 3.4;mL·kg(-1)·min(-1) 113.9 ± 19.7 beats/min) and LP (17.1 ± 7.5 mL·kg(-1)·min(-1); 142.8 ± 22.7 beats/min). Peak power output was also significantly lower in the TP group (30.0 ± 6.9W) compared with the HP (55.5 ± 7.56W) and LP groups (62.5 ± 12.2W). Systolic blood pressure responses to the postural challenge varied significantly between groups (-3.0 ± 33.5 mmHg in TP, 17.8 ± 14.7 mmHg in HP, 21.6 ± 18.7 mmHg in LP). Orthostatic hypotension was most prevalent among participants with motor complete TP (73%). Results from the questionnaire revealed that although participants value exercise and see benefits to regular participation, they have low confidence in their abilities to perform the task of either aerobic or strengthening exercise. Exercise is well tolerated in adults with subacute SCI. Exercise interventions at this stage should focus on improving task-specific self-efficacy, and attention should be made to blood pressure regulation, particularly in individuals with motor complete TP. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  12. Brain MRI findings of spontaneous intracranial hypotension

    Energy Technology Data Exchange (ETDEWEB)

    Park, Won Kyu; Byun, Woo Mok; Cho, Jae Ho; Cho Kil Ho; Hwang, Mi Soo; Park, Bok Hwan [Yeungnam Univ. College of Medicine, Taegu (Korea, Republic of); Joo, Yang Gu [Keimyoung Univ. College of Medicine, Taegu (Korea, Republic of); Lee, Sang Jin [Soonchunhyang Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-09-01

    To evaluate brain MRI findings of spontaneous intracranial hypotension. A retrospective review of MRI findings was conducted on six patients with clinically proven spontaneous intracranial hypotension; no patient had a history of previous spinal puncture. Follow-up MRI was available in two patients, and to detect CSF leakage, radio-nuclide cisternography(n=3D5), myelography(n=3D1), and MR myelography(n=3D1) were performed. On contrast-enhanced T1WI, diffuse dural enhancement was seen in all cases, subdural hematoma or hygroma was seen in four cases, pituitary gland prominence in four, dural sinus dilatation in four, downward displacement of the cerebellar tonsil in two, downward displacement of the iter in one, and suprasellar and prepontine cistern effacement in two. In no patient was abnormal CSF leakage found. Although dural enhancement, as seen on MRI, is not specific, diffuse enhancement of the dura mater accompanied by subdural hematoma, hygroma, pituitary gland prominence, dural sinus dilatation, downward displacement of the cerebellar tonsil, or suprasellar and prepontine cistern effacement can strongly suggest intracranial hypotension.=20.

  13. An investigation of patterns in hemodynamic data indicative of impending hypotension in intensive care

    Directory of Open Access Journals (Sweden)

    Lee Joon

    2010-10-01

    Full Text Available Abstract Background In the intensive care unit (ICU, clinical staff must stay vigilant to promptly detect and treat hypotensive episodes (HEs. Given the stressful context of busy ICUs, an automated hypotensive risk stratifier can help ICU clinicians focus care and resources by prospectively identifying patients at increased risk of impending HEs. The objective of this study was to investigate the possible existence of discriminatory patterns in hemodynamic data that can be indicative of future hypotensive risk. Methods Given the complexity and heterogeneity of ICU data, a machine learning approach was used in this study. Time series of minute-by-minute measures of mean arterial blood pressure, heart rate, pulse pressure, and relative cardiac output from 1,311 records from the MIMIC II Database were used. An HE was defined as a 30-minute period during which the mean arterial pressure was below 60 mmHg for at least 90% of the time. Features extracted from the hemodynamic data during an observation period of either 30 or 60 minutes were analyzed to predict the occurrence of HEs 1 or 2 hours into the future. Artificial neural networks (ANNs were trained for binary classification (normotensive vs. hypotensive and regression (estimation of future mean blood pressure. Results The ANNs were successfully trained to discriminate patterns in the multidimensional hemodynamic data that were predictive of future HEs. The best overall binary classification performance resulted in a mean area under ROC curve of 0.918, a sensitivity of 0.826, and a specificity of 0.859. Predicting further into the future resulted in poorer performance, whereas observation duration minimally affected performance. The low prevalence of HEs led to poor positive predictive values. In regression, the best mean absolute error was 9.67%. Conclusions The promising pattern recognition performance demonstrates the existence of discriminatory patterns in hemodynamic data that can indicate

  14. Orthostatic Intolerance Is Independent of the Degree of Autonomic Cardiovascular Adaptation after 60 Days of Head-Down Bed Rest

    Science.gov (United States)

    Aubert, André E.

    2015-01-01

    Spaceflight and head-down bed rest (HDBR) can induce the orthostatic intolerance (OI); the mechanisms remain to be clarified. The aim of this study was to determine whether or not OI after HDBR relates to the degree of autonomic cardiovascular adaptation. Fourteen volunteers were enrolled for 60 days of HDBR. A head-up tilt test (HUTT) was performed before and after HDBR. Our data revealed that, in all nonfainters, there was a progressive increase in heart rate over the course of HDBR, which remained higher until 12 days of recovery. The mean arterial pressure gradually increased until day 56 of HDBR and returned to baseline after 12 days of recovery. Respiratory sinus arrhythmia and baroreflex sensitivity decreased during HDBR and remained suppressed until 12 days of recovery. Low-frequency power of systolic arterial pressure increased during HDBR and remained elevated during recovery. Three subjects fainted during the HUTT after HDBR, in which systemic vascular resistance did not increase and remained lower until syncope. None of the circulatory patterns significantly differed between the fainters and the nonfainters at any time point. In conclusion, our data indicate that the impaired orthostatic tolerance after HDBR could not be distinguished by estimation of normal hemodynamic and/or neurocardiac data. PMID:26425559

  15. Orthostatic Intolerance Is Independent of the Degree of Autonomic Cardiovascular Adaptation after 60 Days of Head-Down Bed Rest

    Directory of Open Access Journals (Sweden)

    Jiexin Liu

    2015-01-01

    Full Text Available Spaceflight and head-down bed rest (HDBR can induce the orthostatic intolerance (OI; the mechanisms remain to be clarified. The aim of this study was to determine whether or not OI after HDBR relates to the degree of autonomic cardiovascular adaptation. Fourteen volunteers were enrolled for 60 days of HDBR. A head-up tilt test (HUTT was performed before and after HDBR. Our data revealed that, in all nonfainters, there was a progressive increase in heart rate over the course of HDBR, which remained higher until 12 days of recovery. The mean arterial pressure gradually increased until day 56 of HDBR and returned to baseline after 12 days of recovery. Respiratory sinus arrhythmia and baroreflex sensitivity decreased during HDBR and remained suppressed until 12 days of recovery. Low-frequency power of systolic arterial pressure increased during HDBR and remained elevated during recovery. Three subjects fainted during the HUTT after HDBR, in which systemic vascular resistance did not increase and remained lower until syncope. None of the circulatory patterns significantly differed between the fainters and the nonfainters at any time point. In conclusion, our data indicate that the impaired orthostatic tolerance after HDBR could not be distinguished by estimation of normal hemodynamic and/or neurocardiac data.

  16. Comparison of hypotensive, diuretic and renal effects between cladodes of Opuntia ficus-indica and furosemide.

    Science.gov (United States)

    Bakour, Meryem; Al-Waili, Noori; El-Haskoury, Redouan; El-Menyiy, Nawal; Al-Waili, Thia; Al-Waili, Ali; Lyoussi, Badiaa

    2017-09-01

    To investigate the diuretic, hypotensive and renal effect of Opuntia ficus-indica in two different species in oral and intravenous administration. Diuretic activity was evaluated in rats with the plant cladode gel and aqueous extract administrated orally, and was evaluated in rabbits with plant extract administered intravenously. Single and repeated doses of cladode gel or aqueous extract of cladode were tested. Urine volume and blood and urine creatinine, sodium and potassium were measured, and creatinine clearance was calculated. The hypotensive effect of lyophilized extract of cladode was evaluated in rabbits. Two polyethylene PE50 catheters were used: one in the jugular vein for the infusion of the plant extract and the other in the carotid for the evaluation of the arterial pressure. The cladode gel or aqueous extract increased urine volume, creatinine clearance and urinary excretion of sodium and potassium without significant effect on serum creatinine or blood urea. Furosemide, gel and aqueous extract of cladode insignificantly lowered plasma potassium in rats. Intravenous administration of the lyophilized extract caused a significant decrease in mean arterial pressure in rabbits with a significant increase in urine volume and urine sodium and potassium; the effect was dose dependent. Intravenous administration of lyophilized extract did not affect plasma sodium or potassium. Gel and aqueous extract of Opuntia ficus-indica cladode have a significant diuretic effect on rats, and the lyophilized extract has a diuretic and hypotensive effect on normotensive rabbits without deterioration in renal function test. Additional studies on active ingredients are essential to pave the way for clinical studies on diuretic and hypotensive effect of the plant. Copyright © 2017 Hainan Medical University. Production and hosting by Elsevier B.V. All rights reserved.

  17. Opposing effects of particle pollution, ozone, and ambient temperature on arterial blood pressure.

    Science.gov (United States)

    Hoffmann, Barbara; Luttmann-Gibson, Heike; Cohen, Allison; Zanobetti, Antonella; de Souza, Celine; Foley, Christopher; Suh, Helen H; Coull, Brent A; Schwartz, Joel; Mittleman, Murray; Stone, Peter; Horton, Edward; Gold, Diane R

    2012-02-01

    Diabetes increases the risk of hypertension and orthostatic hypotension and raises the risk of cardiovascular death during heat waves and high pollution episodes. We examined whether short-term exposures to air pollution (fine particles, ozone) and heat resulted in perturbation of arterial blood pressure (BP) in persons with type 2 diabetes mellitus (T2DM). We conducted a panel study in 70 subjects with T2DM, measuring BP by automated oscillometric sphygmomanometer and pulse wave analysis every 2 weeks on up to five occasions (355 repeated measures). Hourly central site measurements of fine particles, ozone, and meteorology were conducted. We applied linear mixed models with random participant intercepts to investigate the association of fine particles, ozone, and ambient temperature with systolic, diastolic, and mean arterial BP in a multipollutant model, controlling for season, meteorological variables, and subject characteristics. An interquartile increase in ambient fine particle mass [particulate matter (PM) with an aerodynamic diameter of ≤ 2.5 μm (PM2.5)] and in the traffic component black carbon in the previous 5 days (3.54 and 0.25 μg/m3, respectively) predicted increases of 1.4 mmHg [95% confidence interval (CI): 0.0, 2.9 mmHg] and 2.2 mmHg (95% CI: 0.4, 4.0 mmHg) in systolic BP (SBP) at the population geometric mean, respectively. In contrast, an interquartile increase in the 5-day mean of ozone (13.3 ppb) was associated with a 5.2 mmHg (95% CI: -8.6, -1.8 mmHg) decrease in SBP. Higher temperatures were associated with a marginal decrease in BP. In subjects with T2DM, PM was associated with increased BP, and ozone was associated with decreased BP. These effects may be clinically important in patients with already compromised autoregulatory function.

  18. Orthostatic Tremor and Orthostatic Myoclonus: Weight-bearing Hyperkinetic Disorders: A Systematic Review, New Insights, and Unresolved Questions

    Directory of Open Access Journals (Sweden)

    Anhar Hassan

    2016-11-01

    Full Text Available Background: Orthostatic tremor (OT and orthostatic myoclonus (OM are weight-bearing hyperkinetic movement disorders most commonly affecting older people that induce “shaky legs” upon standing. OT is divided into “classical” and “slow” forms based on tremor frequency. In this paper, the first joint review of OT and OM, we review the literature and compare and contrast their demographic, clinical, electrophysiological, neuroimaging, pathophysiological, and treatment characteristics. Methods: A PubMed search up to July 2016 using the phrases “orthostatic tremor,” “orthostatic myoclonus,” “shaky legs,” and “shaky legs syndrome” was performed. Results: OT and OM should be suspected in older patients reporting unsteadiness with prolonged standing and/or who exhibit cautious, wide-based gaits. Surface electromyography (SEMG is necessary to verify the diagnoses. Functional neuroimaging and electrophysiology suggest the generator of classical OT lies within the cerebellothalamocortical network. For OM, and possibly slow OT, the frontal, subcortical cerebrum is the most likely origin. Clonazepam is the most useful medication for classical OT, and levetiracetam for OM, although results are often disappointing. Deep brain stimulation appears promising for classical OT. Rolling walkers reliably improve gait affected by these disorders, as both OT and OM attenuate when weight is transferred from the legs to the arms. Discussion: Orthostatic hyperkinesias are likely underdiagnosed, as SEMG is often unavailable in clinical practice, and thus may be more frequent than currently recognized. The shared weight-bearing induction of OT and OM may indicate a common pathophysiology. Further research, including use of animal models, is necessary to better define the prevalence and pathophysiology of OT and OM, in order to improve their treatment, and provide additional insights into basic balance and gait mechanisms.

  19. Effects of Vestibular Loss on Orthostatic Responses to Tilts in the Pitch Plane

    Science.gov (United States)

    Wood, Scott J.; Serrador, Jorge M.; Black, F. Owen; Rupert,Angus H.; Schlegel, Todd T.

    2004-01-01

    The purpose of this study was to determine the extent to which vestibular loss might impair orthostatic responses to passive tilts in the pitch plane in human subjects. Data were obtained from six subjects having chronic bilateral vestibular loss and six healthy individuals matched for age, gender, and body mass index. Vestibular loss was assessed with a comprehensive battery including dynamic posturography, vestibulo-ocular and optokinetic reflexes, vestibular evoked myogenic potentials, and ocular counterrolling. Head up tilt tests were conducted using a motorized two-axis table that allowed subjects to be tilted in the pitch plane from either a supine or prone body orientation at a slow rate (8 deg/s). The sessions consisted of three tilts, each consisting of20 min rest in a horizontal position, tilt to 80 deg upright for 10 min, and then return to the horizontal position for 5 min. The tilts were performed in darkness (supine and prone) or in light (supine only). Background music was used to mask auditory orientation cues. Autonomic measurements included beat-to-beat recordings of blood pressure (Finapres), heart rate (ECG), cerebral blood flow velocity in the middle cerebral artery (transcranial Doppler), end tidal CO2, respiratory rate and volume (Respritrace), and stroke volume (impedance cardiography). For both patients and control subjects, cerebral blood flow appeared to exhibit the most rapid adjustment following transient changes in posture. Outside of a greater cerebral hypoperfusion in patients during the later stages of tilt, responses did not differ dramatically between the vestibular loss and control subjects, or between tilts performed in light and dark room conditions. Thus, with the 'exception of cerebrovascular regulation, we conclude that orthostatic responses during slow postural tilts are not substantially impaired in humans following chronic loss of vestibular function, a result that might reflect compensation by nonvisual graviceptor

  20. Use of an Impedance Threshold Device in Spontaneously Breathing Patients with Hypotension Secondary to Trauma: An Observational Cohort Feasibility Study

    Science.gov (United States)

    2014-09-09

    hypotensive patient. Crystalloid infusion is not necessarily benign.1,2 Difficult vascular access, hemodilution, acidosis , decreased oxygen delivery, and...blood pressure, heart rate (HR), respiratory rate, and arterial oxygen saturation (SpO2) were recorded im- mediately before application of the ITD...per minute (p = 0.007). The respiratory rate was constant: 19 (7) breaths before to 18 (4) breaths (p = 0.31) per minute after ITD use. Oxygen

  1. Hypotensive effects of resistance exercise with continuous and intermittent blood flow restriction

    Directory of Open Access Journals (Sweden)

    Gabriel Rodrigues Neto

    Full Text Available Abstract The aim of this study was to compare the acute effects of low-intensity (LI resistance exercise (RE with continuous blood flow restriction (CBFR and intermittent blood flow restriction (IBFR on systolic blood pressure (SBP, diastolic blood pressure (DBP, and mean arterial pressure (MAP. After a one-repetition maximum test, 10 normotensive recreationally trained men performed three experimental protocols. In the three RE protocols, increases in SBP, DBP, and MAP were observed immediately after exercise, but the effect sizes (ESs were greater for the LI + CBFR and high-intensity protocols. There were hypotensive effects on SBP, DBP, and MAP in all three protocols; however, the effects on MAP lasted longer for the LI + IBFR and LI + CBFR protocols. These long-lasting hypotensive effects on DBP and MAP occurred in all three protocols. Thus, we conclude that the post exercise hypotensive effects on SBP, DBP, and MAP appear to occur in all three RE protocols, with the effect on SBP being longer in the LI + IBFR and LI + CBFR protocols.

  2. Effect of QTc interval on prediction of hypotension following subarachnoid block in patients undergoing cesarean section: A comparative study

    Directory of Open Access Journals (Sweden)

    Sampa Dutta Gupta

    2012-01-01

    Full Text Available Background: Previous studies have revealed that QTc interval is prolonged in pre-eclamptic parturients. Another study reflected the relationship between the sympathetic block and QTc interval. Subarachnoid block was safely administered in patients with severe pre-eclampsia. It has also been noticed that hypotension in response to spinal anesthesia is relatively less in pre-eclamptic patients than normal parturients. Aim: To compare the QTc values in normal and pre-eclamptic term parturients and to establish whether any correlation exists between the QTc interval and the systemic hypotension following subarachnoid block. Materials and Methods: Twenty-five pre-eclamptic patients (Group A and 25 normotensive patients (Group B were included in this study. QTc interval was recorded for each patient before subarachnoid block for cesarean section. Changes in arterial blood pressure and heart rate were measured in both the groups and compared. Results: Baseline QTc was significantly higher in the pre-eclamptic group (Group A: 0.47 ± 0.11 with that of control (Group B: 0.36. ± 0.02. Significant fall in blood pressure was seen only in one group with QTc between 0.38 and 0.39 in Group A. Hypotension was significantly more in normotensive mothers (Group B. However, no statistical correlation could be drawn from this study between QTc interval and hypotension, although a trend toward increasing hypotension with decreasing QTc was present. Discussion : The prolonged QTc intervals seen in pre-eclamptic patients may be due to the contributory effects of sympathetic hyperactivity, hypertension, and hypocalcemia secondary to underlying vasoconstriction. Decreased vagal control of heart in pre-eclampsia may have produced the difference in change in hemodynamic status between pre-eclamptic and normotensive parturient. Conclusion: Any consistent correlation between QTc and hypotension following subarachnoid block could not be derived from this study. To achieve a

  3. Comparison of metaraminol, phenylephrine and ephedrine in prophylaxis and treatment of hypotension in cesarean section under spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Fábio Farias de Aragão

    2014-09-01

    Full Text Available Maternal hypotension is a common complication after spinal anesthesia for cesarean section, with deleterious effects on the fetus and mother. Among the strategies aimed at minimizing the effects of hypotension, vasopressor administration is the most efficient. The aim of this study was to compare the efficacy of phenylephrine, metaraminol, and ephedrine in the prevention and treatment of hypotension after spinal anesthesia for cesarean section. Ninety pregnant women, not in labor, undergoing cesarean section were randomized into three groups to receive a bolus followed by continuous infusion of vasopressor as follows: phenylephrine group (50 μg + 50 μg/min; metaraminol group (0.25 mg + 0.25 mg/min; ephedrine group (4 mg + 4 mg/min. Infusion dose was doubled when systolic blood pressure decreased to 80% of baseline and a bolus was given when systolic blood pressure decreased below 80%. The infusion dose was divided in half when systolic blood pressure increased to 120% and was stopped when it became higher. The incidence of hypotension, nausea and vomiting, reactive hypertension, bradycardia, tachycardia, Apgar scores, and arterial cord blood gases were assessed at the 1st and 5th minutes. There was no difference in the incidence of hypotension, bradycardia, reactive hypertension, infusion discontinuation, atropine administration or Apgar scores. Rescue boluses were higher only in the ephedrine group compared to metaraminol group. The incidence of nausea and vomiting and fetal acidosis were greater in the ephedrine group. The three drugs were effective in preventing hypotension; however, fetal effects were more frequent in the ephedrine group, although transient.

  4. Reliability of oscillometric central hemodynamic responses to an orthostatic challenge

    OpenAIRE

    Stoner, Lee; Bonner, Chantel; Credeur, Daniel; Lambrick, Danielle; Faulkner, James; Wadsworth, Daniel; Williams, Michelle A.

    2015-01-01

    BackgroundMonitoring central hemodynamic responses to an orthostatic challenge may provide important insight into autonomic nervous system function. Oscillometric pulse wave analysis devices have recently emerged, presenting clinically viable options for investigating central hemodynamic properties. The purpose of the current study was to determine whether oscillometric pulse wave analysis can be used to reliably (between-day) assess central blood pressure and central pressure augmentation (a...

  5. HYPOTENSIVE AND CARDIOINHIBOTORY EFFECTS OF THE AQUEOUS AND ETHANOL EXTRACTS OF CELERY (APIUM GRAVEOLENS, APIACEAE

    Directory of Open Access Journals (Sweden)

    Dragana Pavlović

    2010-03-01

    Full Text Available In this study we present the effects of aqueous and ethanol extracts of celery (Apium graveolens L., Apiaceae investigated on the mean blood pressure of anaesthetized rabbits and contractility of isolated atria of the rats. In our experiments were used rabbits and Wistar albino rats. The effects of extracts (0.5-15 mg/kg on blood pressure were recorded directly from the carotid artery. Rat isolated atria was mounted in 10 ml tissue bath. An equilibrium period of 30 min was given before the application of the extracts (0.02-0.75 mg/ml. In anesthetized rabbit, intravenous administration of aqueous extracts induced least hypotensive effects (14.35±2.94%, while the ethanol extract caused the greatest fall in the blood pressure (45.79±10.86%. Hypotensive effects of the extracts were partially blocked by atropine (0.3 mg/kg, an unselective muscarinic receptor antagonist. In isolated rat atria both aqueous and ethanolic extracts of celery, exhibit a negative chronotropic and an inotropic action. Aqueous extract decreased rate of contractions for 12.88±2.74% and amplitude for 8.73±0.89%. Ethanol extract inhibited rate of the atria contractions for 34.26±5.69%, and amplitude for 25.40±3.61%. Pretreatment of the atria with atropine (1μM partially blocked inhibitory response of aqueous and ethanol extracts. Ethanol extract of celery exhibited significantly greater hypotensive and cardio-depressant activities then aqueous extract (p<0.05. These data suggest that the aqueous and ethanol extracts of celery caused the hypotensive, negative inotropic and chronotropic effects, which could partially be mediated possibly via stimulation of muscarinic receptors. Inhibitory effect of ethanol extract was significant comparing to aqueous extract of celery.

  6. Obstetric spinal hypotension: Preoperative risk factors and the ...

    African Journals Online (AJOL)

    Obstetric spinal hypotension: Preoperative risk factors and the development of a preliminary risk score – the PRAM score. ... We used empirical cut-point estimations in a logistic regression model to develop a scoring system for prediction of hypotension. Results. From 504 eligible patients, preoperative heart rate (odds ratio ...

  7. Sleep deprivation increases blood pressure in healthy normotensive elderly and attenuates the blood pressure response to orthostatic challenge.

    Science.gov (United States)

    Robillard, Rébecca; Lanfranchi, Paola A; Prince, François; Filipini, Daniel; Carrier, Julie

    2011-03-01

    To determine how aging affects the impact of sleep deprivation on blood pressure at rest and under orthostatic challenge. Subjects underwent a night of sleep and 24.5 h of sleep deprivation in a crossover counterbalanced design. Sleep laboratory. Sixteen healthy normotensive men and women: 8 young adults (mean 24 years [SD 3.1], range 20-28 years) and 8 elderly adults (mean 64.1 years [SD 3.4], range 60-69 years). Sleep deprivation. Brachial cuff arterial blood pressure and heart rate were measured in semi-recumbent and upright positions. These measurements were compared across homeostatic sleep pressure conditions and age groups. Sleep deprivation induced a significant increase in systolic and diastolic blood pressure in elderly but not young adults. Moreover, sleep deprivation attenuated the systolic blood pressure orthostatic response in both age groups. Our results suggest that sleep deprivation alters the regulatory mechanisms of blood pressure and might increase the risk of hypertension in healthy normotensive elderly.

  8. Development of an Experimental and Digital Cardiovascular Arterial Model for Transient Hemodynamic and Postural Change Studies: "A Preliminary Framework Analysis".

    Science.gov (United States)

    Hewlin, Rodward L; Kizito, John P

    2018-03-01

    femoral sections to yield pressure difference data useful for orthostatic hypotension analysis. Flow parametric data such as vorticity (flow reversal), wall shear stress, normal stress, and medical drug transit data was also obtained from the digital arterial model CFD simulations. Although the present work is preliminary work, the experimental and digital models proves to be useful in providing flow parametric data of interest such as: (1) normal stress which is useful for predicting the magnitude of forces which could promote arterial rupture or dislodging of medical implants, (2) wall shear stress which is useful for analyzing the magnitude of drug transport at the arterial wall, (3) vorticity which is useful for predicting the magnitude of flow reversal, and (4) arterial compliance in the case of the experimental model which could be useful in the efforts of developing FSI numerical simulations that incorporates compliance which realistically models the flow in the arterial system.

  9. No effect of Pindolol on postural hypotension in type 1 (insulin-dependent) diabetic patients with autonomic neuropathy. A randomised double-blind controlled study

    DEFF Research Database (Denmark)

    Dejgård, A; Hilsted, J

    1988-01-01

    of this therapy we performed a double-blind placebo controlled cross-over study with Pindolol (15 mg/day). Eight Type 1 (insulin-dependent) diabetic patients with autonomic neuropathy and signs and symptoms of orthostatic hypotension (systolic blood pressure decrease greater than 30 mm Hg when standing......) participated in the study. Patients were treated for 10 weeks. Clinical examinations were performed every fortnight and patients registered postural symptoms twice daily on a visual analog scale. No significant changes were seen in blood pressure recordings, heart-rate or visual analog scale registration...... during treatment with Pindolol compared to placebo. Our study does not support the suggestion that Pindolol is a valuable drug for treatment of diabetic patients with autonomic neuropathy and postural giddiness....

  10. Dopamine therapy does not affect cerebral autoregulation during hypotension in newborn piglets.

    Directory of Open Access Journals (Sweden)

    Vibeke Ramsgaard Eriksen

    Full Text Available Hypotensive neonates who have been treated with dopamine have poorer neurodevelopmental outcome than those who have not been treated with dopamine. We speculate that dopamine stimulates adrenoceptors on cerebral arteries causing cerebral vasoconstriction. This vasoconstriction might lead to a rightward shift of the cerebral autoregulatory curve; consequently, infants treated with dopamine would have a higher risk of low cerebral blood flow at a blood pressure that is otherwise considered "safe".In anaesthetized piglets, perfusion of the brain, monitored with laser-doppler flowmetry, and cerebral venous saturation was measured at different levels of hypotension. Each piglet was studied in two phases: a phase with stepwise decreases in MAP and a phase with stepwise increases in MAP. We randomized the order of the two phases, whether dopamine was given in the first or second phase, and the infusion rate of dopamine (10, 25, or 40 μg/kg/min. In/deflation of a balloon catheter, placed in vena cava, induced different levels of hypotension. At each level of hypotension, fluctuations in MAP were induced by in/deflations of a balloon catheter in descending aorta.During measurements, PaCO2 and arterial saturation were stable. MAP levels ranged between 14 and 82 mmHg. Cerebral autoregulation (CA capacity was calculated as the ratio between %-change in cerebrovascular resistance and %-change in MAP induced by the in/deflation of the arterial balloon. A breakpoint in CA capacity was identified at a MAP of 38±18 mmHg without dopamine and at 44±18, 31±14, and 24±14 mmHg with dopamine infusion rates of 10, 25, and 40 μg/kg/min (p = 0.057. Neither the index of steady-state cerebral perfusion nor cerebral venous saturation were affected by dopamine infusion.Dopamine infusion tended to improve CA capacity at low blood pressures while an index of steady-state cerebral blood flow and cerebral venous saturation were unaffected by dopamine infusion. Thus

  11. Prevention of post-spinal hypotension using crystalloid, colloid and ephedrine with three different combinations: A double blind randomized study

    Directory of Open Access Journals (Sweden)

    Mitra Jabalameli

    2012-01-01

    Full Text Available Background: The benefit of prophylactic combination therapy using crystalloid and colloid preload with ephedrine has not been cleared to prevent maternal hypotension after spinal anesthesia at cesarean delivery. This study evaluated the efficacy of three combinational methods to prevent hypotension following spinal anesthesia. Materials and Methods: In this prospective double blind trial, 150 candidates of elective cesarean delivery under spinal anesthesia were randomly allocated to three treatment groups; 1---Ringer′s Lactate (RL solution (15 ml/kg plus Hemaxel (7 ml/kg preload, 2---RL solution (15 ml/kg preload plus ephedrine (15 mg, IV, bolus, 3---Hemaxel (7 ml/kg preload plus ephedrine (15 mg, IV, bolus. Maternal hemodynamic changes during 60 min after spinal injection, nausea/vomiting, and neonatal condition were compared among the groups. Results: The cumulative incidence of hypotension was 44%, 40%, and 46% in groups 1 to 3, respectively. There were not significant differences in supplementary ephedrine requirement among groups which received or among groups which did not receive prophylactic ephedrine. Groups were not different in the incidence of hypertension and nausea or vomiting. There were no significant differences among groups in Apgar scores at 1 or 5 min and umbilical artery PH. Conclusion: Combination of preventive methods decreased the occurrence of hypotension following spinal anesthesia to an acceptable level. Overall, the most effective method was a combination of crystalloid preload with ephedrine.

  12. Dependency of blood pressure upon cardiac filling in patients with severe postural hypotension

    DEFF Research Database (Denmark)

    Mehlsen, J; Haedersdal, C; Stokholm, K H

    1994-01-01

    by vasoconstriction. The reduction in cardiac output resulted from reductions in left ventricular end-diastolic volumes with unchanged left ventricular ejection fractions and only moderate increments in heart rate. The study was demonstrated that blood pressure is strongly dependent upon cardiac filling in severe......Autonomic denervation of the vascular bed results theoretically in a stronger dependency of blood pressure upon intravascular volume, and the study described aimed at an investigation of the relation between cardiac filling and arterial blood pressure in patients with severe postural hypotension....... Seven patients were studied during head-up tilt at three different tilt angles using intra-arterial blood pressure recordings and estimates of left ventricular volumes by radioisotope ventriculography. Blood pressure fell dramatically during head-up tilt due to reductions in cardiac output unopposed...

  13. Dependency of blood pressure upon cardiac filling in patients with severe postural hypotension

    DEFF Research Database (Denmark)

    Mehlsen, J; Haedersdal, C; Stokholm, K H

    1994-01-01

    Autonomic denervation of the vascular bed results theoretically in a stronger dependency of blood pressure upon intravascular volume, and the study described aimed at an investigation of the relation between cardiac filling and arterial blood pressure in patients with severe postural hypotension....... Seven patients were studied during head-up tilt at three different tilt angles using intra-arterial blood pressure recordings and estimates of left ventricular volumes by radioisotope ventriculography. Blood pressure fell dramatically during head-up tilt due to reductions in cardiac output unopposed...... by vasoconstriction. The reduction in cardiac output resulted from reductions in left ventricular end-diastolic volumes with unchanged left ventricular ejection fractions and only moderate increments in heart rate. The study was demonstrated that blood pressure is strongly dependent upon cardiac filling in severe...

  14. Det arterielle blodtryks afhaengighed af hjertets fyldning ved svaer ortostatisk hypotension

    DEFF Research Database (Denmark)

    Mehlsen, J; Haedersdal, C; Stokholm, K H

    1995-01-01

    The present study aimed at an investigation of the relation between arterial blood pressure and cardiac filling in patients with severe postural hypotension. Seven patients aged 49 to 84 years were studied during head-up tilt at three different tilt angles (median values: 0, 25, and 45 degrees...... with a reduction in left ventricular end-diastolic volume index from 59 ml m-2 (30-65) to 36 ml m-2 (23-44) and 22 ml m-2 (16-38; p postural reductions in cardiac output were unopposed by vasoconstriction. The study has demonstrated that blood pressure......) using intraarterial blood pressure recordings and estimates of left ventricular volumes by radioisotope ventriculography. Mean arterial blood pressure was reduced from 105 mmHg (79-129) in the horizontal position to 97 mmHg (61-112) and 83 mmHg (36-93; p

  15. Prevention of spinal anaesthesia-induced hypotension in the elderly: i.m. methoxamine or combined hetastarch and crystalloid.

    LENUS (Irish Health Repository)

    Buggy, D J

    2012-02-03

    We have compared two methods of reducing hypotension during spinal anaesthesia in elderly patients, 6% hetastarch and crystalloid or methoxamine 10 mg i.m., in terms of haemodynamic stability and requirements for additional vasopressors. Sixty-two patients (aged 60-97 yr) undergoing surgical fixation of fractured neck of femur were allocated randomly to receive 6% hetastarch (Hespan) 500 ml followed by Hartmann\\'s solution 500 ml (group HS, n = 32) or a bolus injection of methoxamine 10 mg i.m. (group MX, n = 30), 10 min before induction of spinal anaesthesia with 0.5% hyperbaric bupivacaine 2.25-3.0 ml. Arterial pressure was measured non-invasively by an oscillotonometer at 2-min intervals from 0 to 40 min and at 5-min intervals thereafter. Methoxamine 2 mg i.v. was given if systolic arterial pressure (SAP) decreased to < 100 mm Hg. Hypotension was defined as a 25% decrease from baseline SAP or mean arterial pressure (MAP). Patient data, sensory level and blood loss were similar in the two groups. SAP and MAP increased initially from baseline until induction of spinal anaesthesia and then decreased for 30 min in both groups, but remained higher in group MX (P < 0.05). Heart rate (HR) decreased from baseline in group MX (P < 0.05) and was less than in group HS at all times from 2 to 60 min (P < 0.01). The incidence of SAP hypotension (47% vs 75%; P = 0.03, odds ratio (OR) = 3.43) and MAP hypotension (47% vs 67%; P = 0.09, OR = 2.51) was less in group MX than in group HS. Requirements for rescue methoxamine i.v. (27% vs 53%, P = 0.04, OR = 3.11) was less in group MX than in group HS but the dose of rescue methoxamine given (mean 6.3 (95% confidence intervals 3.0-9.6) vs 8.9 (5.6-12.2) mg) and time to onset of hypotension (20.7 (14.5-26.7) vs 17.3 (11.4-23.1) min) were similar in groups MX and HS, respectively. We conclude that methoxamine 10 mg i.m., given 10 min before induction of spinal anaesthesia in normovolaemic elderly patients, reduced subsequent SAP and

  16. Orthostatic function and the cardiovascular response to early mobilization after breast cancer surgery

    DEFF Research Database (Denmark)

    Gamborg Müller, Rasmus; Bundgaard-Nielsen, Morten; Kehlet, H

    2010-01-01

    Early postoperative mobilization is essential for an enhanced recovery, but it can be hindered by orthostatic intolerance, characterized by signs of cerebral hypoperfusion, such as dizziness, nausea, vomiting, and ultimately syncope. Orthostatic intolerance is frequent after major surgical...... breast cancer surgery....

  17. Acute volume expansion preserves orthostatic tolerance during whole-body heat stress in humans.

    Science.gov (United States)

    Keller, David M; Low, David A; Wingo, Jonathan E; Brothers, R Matthew; Hastings, Jeff; Davis, Scott L; Crandall, Craig G

    2009-03-01

    Whole-body heat stress reduces orthostatic tolerance via a yet to be identified mechanism(s). The reduction in central blood volume that accompanies heat stress may contribute to this phenomenon. The purpose of this study was to test the hypothesis that acute volume expansion prior to the application of an orthostatic challenge attenuates heat stress-induced reductions in orthostatic tolerance. In seven normotensive subjects (age, 40 +/- 10 years: mean +/- S.D.), orthostatic tolerance was assessed using graded lower-body negative pressure (LBNP) until the onset of symptoms associated with ensuing syncope. Orthostatic tolerance (expressed in cumulative stress index units, CSI) was determined on each of 3 days, with each day having a unique experimental condition: normothermia, whole-body heating, and whole-body heating + acute volume expansion. For the whole-body heating + acute volume expansion experimental day, dextran 40 was rapidly infused prior to LBNP sufficient to return central venous pressure to pre-heat stress values. Whole-body heat stress alone reduced orthostatic tolerance by approximately 80% compared to normothermia (938 +/- 152 versus 182 +/- 57 CSI; mean +/- S.E.M., P body heating completely ameliorated the heat stress-induced reduction in orthostatic tolerance (1110 +/- 69 CSI, P stress results in many cardiovascular and neural responses that directionally challenge blood pressure regulation, reduced central blood volume appears to be an underlying mechanism responsible for impaired orthostatic tolerance in the heat-stressed human.

  18. Orthostatic function and the cardiovascular response to early mobilization after breast cancer surgery

    DEFF Research Database (Denmark)

    Gamborg Müller, Rasmus; Bundgaard-Nielsen, Morten; Kehlet, H

    2010-01-01

    procedures, because of an attenuated cardiovascular response, but the cardiovascular response and the incidence of orthostatic intolerance after minor procedures have not been clarified. We investigated the cardiovascular response and the incidence of orthostatic intolerance during early mobilization after...... breast cancer surgery....

  19. Orthostatic circulatory control in the elderly evaluated by non-invasive continuous blood pressure measurement

    NARCIS (Netherlands)

    Imholz, B. P.; Dambrink, J. H.; Karemaker, J. M.; Wieling, W.

    1990-01-01

    1. Continuous orthostatic responses of blood pressure and heart rate were measured in 40 healthy and active elderly subjects over 70 years of age in order to assess the time course and rapidity of orthostatic cardiovascular adaptation in old age. 2. During the first 30 s (initial phase) the effects

  20. The Role of Lumbar Sympathetic Nerves in Regulation of Blood Flow to Skeletal Muscle during Anaphylactic Hypotension in Anesthetized Rats.

    Directory of Open Access Journals (Sweden)

    Jie Song

    Full Text Available During hypovolemic shock, skeletal muscle blood flow could be redistributed to vital organs via vasoconstriction in part evoked by activation of the innervating sympathetic nerve activity. However, it is not well known whether this mechanism operates during anaphylactic shock. We determined the femoral artery blood flow (FBF and lumbar sympathetic nerve activity (LSNA mainly regulating the hindquater muscle blood flow during anaphylactic hypotension in anesthetized rats. Anesthetized Sprague-Dawley rats were randomly allocated to the following groups (n = 7/group: (1 non-sensitized, (2 anaphylaxis, (3 anaphylaxis-lumbar sympathectomy (LS and (4 anaphylaxis-sinoaortic denervation (SAD groups. Anaphylaxis was induced by an intravenous injection of the ovalbumin antigen to the sensitized rats. The systemic arterial pressure (SAP, heart rate (HR, central venous pressure (CVP, FBF and LSNA were continuously measured. In the anaphylaxis group, LSNA and HR increased, while SAP and FBF decreased after antigen injection. In the anaphylaxis-SAD group, LSNA did not significantly change during the early phase, but the responses of SAP and FBF were similar to those in the anaphylaxis group. In the anaphylaxis-LS group, both FBF and SAP decreased similarly to the anaphylaxis group during anaphylactic hypotension. These results indicated that LSNA increased via baroreceptor reflex, but this sympathoexcitation or LS did not affect antigen-induced decreases in FBF or SAP. Lumbar sympathetic nerves are not involved in regulation of the blood flow to the hindlimb or systemic blood pressure during anaphylactic hypotension in anesthetized rats.

  1. Leg blood pressure measured in orthostatic posture is associated with left ventricular mass in normotensive subjects.

    Science.gov (United States)

    Gemignani, Tiago; Matos-Souza, José R; Franchini, Kleber G; Nadruz, Wilson

    2012-10-01

    Changing from a supine to an orthostatic posture is associated with substantial increments in leg blood pressure (BP) levels, which could ultimately influence the hemodynamic burden imposed on the heart. This study investigated the relationship between brachial and leg BP measurements and the left cardiac chamber's structure and assessed the role of body posture changes in this regard. One hundred and thirty normotensive, nondiabetic, nonsmoking, normolipemic subjects were evaluated by a clinical history, anthropometry, the analysis of metabolic parameters, echocardiography, and the measurement of BP in the arm and the calf in both supine and orthostatic positions. Significant correlation coefficients between the leg BP measurements and the cardiac structure were detected, especially between the orthostatic pulse pressure (PP) and the left ventricular (LV) wall thickness (r = 0.38; P < 0.001), the orthostatic PP and the LV mass (r = 0.37; P < 0.001), and the orthostatic systolic BP (SBP) and the left atrial size (r = 0.35; P < 0.001). Stepwise and standard regression analysis adjusted for brachial BP and anthropometric and metabolic variables confirmed that the leg orthostatic PP was independently related to the LV wall thickness and mass. Moreover, the leg orthostatic SBP was associated with the left atrial dimension even after adding the LV mass to the statistical models. Finally, triglyceride levels and body surface area showed significant relationship with leg orthostatic PP and SBP, whereas brachial orthostatic PP and SBP were only associated with age and anthropometric variables. Orthostatic leg BP is independently associated with the cardiac structure in normotensive subjects.

  2. Reliability of oscillometric central hemodynamic responses to an orthostatic challenge.

    Science.gov (United States)

    Stoner, Lee; Bonner, Chantel; Credeur, Daniel; Lambrick, Danielle; Faulkner, James; Wadsworth, Daniel; Williams, Michelle A

    2015-08-01

    Monitoring central hemodynamic responses to an orthostatic challenge may provide important insight into autonomic nervous system function. Oscillometric pulse wave analysis devices have recently emerged, presenting clinically viable options for investigating central hemodynamic properties. The purpose of the current study was to determine whether oscillometric pulse wave analysis can be used to reliably (between-day) assess central blood pressure and central pressure augmentation (augmentation index) responses to a 5 min orthostatic challenge (modified tilt-table). Twenty healthy adults (26.4 y (SD 5.2), 55% F, 24.7 kg/m(2) (SD 3.8)) were tested on 3 different mornings in the fasted state, separated by a maximum of 7 days. Central hemodynamic variables were assessed on the left arm using an oscillometric device. Repeated measures analysis of variance indicated a significant main effect of the modified tilt-table for all central hemodynamic variables (P response to the tilt, central diastolic pressure increased by 4.5 mmHg (CI: 2.6, 6.4), central systolic blood pressure increased by 2.3 (CI: 4.4, 0.16) mmHg, and augmentation index decreased by an absolute - 5.3%, (CI: -2.7, -7.9%). The intra-class correlation coefficient values for central diastolic pressure (0.83-0.86), central systolic blood pressure (0.80-0.87) and AIx (0.79-0.82) were above the 0.75 criterion in both the supine and tilted positions, indicating excellent between-day reliability. Central hemodynamic responses to an orthostatic challenge can be assessed with acceptable between-day reliability using oscillometric pulse wave analysis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  3. Development of a model to assess orthostatic responses

    Science.gov (United States)

    Rubin, Marilyn

    1993-01-01

    A major change for crewmembers during weightlessness in microgravity is the redistribution of body fluids from the legs into the abdomen, thorax, and head. The fluids continue to be sequestered in these areas throughout the flight. Upon reentry into gravity on landing, these same body fluids are displaced again to their normal locations, however, not without hazardous incidence to the crewmembers. The problem remains that upon landing, crewmembers are subject to orthostasis, that is, the blood flowing into the legs reduces the blood supply to the brain and may result in the crewmember fainting. The purpose of this study was to develop a model of testing orthostatic responses of blood pressure regulating mechanisms of the cardiovascular system, when challenged, to maintain blood pressure to the brain. To accomplish this, subjects' responses were assessed as they proceeded from the supine position of progressive head-up tilt positions of 30 deg, 60 deg, and 90 deg angles. A convenience sample consisted of 21 subjects, females (N=11) and males (N=10), selected from a list of potential subjects available through the NASA subject screening office. The methodology included all non-invasive measurements of blood pressure, heart rate, echocardiograms, cardiac output, cardiac stroke volume, fluid shifts in the thorax, ventricular ejection and velocity times, and skin blood perfusion. The Fischer statistical analysis was done of all data with the significance level at .05. Significant differences were demonstrated in many instances of changes of posture for all variables. Based on the significance of the findings of this study, this model for assessing orthostatic responses does provide an adequate challenge to the blood pressure regulatory systems. While individuals may use different adaptations to incremental changes in gravity, the subjects, in aggregate, demonstrated significant adaptive cardiovascular changes to orthostatic challenges which were presented to them.

  4. Autogenic-feedback training: A countermeasure for orthostatic intolerance

    Science.gov (United States)

    Cowings, Patricia S.; Toscano, William B.; Kamiya, Joe; Miller, Neal E.; Pickering, Thomas G.

    1991-01-01

    NASA has identified cardiovascular deconditioning as a serious biomedical problem associated with long-duration exposure to microgravity in space. High priority has been given to the development of countermeasures for this disorder and the resulting orthostatic intolerance experienced by crewmembers upon their return to the 1g norm of Earth. The present study was designed to examine the feasibility of training human subjects to control their own cardiovascular responses to gravitational stimulation (i.e., a tilt table). Using an operant conditioning procedure, Autogenic-Feedback Training (AFT), we would determine if subjects could learn to increase their own blood pressure voluntarily.

  5. Postural hypotension in type 1 diabetes: The influence of glycemic ...

    African Journals Online (AJOL)

    2013-06-04

    saharan ... Key words: Diabetes mellitus, duration, glycemic control, postural hypotension. Date of ... or older) provided informed consent before enrolment in the study. .... asymptomatic despite significant falls in blood pressure.[26].

  6. Hypotensive Activity of Moringa oleifera Lam (Moringaceae) Root ...

    African Journals Online (AJOL)

    Tropical Journal of Pharmaceutical Research May 2015; 14(5): 823-830 ... Purpose: To explore the hypotensive activity and chemical composition of Moringa oleifera Lam. (Moringaceae) ...... essential oil from leaves of Moringa oleifera Lam.

  7. Intradialytic Hypotension and Cardiac Remodeling: A Vicious Cycle

    Directory of Open Access Journals (Sweden)

    Chia-Ter Chao

    2015-01-01

    Full Text Available Hemodynamic instability during hemodialysis is a common but often underestimated issue in the nephrologist practice. Intradialytic hypotension, namely, a decrease of systolic or mean blood pressure to a certain level, prohibits the safe and smooth achievement of ultrafiltration and solute removal goal in chronic dialysis patients. Studies have elucidated the potential mechanisms involved in the development of Intradialytic hypotension, including excessive ultrafiltration and loss of compensatory mechanisms for blood pressure maintenance. Cardiac remodeling could also be one important piece of the puzzle. In this review, we intend to discuss the role of cardiac remodeling, including left ventricular hypertrophy, in the development of Intradialytic hypotension. In addition, we will also provide evidence that a bidirectional relationship might exist between Intradialytic hypotension and left ventricular hypertrophy in chronic dialysis patients. A more complete understanding of the complex interactions in between could assist the readers in formulating potential solutions for the reduction of both phenomena.

  8. Association between intraoperative hypotension and myocardial injury after vascular surgery

    NARCIS (Netherlands)

    van Waes, JAR; Van Klei, Wilton A.; Wijeysundera, Duminda N.; Van Wolfswinkel, Leo; Lindsay, Thomas F.; Beattie, W. Scott

    2016-01-01

    Background: Postoperative myocardial injury occurs frequently after noncardiac surgery and is strongly associated with mortality. Intraoperative hypotension (IOH) is hypothesized to be a possible cause. The aim of this study was to determine the association between IOH and postoperative myocardial

  9. Neural mechanism of electroacupuncture's hypotensive effects

    Science.gov (United States)

    Li, Peng; Longhurst, John C.

    2010-01-01

    EA at P 5–6 and S 36–37 using low current and low frequency may be able to reduce elevated blood pressure in a subset of patients (~70%) with mild to moderate hypertension. The effect is slow in onset but is long-lasting. Experimental studies have shown that EA inhibition of cardiovascular sympathetic neurons that have been activated through visceral reflex stimulation is through activation of neurons in the arcuate nucleus of the hypothalamus, vlPAG in the midbrain and NRP in the medulla, which, in turn, inhibit the activity of premotor sympathetic neurons in the rVLM. The arcuate also provides direct projections to the rVLM that contain endorphins. Glutamate, acetylcholine, opioids, GABA, nociceptin, serotonin and endocannabinoids all appear to participate in the EA hypotensive response although their importance varies between nuclei. Thus, a number of mechanisms underlying the long-lasting effect of EA on cardiovascular function have been identified but clearly further investigation is warranted. PMID:20444652

  10. Effects of beach-chair position and induced hypotension on cerebral oxygen saturation in patients undergoing arthroscopic shoulder surgery.

    Science.gov (United States)

    Lee, Jae Hoon; Min, Kyeong Tae; Chun, Yong-Min; Kim, Eun Jung; Choi, Seung Ho

    2011-07-01

    We investigated the effects of the beach-chair position and induced hypotension on regional cerebral oxygen saturation (rSO(2)) in patients undergoing arthroscopic shoulder surgery by using near-infrared spectroscopy. Twenty-eight patients scheduled for arthroscopic shoulder surgery were enrolled prospectively. After induction of anesthesia, mechanical ventilation was controlled to maintain Paco(2) at 35 to 40 mm Hg. Anesthesia was maintained with sevoflurane and remifentanil. After radial artery cannulation, mean arterial pressure (MAP) was measured at the external auditory meatus level and maintained between 60 and 65 mm Hg. The rSO(2) was measured by use of near-infrared spectroscopy. MAP and rSO(2) were recorded at the following times: before induction (T(0)), immediately after induction (T(1) [baseline]), after beach-chair position (T(2)), immediately after induced hypotension (T(3)), 1 hour after induced hypotension (T(4)), and after supine position at the end of surgery (T(5)). Cerebral desaturation was defined as a reduction in rSO(2) to less than 80% of baseline value for 15 seconds or greater. A total of 27 patients were evaluated until the end of this study. The MAP at T(2) was significantly lower than that at T(1). The MAP values at T(3) and T(4) were significantly lower than those at T(1) and T(2). The rSO(2) at T(2) was significantly lower than that at T(1). Unlike the pattern of change in the MAP, there was no additional decrease in rSO(2) at T(3) and T(4). There were 2 patients who had an episode of cerebral desaturation. The beach-chair position combined with induced hypotension significantly decreases rSO(2) in patients undergoing shoulder arthroscopic surgery under general anesthesia. Level IV, study of nonconsecutive patients without consistently applied reference gold standard. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  11. Orthostatic Tremor: An Update on a Rare Entity

    Science.gov (United States)

    Benito-León, Julián; Domingo-Santos, Ángela

    2016-01-01

    Background Orthostatic tremor (OT) remains among the most intriguing and poorly understood of movement disorders. Compared to Parkinson’s disease or even essential tremor, there are very few articles addressing more basic science issues. In this review, we will discuss the findings of main case series on OT, including data on etiology, pathophysiology, diagnostic approach, treatment strategies, and outcome. Methods Data for this review were identified by searching PUBMED (January 1966 to August 2016) for the terms “orthostatic tremor” or “shaky leg syndrome,” which yielded 219 entries. We did not exclude papers on the basis of language, country, or publication date. The electronic database searches were supplemented by articles in the authors’ files that pertained to this topic. Results Owing to its rarity, the current understanding of OT is limited and is mostly based on small case series or case reports. Despite this, a growing body of evidence indicates that OT might be a progressive condition that is clinically heterogeneous (primary vs. secondary cases) with a broader spectrum of clinical features, mainly cerebellar signs, and possible cognitive impairment and personality disturbances. Along with this, advanced neuroimaging techniques are now demonstrating distinct anatomical and functional changes, some of which are consistent with neuronal loss. Discussion OT might be a family of diseases, unified by the presence of leg tremor, but further characterized by etiological and clinical heterogeneity. More work is needed to understand the pathogenesis of this condition. PMID:27713855

  12. In vivo and in vitro hypotensive effect of aqueous extract of Moringa stenopetala.

    Science.gov (United States)

    Mengistu, M; Abebe, Y; Mekonnen, Y; Tolessa, T

    2012-12-01

    Moringa stenopetala, Baker f. (Moringaceae) is used for food and medicine in Southern Ethiopia. To substantiate the hypotensive effect of M. stenopetala in vivo and in vitro. An in vivo experiment was carried out on male guinea pigs anaesthetized with pentobarbital. The arterial blood pressure was recorded from a carotid artery filled with heparinized saline via an arterial cannula connected to a pressure transducer. For the in vitro experiment the descending thoracic aorta was removed and kept moistened in Krebs-Henseleit solution and then mounted in a 20ml tissue bath maintained at 37°C and bubbled with a mixture of 95% oxygen and 5% carbon dioxide. Crude aqueous leaf extract of M. stenopetala caused significant fall in systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MABP) at doses of 10, 20, 30 and 40 mg/kg in normotensive anaesthetized guinea pigs (n = 12). The effect might have been mediated by non-autonomic nervous system as the effect is not altered by atropine and propranolol. The extract also caused significant dose and time dependent inhibition of K(+) induced contraction on guinea pig aorta. M.stenopetala has blood pressure lowering effect substantiating the use of the plant in traditional medicine.

  13. Postural tachycardia syndrome and other forms of orthostatic intolerance in Ehlers-Danlos syndrome.

    Science.gov (United States)

    Roma, Maria; Marden, Colleen L; De Wandele, Inge; Francomano, Clair A; Rowe, Peter C

    2018-03-05

    To review the association between orthostatic intolerance syndromes and both joint hypermobility and Ehlers-Danlos syndrome, and to propose reasons for identifying hereditary connective tissue disorders in those with orthostatic intolerance in the context of both clinical care and research. We searched the published peer-reviewed medical literature for papers reporting an association between joint hypermobility or Ehlers-Danlos syndrome and orthostatic intolerance. We identified 10 relevant papers. Although methodological variability between studies introduces some limitations, the published literature consistently identifies a significantly higher prevalence of orthostatic intolerance symptoms in patients with joint hypermobility or Ehlers-Danlos syndrome than in healthy controls, and a significantly higher prevalence of cardiovascular and autonomic abnormalities both at rest and during orthostatic challenge. Postural tachycardia syndrome is the most commonly recognized circulatory disorder. The severity of orthostatic symptoms in those with EDS correlates with impairments in quality of life. There is a strong association between several forms of cardiovascular dysfunction, most notably postural tachycardia syndrome, and joint hypermobility or Ehlers-Danlos syndrome. We propose that recognition of joint hypermobility and Ehlers-Danlos syndrome among those with orthostatic intolerance syndromes has the potential to improve clinical care and the validity of research findings. Copyright © 2018 Elsevier B.V. All rights reserved.

  14. Midodrine as adjunctive support for treatment of refractory hypotension in the intensive care unit: a multicenter, randomized, placebo controlled trial (the MIDAS trial).

    Science.gov (United States)

    Anstey, Matthew H; Wibrow, Bradley; Thevathasan, Tharusan; Roberts, Brigit; Chhangani, Khushi; Ng, Pauline Yeung; Levine, Alexander; DiBiasio, Alan; Sarge, Todd; Eikermann, Matthias

    2017-03-21

    Patients admitted to intensive care units (ICU) are often treated with intravenous (IV) vasopressors. Persistent hypotension and dependence on IV vasopressors in otherwise resuscitated patients lead to delay in discharge from ICU. Midodrine is an oral alpha-1 adrenergic agonist approved for treatment of symptomatic orthostatic hypotension. This trial aims to evaluate whether oral administration of midodrine is an effective adjunct to standard therapy to reduce the duration of IV vasopressor treatment, and allow earlier discharge from ICU and hospital. The MIDAS trial is an international, multicenter, randomized, double-blind, placebo-controlled clinical trial being conducted in the USA and Australia. We are targeting 120 patients. Adult patients admitted to the ICU who are resuscitated and otherwise stable on low dose IV vasopressors for at least 24 h will be considered for recruitment. Participants will be randomized to receive midodrine (20 mg) or placebo three times a day, in addition to standard care. The primary outcome is time (hours) from initiation of midodrine or placebo to discontinuation of IV vasopressors. Secondary outcomes include time (hours) from ICU admission to discharge readiness, ICU length of stay (LOS) (days), hospital LOS (days), rates of ICU readmission, and rates of adverse events related to midodrine administration. Midodrine is approved by the Food and Drug Administration (FDA) for the treatment of symptomatic orthostatic hypotension. In August 2010, FDA proposed to withdraw approval of midodrine because of lack of studies that verify the clinical benefit of the drug. We obtained Investigational New Drug (IND 113,330) approval to study its effects in critically ill patients who require IV vasopressors but are otherwise ready for discharge from the ICU. A pilot observational study in a cohort of surgical ICU patients showed that the rate of decline in vasopressor requirements increased after initiation of midodrine treatment. We

  15. TERMAL BALANCE MANAGEMENT FOR INTRADIALYSIS HYPOTENSION PREVENTION

    Directory of Open Access Journals (Sweden)

    A. G. Strokov

    2012-01-01

    Full Text Available Intradialytic hypotension (IDH remains an important cause of morbidity and mortality in chronic hemodialysis (HD patients and can be ameliorated by low temperature HD. Biofeed-back temperature-control device BTM® (Fresenius Medical Care, Germany was used for precision temperature measurement and to deliver isothermic (ITD or thermoneutral (TND dialysis. At stage one 24 stable dialysis patients were studied in terms of inlet blood temperature (IBT variation during sessions with normal (36,5 °С-ND and cold dialysate (35 °С-CD. IBT was increasing in both cases however the increase was significantly lower in CD. At stage two, 18 patients underwent programmed cooling during two ITD and two TND sessions. In TND high correlation (r = 0.66; р < 0.05 was observed between IBT increase and ultrafiltration rate. Keeping IBT stable during ITD required cons- tant decrease of dialysate temperature to 34.9 ± 0.2 °С at the end of session. At stage three, 19 IDH-prone patients were displaced from regular dialysis program to ITD. As a result,the decrease overall rate of IDH from 36.2 ± 1.1% to 11.3 ± 4,6% was observed. Conclusions: 1. The main mechanism of body temperature raise during HD is heat retention secondary to the compensatory response to loss of plasma volume, resulting in increase of the total peripheral resistance. 2. CD is effective for IDH prevention. 3. ITD is the optimal version of CD. 

  16. Orthostatic intolerance and postural tachycardia syndrome as suspected adverse effects of vaccination against human papilloma virus

    DEFF Research Database (Denmark)

    Brinth, Louise S; Pors, Kirsten; Theibel, Ann C

    2015-01-01

    of postural orthostatic tachycardia syndrome (POTS) rested on finding a sustained heart rate increment of >30min(-1) (>40min(-1) in adolescents) or to levels >120min(-1) during orthostatic challenge. RESULTS: 35 women aged 23.3±7.1 years participated. Twenty-five had a high level of physical activity before...... vaccination and irregular periods were reported by all patients not on treatment with oral contraception. Serum bilirubin was below the lower detection limit in 17 patients. Twenty-one of the referred patients fulfilled the criteria for a diagnosis of POTS (60%, 95%CI 43-77%). All patients had orthostatic...

  17. Induced hypotension for functional endoscopic sinus surgery: A comparative study of dexmedetomidine versus esmolol

    Directory of Open Access Journals (Sweden)

    Tarek Shams

    2013-01-01

    Full Text Available Objective: A comparative study to evaluate the efficacy of dexmedetomidine as a hypotensive agent in comparison to esmolol in Functional Endoscopic Sinus Surgery (FESS. Methods: Forty patients ASA I or II scheduled for FESS were equally randomly assigned to receive either dexmedetomidine 1 μg/Kg over 10 min before induction of anesthesia followed by 0.4-0.8 μg/Kg/h infusion during maintenance (DEX group, or esmolol, loading dose 1mg/kg was infused over one min followed by 0.4-0.8 mg/kg/h infusion during maintenance (E group to maintain mean arterial blood pressure (MAP between (55-65 mmHg. General anesthesia was maintained with sevoflurane 2%-4%. The surgical field was assessed using Average Category Scale and average blood loss was calculated. Hemodynamic variables (MAP and HR; arterial blood gas analysis; plasma cortisol level; intraoperative fentanyl consumption; Emergence time and total recovery from anesthesia (Aldrete score ≥9 were recorded. Sedation score was determined at 15, 30, 60 min after tracheal extubation and time to first analgesic request was recorded. Result: Both DEX group and E group reached the desired MAP (55-65 mmHg with no intergroup differences in MAP or HR. The for the quality of the surgical filed in the range of MAP (55-65 mmHg were <=2 with no significant differences between group scores during hypotensive period. Mean intraoperative fentanyl consumption was significantly lower in DEX group than E group. Cortisol level showed no significant changes between or within groups. No significant changes were observed in arterial blood gases. Emergence time and time to achieve Aldrete score ≥9 were significantly lower in E group compared with DEX group. The sedation score were significantly lower in E group compared with DEX group at 15 and 30 minutes postoperatively. Time to first analgesic request was significantly longer in DEX group. Conclusion: Both dexmedetomidine or esmolol with sevoflurane are safe agents for

  18. Feasibility of dexmedetomidine assisting sevoflurane for controlled hypotension in endoscopic sinus surgery

    Directory of Open Access Journals (Sweden)

    Guang-jie GAO

    2012-01-01

    Full Text Available Objective  To explore the feasibility of dexmedetomidine as an adjuvant of sevoflurane for controlled hypotension in endoscopic sinus surgery. Methods  Forty-eight patients (ASA Ⅰor Ⅱ scheduled for endoscopic sinus surgery were randomly assigned into two groups (n=24: control group (group I and dexmedetomidine group (group Ⅱ. In both groups, intravenous injection of midazolam, propofol, fentanyl, and atracurium besilate was given to induce anesthesia, and propofol, fentanyl, atracurium besilate, together with sevoflurane inhalation were used to maintain anesthesia. The radial artery was cannulated to monitor the invasive mean arterial pressure (MAP. Controlled hypotension was induced by adjusting the sevoflurane concentration in group Ⅰ. In group Ⅱ, within 15min to 30min before the induction of anesthesia, dexmedetomidine was administered in a dose of 0.8μg/kg via intravenous infusion pump, then maintained at 0.4μg/(kg·h. Sevoflurane concentration was adjusted to maintain the target blood pressure at the beginning of surgery. The MAP was maintained at 65-75mmHg up to the end of operation. Meanwhile, the heart rate (HR, MAP, epinephrine (E, and norepinephrine (NE concentrations were recorded at the time of induction of anesthesia (T0, beginning of controlled hypotension (T1, 30min after controlled hypotension (T2, and at the time when extubation was performed (T3. Blood gas analysis and determination of lactic acid concentration were conducted using the blood drawn from the radial artery during the operation. The surgical field quality was assessed based on Fromme scores of surgical field quality (SSFQ. Meanwhile, the dose of sevoflurane, propofol, and fentanyl, MAP, the recovery time of anesthesia, and the incidence rate of untoward effects were recorded. Results  The doses of propofol, fentanyl and sevoflurane, and MAC value in group Ⅱwas significantly diminished compared with group Ⅰ(P<0.01. In addition, the surgical

  19. Transdermal glyceryl trinitrate (nitroglycerin in healthy persons: acute effects on skin temperature and hemodynamic orthostatic response

    Directory of Open Access Journals (Sweden)

    Eva Maria Augusta Boeckh Haebisch

    Full Text Available In order to find an explanation for individual reactions to transdermal glyceryl trinitrate (GTN we studied the skin temperature and hemodynamic reactions in 63 healthy persons. The data were obtained before and after the application of GTN and Glycerin (GL placebo patches, during one hour. The skin temperature was measured on both forearms, the local (left sided and systemic (right sided reaction on GTN was related to the skin fold and the calculated body fat content. The bilateral rise of skin temperature and its duration was higher and longer in obese than in lean persons mainly in obese women. The UV induced thermo and the later photothermoreaction (Erythema was reduced on the left forearm after the application of GTN and GL patches. The observed hemodynamic GTN effect confirmed known postural reactions, such as decreased arterial pressure (ΔmAP = -2.9%, increased heart rate (ΔHR = +7,4% and QTc prolongation (ΔQTc = +4,9% in upright position. An adverse drug effect with increased mean blood pressure (ΔmAP = +12% and increased heart rate (ΔHR = + 10.4% mainly in supine position was observed in 11 % of the participants, but only in men. Such a reaction was already described by Murell, 1879. Individual GTN effects were analyzed and related to habits and family history. In male smokers and in persons with hypertensive and diabetic close relatives, the hypotensive GTN effect was accentuated in supine position. In the upright position the group with hypertensives in the family presented a moderate hypotensive reaction without secondary tachycardia and the smokers presented only a slightly increased heart rate. Our observations suggest that individual reactions to transdermal glyceryl trinitrate (GTN with its active component nitric oxide (NO depends on physiological conditions, related to endogenous vasoactive substances, mainly the interaction with EDRF (the endogenous NO and the activity of the Renin-Angiotensin System.

  20. Acute hypotensive and diuretic activities of Berberis vulgaris root bark aqueous extract in normal rats

    Directory of Open Access Journals (Sweden)

    Muhammad Ahmed

    2018-03-01

    Full Text Available ABSTRACT The aim of this study is to investigate the effectiveness of intravenous administration of Berberis vulgaris root bark aqueous extract (BRBD on the cardiovascular and renal functions of healthy normotensive rats. The different doses of BRBD 1, 10 and 20 mg/kg were administered intravenously (i.v in normal rats. Blood pressure, diuretic activity and serum renal profile were analyzed. Intravenous injection of BRBD at the different doses of 1, 10 and 20 mg/kg showed a dose-dependent reduction in mean arterial blood pressure (P<0.001. At different doses of 1, 10 and 20 mg/kg, the hypotensive effect remained for more than one hour. Single dose administration of BRBD at doses of 10 and 20 mg/kg caused a significant increase in urine output (P<0.001 as compared to the control rats. Serum renal profile test (albumin, Urea, Uric Acid, creatinine and BUN did not show any significant alteration. The authors conclude that the BRBD is a potent hypotensive and possesses diuretic potential

  1. Cerebral blood flow and metabolism during controlled hypotension with sodium-nitroprusside and general anaesthesia for total hip replacement a.m. Charnley

    International Nuclear Information System (INIS)

    Buenemann, L.; Jensen, K.; Thomsen, L.; Riisager, S.

    1987-01-01

    Cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRo 2 ) were studied during hypotension induced with sodium nitroprusside (SNP) in 10 patients undergoing total hip replacement a.m. Charnley. Cerebral blood flow was measured using an injection of xenon-133 into an arm vein. The decay curve was detected by five scintillation counters placed over each hemisphere and analysed with the Novo 10a cerebrograph. Blood samples were drawn from the radial artery and the jugular venous bulb to calculate the CMRo 2 . In the gropu as a whole, there were significant decreases in mean arterial pressure and in cerebrovascular resistance. There were no significant changes, in either CBF or CMRo 2 in the gropu as a whole, but there were substantial individual differences. In conclusion, the use of SNP-induced hypotension for extracranial surgery should be used only in patients monitored closely. (author)

  2. [The use of low-frequency magnetotherapy and EHF puncture in the combined treatment of arterial hypertension in vibration-induced disease].

    Science.gov (United States)

    Drobyshev, V A; Filippova, G N; Loseva, M I; Shpagina, L A; Shelepova, N V; Zhelezniak, M S

    2000-01-01

    Combination of EHF therapy + magnetotherapy + drugs results in faster and persistent hypotensive and analgetic effect compared to standard drug therapy, potentiates action of vascular drugs on cerebral and peripheral circulation, reduces dose of hypotensive drugs in patients with arterial hypertension and vibration disease.

  3. Identification of Hypotensive Emergency Department Patients with Cardiogenic Etiologies.

    Science.gov (United States)

    Henning, Daniel J; Kearney, Kathleen E; Hall, Michael Kennedy; Mahr, Claudius; Shapiro, Nathan I; Nichol, Graham

    2018-02-01

    Identify predictors of cardiogenic etiology among emergency department (ED) patients with hypotension, and use these predictors to create a clinical tool to discern cardiogenic etiology of hypotension. This secondary analysis evaluated a prospective cohort of consecutive patients with hypotension in an urban, academic, tertiary care ED from November 2012 to September 2013. We included adults with hypotension, defined as a new vasopressor requirement, systolic blood pressure (SBP)  0.1 ng/mL (37.5, 7.1-198.2), electrocardiographic ischemia (8.9, 4.0-19.8), history of heart failure (2.0, 1.1-3.3), and absence of fever (4.5, 2.3-8.7) (area under the curve [AUC] = 0.83). The prediction score created from these predictors yielded 78% sensitivity and 77% specificity for cardiogenic etiology (AUC = 0.827). Clinical predictors offer reasonable ED screening sensitivity for cardiogenic hypotension, while demonstrating sufficient specificity to facilitate early cardiac interventions.

  4. Autonomic Functions Associated with Blood Pressure Regulation and Orthostatic Performance in Women

    National Research Council Canada - National Science Library

    Convertino, Victor

    1997-01-01

    ... in men and women to test the hypothesis that greater orthostatic intolerance in women would be associated with impairment of specific mechanisms of blood pressure regulation. Heart rate (HR), stroke volume (SV), cardiac output (Q...

  5. Thalamic Ventral Intermediate Nucleus Deep Brain Stimulation for Orthostatic Tremor

    Directory of Open Access Journals (Sweden)

    Alexander C. Lehn

    2017-07-01

    Full Text Available Background: Orthostatic tremor (OT was first described in 1977. It is characterized by rapid tremor of 13–18 Hz and can be recorded in the lower limbs and trunk muscles. OT remains difficult to treat, although some success has been reported with deep brain stimulation (DBS.Case Report: We report a 68-year-old male with OT who did not improve significantly after bilateral thalamic stimulation.Discussion: Although some patients were described who improved after DBS surgery, more information is needed about the effect of these treatment modalities on OT, ideally in the form of randomized trial data. 

  6. Orthostatic hypoxaemia in dialysed adult polycystic kidney disease patients.

    Science.gov (United States)

    Korzets, Z; Golan, E; Ben-Chitrit, S; Smorjik, Y; Os, P; Bernheim, J

    1997-04-01

    Recently we observed a unique clinical phenomenon, namely, orthostatic or postural hypoxaemia in a 72-year-old female adult polycystic kidney disease (APKD) patient, maintained on CAPD. Extensive investigations failed to yield a satisfactory explanation for her ambulatory hypoxaemia. To validate our observation, 15 dialysed patients underwent blood gases analyses in both the supine and ambulatory positions (SpO2 and ApO2 respectively). Patients were divided into two groups: group 1 (n-7) whose end-stage renal failure (ESRF) was due to APKD and group 2 (n-8) in whom ESRF was due to other causes. Both haemodialysed (HD) and CAPD patients were included. ApO2 was determined as the pO2 immediately upon standing up. Readings in HD patients were taken at the end of the dialysis session, that is, at the patients' dry weight. Respective SpO2 and ApO2 of the two groups were 85 +/- 17.1 and 78 +/- 20.5 vs 85.8 +/- 19 and 91 +/- 21 mmHg. Delta change in pO2 defined as the mean decrease (negative value) or mean increase (positive value) of ApO2 in relation to SpO2 was -7.85 (group 1) vs + 5.2 mmHg (group 2), P delta. In group 2, four of eight showed a positive delta whilst the remaining four had no change in the delta value. Orthostatic hypoxaemia may occur in dialysed patients whose ESRF is due to APKD.

  7. Heart rate variability analysis in postural orthostatic tachycardia syndrome: a case report

    Directory of Open Access Journals (Sweden)

    Raffaele Calabrò

    2006-09-01

    Full Text Available The authors present a case of 36 year old male patient with idiopathic postural orthostatic tachycardia syndrome (POTS diagnosed during head-up tilt testing. Power spectral analysis of heart rate variability (HRV during the tilt test revealed that the ratio of low and high frequency powers (LF/HF increased with the onset of orthostatic intolerance. This analysis confirmed in our patient a strong activation in sympathetic tone.

  8. Hypotensive effect of aqueous extract of Averrhoa carambola L. (Oxalidaceae) in rats: an in vivo and in vitro approach.

    Science.gov (United States)

    Soncini, Roseli; Santiago, Michael B; Orlandi, Lidiane; Moraes, Gabriel O I; Peloso, André Luiz M; dos Santos, Marcelo H; Alves-da-Silva, Geraldo; Paffaro, Valdemar A; Bento, Antonio C; Giusti-Paiva, Alexandre

    2011-01-27

    Averrhoa carambola L. (Oxalidaceae) leaves are used in Brazilian traditional medicine to treat hypertension. This study was conducted to evaluate the hypotensive effect of the aqueous extract of Averrhoa carambola (AEAc) and its underlying mechanisms in the isolated rat aorta. The effect of AEAc on the mean arterial pressure (MAP) was determined in vivo in anesthetized rats. In vitro, thoracic aortic rings were isolated and suspended in organ baths, and the effects of AEAc were studied by means of isometric tension recording experiments. In HPLC analysis, the fingerprint chromatogram of AEAc was established. In normotensive rats, AEAc (12.5-50.0 mg/kg, i.v.) induced dose-dependent hypotension. In vitro, AEAc caused a depression in the E(max) response to phenylephrine without a change in sensibility. Also, in a depolarized Ca(2+)-free medium, AEAc inhibited CaCl(2)-induced contractions and caused a concentration-dependent rightward shift of the response curves, indicating that AEAc inhibited the contractile mechanisms involving extracellular Ca(2+) influx. These results demonstrate the hypotensive effects of AEAc, and these effects may, in part, be due to the inhibition of Ca(2+), which supports previous claims of its traditional use. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  9. Intra-dialytic blood oxygen saturation (SO2): association with dialysis hypotension (the SOGLIA Study).

    Science.gov (United States)

    Mancini, E; Perazzini, C; Gesualdo, L; Aucella, F; Limido, A; Scolari, F; Savoldi, S; Tramonti, M; Corazza, L; Atti, M; Severi, S; Bolasco, P; Santoro, A

    2017-12-01

    Intradialytic hypotension (IDH) has a dramatic impact on the main outcomes of dialysis patients. Early warning of hemodynamic worsening during dialysis would enable preventive measures to be taken. Blood oxygen saturation (SO 2 ) is used for hemodynamic monitoring in the critical care setting and may provide useful information about IDH onset. To evaluate whether short- and medium-term variations in the SO 2 signal (ST-SO 2var , MT-SO 2var ,) during dialysis are a predictor of IDH. In this 3-month observational cohort study, 51 hypotension-prone chronic hemodialysis (HD) patients, with vascular access by arteriovenous fistula (AVF) or central venous catheter (CVC), were enrolled. Continuous non-invasive blood SO 2 was monitored (fc = 0.2 Hz) by an optical sensor on the arterial line of the extracorporeal circulation; blood pressure (every 30 min), symptoms and their time of appearance were noted. Predictive power of IDH was expressed by the area under curve (AUC) sensitivity and specificity based on intradialytic variations in SO 2 . A total of 1290 HD sessions were analyzed. Overall, off-line ST-SO 2var analysis proved able to correctly predict IDH in 67 % of the sessions where IDH occurred. The best predictive performance was found in the presence of highly arterialized AVF (SO 2  > 95 %) (75 % sensitivity; AUC 0.825; p < 0.05). On the contrary, in sessions with CVC, IDH prediction proved more efficient by MT-SO 2var (AUC 0.575; p = 0.01). Intradialytic SO 2 variability could be a valid parameter to detect in advance the hemodynamic worsening that precedes IDH. Appropriate timely intervention could help prevent IDH onset.

  10. Evaluation and treatment of hypotension in the preterm infant.

    LENUS (Irish Health Repository)

    Dempsey, E M

    2012-01-31

    A large proportion of very preterm infants receive treatment for hypotension. The definition of hypotension is unclear, and, currently, there is no evidence that treating it improves outcomes or, indeed, which treatment to choose among the available alternatives. Assessment of circulatory adequacy of the preterm infant requires a careful clinical assessment and may also require ancillary investigations. The most commonly used interventions, fluid boluses and dopamine, are problematic: fluid boluses are statistically associated with worse clinical outcomes and may not even increase blood pressure, whereas dopamine increases blood pressure mostly by causing vasoconstriction and may decrease perfusion. For neither intervention is there any reliable data showing clinical benefit. Prospective trials of intervention for hypotension and circulatory compromise are urgently required.

  11. Peripheral and central vascular conductance influence on post-exercise hypotension

    Directory of Open Access Journals (Sweden)

    Endo Masako Y

    2012-12-01

    Full Text Available Abstract Background Post-exercise hypotension (PEH following prolonged dynamic exercise arises from increased total vascular conductance (TVC via skeletal muscle vasodilation. However, arterial vasodilation of skeletal musculatures does not entirely account for the rise in TVC. The aim of the present study was to determine the contribution of vascular conductance (VC of the legs, arms, kidneys and viscera to TVC during PEH. Methods Eight subjects performed a single period of cycling at 60% of heart rate (HR reserve for 60 minutes. Blood flow in the right renal, superior mesenteric, right brachial and right femoral arteries was measured by Doppler ultrasonography in a supine position before exercise and during recovery. HR and mean arterial pressure (MAP were measured continuously. MAP decreased significantly from approximately 25 minutes after exercise cessation compared with pre-exercise baseline. TVC significantly increased (approximately 23%; P Conclusion PEH was not induced by decreased cardiac output, but by increased TVC, two-thirds of the rise in which can be attributed to increased VC in active and inactive limbs.

  12. A New Orally Active, Aminothiol Radioprotector-Free of Nausea and Hypotension Side Effects at Its Highest Radioprotective Doses

    Energy Technology Data Exchange (ETDEWEB)

    Soref, Cheryl M. [ProCertus BioPharm, Inc., Madison, WI (United States); Hacker, Timothy A. [Department of Medicine, Cardiovascular Physiology Core, University of Wisconsin-Madison, Madison, WI (United States); Fahl, William E., E-mail: fahl@oncology.wisc.edu [ProCertus BioPharm, Inc., Madison, WI (United States); McArdle Laboratory for Cancer Research, University of Wisconsin Carbone Cancer Center, Madison, WI (United States)

    2012-04-01

    Purpose: A new aminothiol, PrC-210, was tested for orally conferred radioprotection (rats, mice; 9.0 Gy whole-body, which was otherwise lethal to 100% of the animals) and presence of the debilitating side effects (nausea/vomiting, hypotension/fainting) that restrict use of the current aminothiol, amifostine (Ethyol, WR-2721). Methods and Materials: PrC-210 in water was administered to rats and mice at times before irradiation, and percent-survival was recorded for 60 days. Subcutaneous (SC) amifostine (positive control) or SC PrC-210 was administered to ferrets (Mustela putorius furo) and retching/emesis responses were recorded. Intraperitoneal amifostine (positive control) or PrC-210 was administered to arterial cannulated rats to score drug-induced hypotension. Results: Oral PrC-210 conferred 100% survival in rat and mouse models against an otherwise 100% lethal whole-body radiation dose (9.0 Gy). Oral PrC-210, administered by gavage 30-90 min before irradiation, conferred a broad window of radioprotection. The comparison of PrC-210 and amifostine side effects was striking because there was no retching or emesis in 10 ferrets treated with PrC-210 and no induced hypotension in arterial cannulated rats treated with PrC-210. The tested PrC-210 doses were the ferret and rat equivalent doses of the 0.5 maximum tolerated dose (MTD) PrC-210 dose in mice. The human equivalent of this mouse 0.5 MTD PrC-210 dose would likely be the highest PrC-210 dose used in humans. By comparison, the mouse 0.5 MTD amifostine dose, 400 {mu}g/g body weight (equivalent to the human amifostine dose of 910 mg/m{sup 2}), when tested at equivalent ferret and rat doses in the above models produced 100% retching/vomiting in ferrets and 100% incidence of significant, progressive hypotension in rats. Conclusions: The PrC-210 aminothiol, with no detectable nausea/vomiting or hypotension side effects in these preclinical models, is a logical candidate for human drug development to use in healthy

  13. Refractory hypotension due to intraoperative hypothermia during spinal instrumentation

    Directory of Open Access Journals (Sweden)

    Ponniah Vanamoorthy

    2010-01-01

    Full Text Available We report a case of inadvertent hypothermia leading to severe hypotension resistant to high dose vasopressors, which responded to temperature correction in a patient undergoing spinal instrumentation surgery. A 60-year-old female developed severe hypotension during spinal instrumentation surgery. After review of all factors it was found to be secondary to hypothermia. The patient did not respond to high dose vasopressors. However, when normothermia was restored she recovered uneventfully. Patients undergoing lengthy spinal procedures in prone position are vulnerable to develop hypothermia and consequent cardiovascular depression so adequate measures should be taken to prevent hypothermia.

  14. [Effect of complex sanatorium treatment including magnetotherapy on hemodynamics in patients with arterial hypertension].

    Science.gov (United States)

    Efremushkin, G G; Duruda, N V

    2003-01-01

    Forty nine patients with arterial hypertension of stage I-II received combined sanatorium treatment. Of them, 21 had adjuvant total magnetotherapy. All the patients were examined for parameters of central, cerebral hemodynamics and microcirculation. The adjuvant magnetotherapy produced a beneficial effect on hypertension: clinical symptoms attenuated, arterial pressure became more stable, hemodynamics improved, duration of hospitalization reduced, requirement in hypotensive drugs diminished.

  15. Late Posthemorrhagic Structural and Functional Changes in Pulmonary Circulation Arteries

    Directory of Open Access Journals (Sweden)

    S. A. Andreyeva

    2008-01-01

    Full Text Available Objective: to reveal the major regularities and mechanisms of morphological changes in the rat pulmonary circulation arteries in the late posthemorrhagic period and to compare them with age-related features of the vessels. Materials and methods: experiments to generate graduated hemorrhagic hypotension with the blood pressure being maintained at 40 mm Hg were carried out on young (5—6-month albino male Wistar rats. Throughout hypotension and 60 days after blood loss, the blood was tested to determine low and average molecular-weight substances by spectrophotometry and the pro- and antioxidative systems by chemiluminescence. Pulmonary circulation arteries were morphologically studied in young animals, rats in the late posthemorrhagic period and old (24—25-month rats. Results. Sixty-minute hemorrhagic hypotension leads to the development of endotoxemia and imbalance of the pro- and antioxidative systems, the signs of which are observed in the late periods (2 months after hypotension. At the same time, the posthemorrhagic period is marked by the significant pulmonary circulation arterial morphological changes comparable with their age-related alterations in old rat. This shows up mainly in the reorganization of a connective tissue component in the vascular wall: the elevated levels of individual collagen fibers, their structural changes, elastic medial membrane destruction and deformity. At the same time, there is a change in the morphometric parameters of vessels at all study stages while their lowered flow capacity is only characteristic for intraorgan arteries. Conclusion: The increased activity of free radical oxidation and endotoxemia may be believed to be one of the causes of morphological changes in pulmonary circulation arteries in the late posthemorrhagic period, which is similar to age-related vascular alterations. Key words: hemorrhagic hypotension, pulmonary circulation arteries, free radical oxidation, endotoxemia, remodeling, late

  16. Hypotensive Activity of Moringa oleifera Lam (Moringaceae) Root ...

    African Journals Online (AJOL)

    Purpose: To explore the hypotensive activity and chemical composition of Moringa oleifera Lam (Moringaceae) roots. Methods: The fresh roots of M. oleifera was cut into small pieces and successively extracted with petroleum ether (PE) and dichloromethane (DC). PE extract was further divided into MRP and MRP -1.

  17. Burr Hole Drainage for Complicated Spontaneous Intracranial Hypotension Syndrome

    Directory of Open Access Journals (Sweden)

    Yu-Fang Liu

    2008-09-01

    Full Text Available Spontaneous intracranial hypotension is a potentially severe condition that is caused by continuous cerebrospinal fluid leakage. Clinically, most patients have a benign course and the condition remits after conservative management. We report two consecutive patients who presented with acute expansion of subdural collection and disturbed consciousness. Both patients recovered completely after undergoing burr hole drainage.

  18. Postural hypotension in type 1 diabetes: The influence of glycemic ...

    African Journals Online (AJOL)

    Background: Postural hypotension (PH) indicates the presence of cardiac autonomic neuropathy and in diabetes mellitus (DM) is associated with adverse outcome. Nonetheless, PH has been rarely characterized in young persons in Sub‑saharan Africa where suboptimal care of DM is prevalent. Aims: The aim of the study ...

  19. Intravenous granisetron attenuates hypotension during spinal anesthesia in cesarean delivery: A double-blind, prospective randomized controlled study

    Directory of Open Access Journals (Sweden)

    Ahmed A Eldaba

    2015-01-01

    Full Text Available Background and Aims: This study was conducted to determine the effectiveness of intravenous (IV granisetron in the prevention of hypotension and bradycardia during spinal anesthesia in cesarean delivery. Material and Methods: A total of 200 parturients scheduled for elective cesarean section were included in this study. They were randomly divided into two groups. Group I was given 1 mg granisetron diluted in 10 ml normal saline slowly IV, 5 min before spinal anesthesia. Group II was given 10 ml of normal saline, 5 min before spinal anesthesia. Mean arterial blood pressure and heart rate (HR were recorded every 3 min until the end of surgery (for 45 min. The total consumption of vasopressors and atropine were recorded. Apgar scores at 1 and 5 min were also assessed. Results: Serial mean arterial blood pressure and HR values for 45 min after onset of spinal anesthesia were decreased significantly in group II, P < 0.0001. The incidence of hypotension after spinal anesthesia was 64% in group II and 3% in group I (P < 0.0001. The total doses of ephedrine (4.07 ± 3.87 mg vs 10.7 ± 8.9 mg, P < 0.0001, phenylephrine (0.0 microg vs 23.2 ± 55.1 microg, P < 0.0001, and atropine (0.0 mg vs 0.35 ± 0.49 mg P < 0.0001 consumed in both the groups respectively, were significantly less in group I versus group II. Conclusion: Premedication with 1 mg IV granisetron before spinal anesthesia in an elective cesarean section significantly reduces hypotension, bradycardia and vasopressors usage.

  20. Hypoalbuminemia is an important risk factor of hypotension during hemodialysis.

    Science.gov (United States)

    Nakamoto, Hidetomo; Honda, Nobuko; Mimura, Taku; Suzuki, Hiromichi

    2006-10-01

    Hypotension during hemodialysis (HD) is an important problem in patients on HD. To investigate the risk factors that contribute to the hypotension during HD, we compared background factors of hypotensive (HP) patients during HD. Among 58 patients undergoing HD in Tamura Memorial Hospital, 12 patients could not continue full HD because of hypotension. We compared the data of ultrafiltration volume, cardiothoracic ratio (CTR), total protein (TP), serum albumin, blood urea nitrogen (BUN), serum creatinine, total cholesterol (TC), hemoglobin (Hb), blood glucose (BS), brain natriuretic peptide (BNP), and cardiac function between HP patients (HP group; n=12) and sex- and age-matched control patients (NP group; n=12). There were no significant differences of age, sex, and duration of HD between the 2 groups. Cardiothoracic ratio is bigger and BNP is higher in the HP group compared with the NP group (CTR: HP 55.8+/-2.9% vs. NP 47.7+/-1.1%, p=0.0165; BNP: HP 602+/-171 vs. NP 147+/-38, p=0.0167). Serum albumin in the HP group is significantly lower compared with the NP group (HP 3.2+/-0.1 g/dL vs. NP 3.5+/-0.1 g/dL, p=0.0130). However, there were no significant differences of ultrafiltration rate (UFR), BS, TC, Hb, and cardiac function between the 2 groups. There is a significant negative correlation between changes of systolic blood pressure (delta systolic blood pressure) and serum albumin in these patients (r=-0.598, p=0.0016). From these data, we conclude that hypoalbuminemia is a major risk factor of hypotension during HD.

  1. Radionuclide cisternographic findings in patients with spontaneous intracranial hypotension

    International Nuclear Information System (INIS)

    Jung, Dong Jin; Kim, Jae Seung; Ryu, Jin Sook; Shin, Jung Woo; Im, Joo Hyuk; Lee, Myoung Chong; Jung, Sung Joo; Moon, Dae Hyuk; Lee, Hee Kyung

    1998-01-01

    Radionuclide cisternography may be helpful in understanding pathophysiology of postural headache and low CSF pressure in patients with spontaneous intracranial hypotension. The purpose of this study was to characterize radionuclide cisternogrpahic findings of spontaneous intracranial hypotension. The study population consists of 15 patients with spontaneous intracranial hypotension. Diagnosis was based on their clinical symptoms and results of lumbar puncture. All patients underwent radionuclide cisternography following injection of 111 to 222 MBq of Tc-99m DTPA into the lumbar subarachnoid space. Sequential images were obtained between 1/2 hour and 24 hour after the injection of Tc-99m DTPA. Radioactivity of the bladder, soft tissue uptake, migration of radionuclide in the subarachnoid space, and extradural leakage of radionuclide were evaluated according to the scan time. Radionuclide cisternogram showed delayed migration of radionuclide into the cerebral convexity (14/15), increased soft tissue uptake (11/15), and early visualization of bladder activity at 30 min (6/10) and 2 hr (13/13). Cisternography also demonstrated leakage site of CSF in 4 cases and 2 of these were depicted at 30min. Epidural blood patch was done in 11 patients and headache was improved in all cases. The characteristics findings of spontaneous intracranial hypotension were delayed migration of radionuclide and early visualization of the soft tissue and bladder activity. These scintigraphic findings suggest that CSF leakage rather than increased CSF absorption or decreased production may be the main pathophysiology of spontaneous intracranial hypotension. Early and multiple imaging including the bladder and soft tissue is required to observe the entire dynamics of radionuclide migration

  2. Single Coronary Artery with Aortic Regurgitation

    International Nuclear Information System (INIS)

    Katsetos, Manny C.; Toce, Dale T.

    2003-01-01

    An isolated single coronary artery can be associated with normal life expectancy; however, patients are at an increased risk of sudden death. A case is reported of a 54-year-old man with several months of chest pressure with activity. On exercise Sestamibi stress testing, the patient developed a hypotensive response with no symptoms and minimal electrocardiographic changes. Nuclear scanning demonstrated reversible septal and lateral perfusion defects consistent with severe ischemia. Coronary angiography revealed a single coronary artery with the right coronary artery arising from the left main. There were high-grade stenotic lesions in the left anterior descending and circumflex arteries with only moderate atherosclerotic disease in the right coronary artery. An aortogram showed 2-3+ aortic regurgitation, with an ejection fraction of 45% on ventriculography. The patient underwent four-vessel revascularization and aortic valve replacement and did well postoperatively

  3. Effects of dopamine and dobutamine on isoflurane-induced hypotension in Hispaniolan Amazon parrots (Amazona ventralis).

    Science.gov (United States)

    Schnellbacher, Rodney W; da Cunha, Anderson F; Beaufrère, Hugues; Queiroz, Patricia; Nevarez, Javier G; Tully, Thomas N

    2012-07-01

    To assess the effects of dopamine and dobutamine on the blood pressure of isoflurane-anesthetized Hispaniolan Amazon parrots (Amazona ventralis). 8 Hispaniolan Amazon parrots. A randomized crossover study was conducted. Each bird was anesthetized (anesthesia maintained by administration of 2.5% isoflurane in oxygen) and received 3 doses of each drug during a treatment period of 20 min/dose. Treatments were constant rate infusions (CRIs) of dobutamine (5, 10, and 15 μg/kg/min) and dopamine (5, 7, and 10 μg/kg/min). Direct systolic, diastolic, and mean arterial pressure measurements, heart rate, esophageal temperature, and end-tidal partial pressure of CO(2) were recorded throughout the treatment periods. Mean ± SD of the systolic, mean, and diastolic arterial blood pressures at time 0 (initiation of a CRI) were 132.9 ± 22.1 mm Hg, 116.9 ± 20.5 mm Hg, and 101.9 ± 22.0 mm Hg, respectively. Dopamine resulted in significantly higher values than did dobutamine for the measured variables, except for end-tidal partial pressure of CO(2). Post hoc multiple comparisons revealed that the changes in arterial blood pressure were significantly different 4 to 7 minutes after initiation of a CRI. Overall, dopamine at rates of 7 and 10 μg/kg/min and dobutamine at a rate of 15 μg/kg/min caused the greatest increases in arterial blood pressure. Dobutamine CRI at 5, 10, and 15 μg/kg/min and dopamine CRI at 5, 7, and 10 μg/kg/min may be useful in correcting severe hypotension in Hispaniolan Amazon parrots caused by anesthesia maintained with 2.5% isoflurane.

  4. Síndrome de hipotensión intracraneal espontánea Spontaneous intracranial hypotension

    Directory of Open Access Journals (Sweden)

    Juan Ignacio Rojas

    2006-10-01

    Full Text Available El síndrome de hipotensión intracraneal espontánea constituye una entidad clínica cuya principal manifestación es la cefalea ortostática. Esta se acompaña de un descenso en la presión del líquido cefalorraquídeo (LCR y un realce difuso de las paquimeninges evidenciable en la resonancia magnética encefálica, sin que medie historia de trauma craneoencefálico o punción lumbar. Mujer de 24 años de edad sin antecedentes de importancia y cefalea holocraneana de carácter opresivo de 15 días de evolución. La misma se exacerbaba con la bipedestación y cedía con el decúbito. En la punción lumbar se observó pleocitosis a predominio linfocítico, hiperproteinorraquia y abundantes glóbulos rojos, siendo la presión de apertura del LCR de 20 mm H2O. La resonancia magnética encefálica mostró un realce paquimeníngeo difuso luego de la administración del gadolinio. La cisternografía radioisotópica con tecnecio 99 señaló el sitio de pérdida de LCR a nivel dorsal alto, confirmándose la sospecha diagnóstica de hipotensión intracraneal espontánea. La paciente recibió tratamiento médico conservador con evolución clínica favorable. Los hallazgos en los exámenes complementarios y las características clínicas de la cefalea, permitirán confirmar el diagnóstico de hipotensión intracraneal espontánea, evitando de esta manera la realización de procedimientos innecesarios.Spontaneous intracranial hypotension is an infrequent clinical entity characterized by orthostatic headache, low cerebrospinal fluid pressure, and magnetic resonance imaging findings of diffuse pachymeningeal gadolinium enhancement without previous history of head trauma or lumbar puncture. A 24 year-old healthy woman was referred after having daily headaches for two weeks. She described a headache that occurred soon after assuming an upright position and disappeared after resuming a recumbent position. The cerebrospinal fluid showed pleocytosis primarily

  5. Benign joint hypermobility syndrome with postural orthostatic tachycardia syndrome and acrocyanosis

    Directory of Open Access Journals (Sweden)

    Navjyot Kaur

    2017-01-01

    Full Text Available Benign joint hypermobility syndrome (BJHS and postural orthostatic tachycardia syndrome (POTS are two common conditions which are frequently overlooked. While patients with BJHS are known to attend rheumatology, orthopedic, and medical outpatient departments for years with polyarthralgia; POTS is commonly misdiagnosed as anxiety neurosis or panic attack. Described first in 1940, POTS is one of the common causes of orthostatic symptoms in females. POTS is defined as orthostatic intolerance associated with tachycardia exceeding 120 beats/min (bpm or an increase in the heart rate (HR of 30 bpm from baseline within 10 min of changing the posture from a lying to standing position, in the absence of long-term chronic diseases and medications that affect the autonomic or vascular tone. Classified as primary and secondary, the underlying pathophysiological mechanism is assumed to be a failure of peripheral vascular resistance to increase sufficiently in response to orthostatic stress, and consequently, venous pooling occurs in the legs resulting in decreased venous return to the heart. This is compensated by an increase in HR and inotropy. We present a case of BJHS, who reported to us with recurrent episodes of syncope and presyncope and was diagnosed to have POTS secondary to his hypermobility syndrome. Although the tilt-table test is the gold standard for diagnosis of POTS, this case highlights the importance of bedside tests in evaluation of orthostatic symptoms and in diagnosis of relatively common but frequently overlooked syndrome.

  6. Increase in vagal activity during hypotensive lower-body negative pressure in humans

    DEFF Research Database (Denmark)

    Sander-Jensen, K; Mehlsen, J; Stadeager, C

    1988-01-01

    Progressive central hypovolemia is characterized by a normotensive, tachycardic stage followed by a reversible, hypotensive stage with slowing of the heart rate (HR). We investigated circulatory changes and arterial hormone concentrations in response to lower-body negative pressure (LBNP) in six...... volunteers before and after atropine administration. LBNP of 55 mmHg initially resulted in an increase in HR from 55 +/- 4 to 90 +/- 5 beats/min and decreases in mean arterial pressure (MAP) from 94 +/- 4 to 81 +/- 5 mmHg, in central venous pressure from 7 +/- 1 to -3 +/- 1 mmHg, and in cardiac output from 6.......1 +/- 0.5 to 3.7 +/- 0.11/min. Concomitantly, epinephrine and norepinephrine levels increased. After 8.2 +/- 2.3 min of LBNP, the MAP had decreased to 41 +/- 7 mmHg and HR had decreased to 57 +/- 3 beats/min. Vasopressin increased from 1.2 +/- 0.3 to 137 +/- 45 pg/ml and renin activity increased from 1...

  7. Hyperbaric oxygen reduces edema and necrosis of skeletal muscle in compartment syndromes associated with hemorrhagic hypotension

    International Nuclear Information System (INIS)

    Skyhar, M.J.; Hargens, A.R.; Strauss, M.B.; Gershuni, D.H.; Hart, G.B.; Akeson, W.H.

    1986-01-01

    This study examined the effect of exposures to hyperbaric oxygen on the development of the edema and necrosis of muscle that are associated with compartment syndromes that are complicated by hemorrhagic hypotension. A compartment syndrome (twenty millimeters of mercury for six hours) was induced by infusion of autologous plasma in the anterolateral compartment of the left hind limb of seven anesthetized dogs while the mean arterial blood pressure was maintained at sixty-five millimeters of mercury after 30 per cent loss of blood volume. These dogs were treated with hyperbaric oxygen (two atmospheres of pure oxygen) and were compared with six dogs that had an identical compartment syndrome and hypotensive condition but were not exposed to hyperbaric oxygen. Forty-eight hours later, edema was quantified by measuring the weights of the muscles (the pressurized muscle compared with the contralateral muscle), and necrosis of muscle was evaluated by measuring the uptake of technetium-99m stannous pyrophosphate. The ratio for edema was significantly (p = 0.01) greater in dogs that had not been exposed to hyperbaric oxygen (1.15 +/- 0.01) than in the dogs that had been treated with hyperbaric oxygen (1.01 +/- 0.03), and the ratio for necrosis of muscle was also significantly (p = 0.04) greater in dogs that had not had hyperbaric oxygen (1.96 +/- 0.41) than in those that had been treated with hyperbaric oxygen (1.05 +/- 0.11). Comparisons were also made with the muscles of four normal control dogs and separately with the muscles of six normotensive dogs that had an identical compartment syndrome and normal blood pressure and were not treated with hyperbaric oxygen

  8. Involvement of arginine-vasopressin in the diuretic and hypotensive effects of Pereskia grandifolia Haw. (Cactaceae).

    Science.gov (United States)

    Kazama, Caroline Calixto; Uchida, Denise Thiemi; Canzi, Karina Natally; de Souza, Priscila; Crestani, Sandra; Gasparotto, Arquimedes; Laverde, Antonio

    2012-10-31

    Pereskia grandifolia Haw. (Cactaceae), popularly known as "ora-pro-nobis" is well recognized in Brazilian traditional medicine as a diuretic agent, although no scientific data have been published to support this effect. The aim of this work is to evaluate the diuretic and hypotensive activities of the infusion (INFPG) and the ethanol extract (HEPG) of Pereskia grandifolia and possible mechanism of action. The infusions (2.5-10%) and the HEPG (3-100 mg/kg) were orally administered in a single dose or daily (for seven days) to rats. The urine excretion rate, pH, density, conductivity and content of Na(+), K(+), Cl(-) and HCO(3)(-) were measured in the urine of saline-loaded animals. In collected serum samples the concentration of electrolytes, urea, creatinine, aldosterone, vasopressin and angiotensin converting enzyme (ACE) activity were evaluated. The involvement of V(2) vasopressin receptor in the diuretic activity and the hypotensive effect of HEPG were also determined. Water excretion rate was significantly increased by HEPG, while the urinary K(+) and Cl(-) excretion was significantly reduced in acute and prolonged treatment. The oral administration of the HEPG (30mg/kg) significantly reduced serum levels of vasopressin and the mean arterial pressure (MAP) in normotensive rats. All other evaluated parameters have not been affected by any treatment. The results showed that HEPG could present compound(s) responsible for aquaretic activities with no signs of toxicity, and this effect could involve a reduction in the arginine-vasopressin release. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  9. Renal artery pseudoaneurysm

    Directory of Open Access Journals (Sweden)

    Luiz Inácio Roman

    Full Text Available Abstract The renal artery pseudoaneurysm embody a rare vascular complication coming of percutaneous procedures, renal biopsy, nephrectomy, penetrating traumas and more rarely blunt traumas. The clinical can be vary according the patient, the haematuria is the symptom more commom. Is necessary a high level of clinical suspicion for your diagnosis, this can be elucidated by through complementary exams as the eco-color Doppler and the computed tomography scan (CT. This report is a case of a patient submitted a right percutaneous renal biopsy and that, after the procedure started with macroscopic haematuria, urinary tenesmus and hypogastric pain. The diagnosis of pseudoaneurysm was given after one week of evolution when the patient was hospitalized because gross haematuria, tachycardia, hypotension and hypochondrium pain. In the angiotomography revealed a focal dilation of the accessory right renal inferior polar artery, dilation of renal pelvis and all the ureteral course with presence hyperdenso material (clots inside the middle third of the ureter. The treatment for the majority of this cases are conservative, through arterial embolization, indicated for thouse of smaller dimensions in patients who are hemodynamically stable. However, it was decided by clinical treatment with aminocaproic acid 1 g, according to previous studies for therapy of haematuria. The patient received discharge without evidence of macroscopic haematuria and with normal renal ultrasound, following ambulatory care.

  10. The effects of in-flight treadmill exercise on postflight orthostatic tolerance

    Science.gov (United States)

    Siconolfi, Steven F.; Charles, John B.

    1992-01-01

    In-flight aerobic exercise is thought to decrease the deconditioning effects of microgravity. Two deconditioning characteristics are the decreases in aerobic capacity (maximum O2 uptake) and an increased cardiovascular response to orthostatic stress (supine to standing). Changes in both parameters were examined after Shuttle flights of 8 to 11 days in astronauts who performed no in-flight exercise, a lower than normal volume of exercise, and a near-normal volume of exercise. The exercise regimen was a traditional continuous protocol. Maximum O2 uptake was maintained in astronauts who completed a near-normal exercise volume of in-flight exercise. Cardiovascular responses to stand test were equivocal among the groups. The use of the traditional exercise regimen as a means to maintain adequate orthostatic responses produced equivocal responses. A different exercise prescription may be more effective in maintaining both exercise capacity and orthostatic tolerance.

  11. Role of prostaglandin/cAMP pathway in the diuretic and hypotensive effects of purified fraction of Maytenus ilicifolia Mart ex Reissek (Celastraceae).

    Science.gov (United States)

    Leme, Thiago dos Santos Vilhena; Prando, Thiago Bruno Lima; Gasparotto, Francielly Mourão; de Souza, Priscila; Crestani, Sandra; de Souza, Lauro Mera; Cipriani, Thales Ricardo; Lourenço, Emerson Luiz Botelho; Gasparotto, Arquimedes

    2013-10-28

    Although Maytenus ilicifolia is used in Brazilian folk medicine as a diuretic drug, no study has been conducted to this date in order to evaluate this ethnopharmacological statement. So, the aim of this study was to evaluate possible mechanisms involved in acute diuretic activity of the ethanolic supernatant of the infusion (SEI) obtained from Maytenus ilicifolia and to assess its relationship with a hypotensive activity by a bioassay-guided fractionation using normotensive Wistar rats. The preparation obtained from the infusion (SEI) and their respective fractions (Fr·H2O and Fr·EtOAc) were orally administered in a single dose to rats. The urine excretion rate, pH, density, conductivity and content of Na(+), K(+), Cl(-) and HCO3(-) were measured in the urine of saline-loaded animals. Samples of the concentration of electrolytes, urea, creatinine, aldosterone, vasopressin and angiotensin converting enzyme (ACE) activity were evaluated in collected serum. The hypotensive activity and the involvement of nitric oxide, bradykinin and prostaglandin/cAMP pathway in the hypotensive and diuretic effects were also determined. Water and Na(+) excretion rate were significantly increased by Fr·EtOAc and the arterial pressure was significantly reduced, while the urinary excretion of potassium and chloride were reduced. Pre-treatment with indomethacin or DDA (2',5'-dideoxyadenosine) significantly reduced the hypotensive and diuretic activity observed. All other parameters evaluated were not affected by any treatment. The present study reveals that Fr·EtOAc obtained from Maytenus ilicifolia may present compounds responsible for diuretic and hypotensive activities, and this effect, could involve the prostaglandin/cAMP pathway. © 2013 Elsevier Ireland Ltd. All rights reserved.

  12. Hyoscine-N-Butyl-Bromide-Induced Hypotension and Myocardial Ischemia

    Directory of Open Access Journals (Sweden)

    Guan-Liang Chen

    2013-01-01

    Full Text Available Hyoscine N-butyl bromide, also known as scopolamine, is a type of antimuscarinic agent. This drug is associated with numerous common side effects, including abdominal fullness, constipation, urinary retention, blurred vision, skin flushing, tachycardia, decreased sweating, and salivation. The most unfavorable side effect is hemodynamic instability. In the present case, hypotension and acute myocardial infarction developed after intravenous hyoscine injection as a premedication therapy for colonoscopy. It was difficult to differentiate the cause-effect relationship between myocardial infarction and hypotension. Because both conditions were present under drug effects, we considered 2 possible diagnoses. One was coronary spasm with cardiogenic shock, and the other was myocardial ischemic sequela due to shock status. The latter diagnosis was confirmed after a series of examinations.

  13. Increasing incidence of hypotension in the emergency department

    DEFF Research Database (Denmark)

    Holler, Jon G; Henriksen, Daniel P; Mikkelsen, Søren

    2016-01-01

    BACKGROUND: The epidemiology of hypotension as presenting symptom among patients in the Emergency Department (ED) is not clarified. The aim of this study was to describe the incidence, etiology, and overall mortality of hypotensive patients in the ED. METHODS: Population-based cohort study......,000 person years at risk (pyar) and etiological characteristics by means of the International Classification of Diseases, Tenth Revision (ICD-10), as well as 7-day, 30-day, and 90-day all-cause mortality. RESULTS: We identified 3,268 of 438,198 (1 %) cases with a mean overall IR of 125/100,000 pyar (95 % CI......: 121-130). The IR increased 28 % during the period (from 113 to 152 cases per 100,000 pyar). Patients ≥65 years had the highest IR compared to age

  14. Treating Hypotension in Preterm Neonates With Vasoactive Medications

    Directory of Open Access Journals (Sweden)

    Chloe Joynt

    2018-04-01

    Full Text Available Preterm neonates often have hypotension which may be due to various etiologies. While it is controversial to define hypotension in preterm neonates, various vasoactive medications are commonly used to provide the cardiovascular support to improve the blood pressure, cardiac output, or to treat shock. However, the literature on the systemic and regional hemodynamic effects of these antihypotensive medications in neonates is deficient and incomplete, and cautious translation of findings from other clinical populations and animal studies is required. Based on a literature search on published reports, meta-analytic reviews, and selected abstracts, this review discusses the current available information on pharmacologic actions, clinical effects, and side effects of commonly used antihypotensive medications including dopamine, dobutamine, epinephrine, norepinephrine, vasopressin, and milrinone in preterm neonates.

  15. Minoxidil for severe hypertension after failure of other hypotensive drugs.

    Science.gov (United States)

    Devine, B L; Fife, R; Trust, P M

    1977-01-01

    Forty-four patients with severe hypertension who were resistant to treatment with more conventional hypotensive drugs or could not tolerate the side effects were treated with minoxidil, a potent peripheral vasodilator. A beta-blocking drug and a diuretic were used routinely to control, respectively, the tachycardia and fluid retention caused by minoxidil. During treatment the outpatient supine blood pressure fell from a mean of 221/134 mm Hg to 162/98 mm Hg. Eleven patients required additional or alternative hypotensive agents before blood pressure was adequately controlled. Side effects were minor, although the invariable hirsuties caused by minoxidil was unacceptable to three women. The possibility of cardiotoxic effects, raised by early studies in dogs, has not been excluded, and therefore this drug should be used only in patients with severe hypertension. In such patients minoxidil appears to be most effective. PMID:902045

  16. Effects of imipramine of the orthostatic changes in blood pressure, heart rate and plasma catecholamines

    DEFF Research Database (Denmark)

    Nielsen, J R; Johansen, Torben; Arentoft, A

    1983-01-01

    The effect of imipramine on the orthostatic changes in heart rate, blood pressure and plasma catecholamines were examined in six healthy male subjects on two occasions on high sodium balance (Na+ excretion greater than 120 mmol per day) and on low sodium balance (Na+ excretion less than 110 mmol...... per day), respectively. Orthostatic tests were carried out before and 2 h after ingestion of 150 mg imipramine hydrochloride. Imipramine caused a moderate increase in supine systolic blood pressure, and a pronounced increase in the rise in heart rate, when the subjects assumed erect position...

  17. Comprehensive, blinded assessment of balance in orthostatic tremor.

    Science.gov (United States)

    Bhatti, Danish; Thompson, Rebecca; Xia, Yiwen; Hellman, Amy; Schmaderer, Lorene; Suing, Katie; McKune, Jennifer; Penke, Cynthia; Iske, Regan; Roeder, Bobbi Jo; Siu, Ka-Chun; Bertoni, John M; Torres-Russotto, Diego

    2018-02-01

    Orthostatic Tremor (OT) is a movement disorder characterized by a sensation of unsteadiness and tremors in the 13-18 Hz range present upon standing. The pathophysiology of OT is not well understood but there is a relationship between the sensation of instability and leg tremors. Despite the sensation of unsteadiness, OT patients do not fall often and balance in OT has not been formally assessed. We present a prospective blinded study comparing balance assessment in patients with OT versus healthy controls. We prospectively enrolled 34 surface Electromyography (EMG)-confirmed primary OT subjects and 21 healthy controls. Participants underwent evaluations of balance by blinded physical therapists (PT) with standardized, validated, commonly used balance scales and tasks. OT subjects were mostly female (30/34, 88%) and controls were majority males (13/20, 65%). The average age of OT subjects was 68.5 years (range 54-87) and for controls was 69.4 (range 32-86). The average duration of OT symptoms was 18 years. OT subjects did significantly worse on all the balance scales and on most balance tasks including Berg Balance Scale, Functional Gait Assessment, Dynamic Gait Index, Unipedal Stance Test, Functional Reach Test and pull test. Gait speed and five times sit to stand were normal in OT. Common validated balance scales are significantly abnormal in primary OT. Despite the objective finding of impaired balance, OT patients do not commonly have falls. The reported sensation of unsteadiness in this patient population seems to be out of proportion to the number of actual falls. Further studies are needed to determine which components of commonly used balance scales are affected by a sensation of unsteadiness and fear of falling. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Radiologic assessment of spinal CSF leakage in spontaneous intracranial hypotension

    International Nuclear Information System (INIS)

    Han, Chang Jin; Kim, Ji Hyung; Kim, Jang Sung; Kim, Sun Yong; Suh, Jung Ho

    1999-01-01

    To assess the usefulness of imaging modalities in the detection of spinal CSF leakage in spontaneous intracranial hypotension. Fifteen patients who complained of postural headache without any preceding cause showed typical brain MR findings of intracranial hypotension, including radiologically confirmed CSF leakage. All fifteen underwent brain MRI and radionuclide cisternography. CT myelography was performed in eight patients and spinal MRI in six. Medical records, imaging findings and the incidence of spinal CSF leakage during each modality were retrospectively reviewed. CSF leakage was most common at the cervicothoracic junction, where in seven of 15 cases it was seen on radionuclide cisternography as increased focal paraspinal activity. Leakage was noted at the mid-tho-racic level in three patients, at the upper thoracic level in two, and at the cervical and lumbar levels in the remaining two. In two patients multiple CSF leaks were noted, and in all, early radioactive accumulation in the bladder was visualized. CT myelography revealed extrathecal and paraspinal contrast leakage in three of eight patients, and among those who underwent spinal MRI, dural enhancement was observed at the site of CSF leakage in all six, abnormal CSF signal in the neural foramen in one, and epidural CSF collection in one. Radionuclide cisternography is a useful method for the detection of CSF leakage in spontaneous intracranial hypotension. CT myelography and spinal MRI help determine the precise location of leakage

  19. The influence of recovery posture on post-exercise hypotension in normotensive men.

    Science.gov (United States)

    Raine, N M; Cable, N T; George, K P; Campbell, I G

    2001-03-01

    Postexercise hypotension may be the result of an impaired vasoconstrictor response. This hypothesis was investigated by examining the central and peripheral hemodynamic responses during supine and seated recovery after maximal upright exercise. After supine or seated baseline measurements, seven normotensive male volunteers completed a graded upright cycling protocol to volitional exhaustion. This was immediately followed by either supine or seated recovery. Measurements of pulsatile arterial blood pressure and central and peripheral hemodynamic variables recorded 30 min before exercise were compared with those taken throughout 60 min of recovery. Compared with baseline, mean arterial pressure (MAP) was reduced after exercise (P different between the supine (-9 +/- 4 mm Hg) and seated positions (-6 +/- 2 mm Hg). This change in MAP was associated with a reduction in diastolic blood pressure (DBP) (P pressure (APP) (P positions, respectively. The reduction in APP during seated recovery was accompanied by a decline in stroke volume (SV) (P position, that limited the contribution of cardiac output (CO) to the maintenance of MAP. This effect of seated recovery was compensated by greater systemic (SVR) and regional vascular resistances in the forearm (FVR) and the forearm skin (SkVRA). There was also evidence of an augmented return of FVR and SkVRA to resting levels in the seated position after exercise. The lower peripheral resistance in the supine compared with seated recovery position suggests there is potential for greater vasoconstriction, although this is not evoked to increase blood pressure. This further suggests that the arterial baroreceptor reflex is reset to a lower operating pressure after exercise.

  20. Prehospital high-dose sublingual nitroglycerin rarely causes hypotension.

    Science.gov (United States)

    Clemency, Brian M; Thompson, Jeffrey J; Tundo, Gina N; Lindstrom, Heather A

    2013-10-01

    High-dose intravenous nitroglycerin is a common in-hospital treatment for respiratory distress due to congestive heart failure (CHF) with hypertension. Intravenous (IV) nitroglycerin administration is impractical in the prehospital setting. In 2011, a new regional Emergency Medical Services (EMS) protocol was introduced allowing advanced providers to treat CHF with high-dose oral nitroglycerin. The protocol calls for patients to be treated with two sublingual tabs (0.8 mg) when systolic blood pressure (SBP) was >160 mm Hg, or three sublingual tabs (1.2 mg) when SBP was >200 mm Hg, every five minutes as needed. Hypothesis/Problem To assess the protocol's safety, the incidence of hypotension following prehospital administration of multiple simultaneous nitroglycerin (MSN) tabs by EMS providers was studied. This study was a retrospective cohort study of patients from a single commercial EMS agency over a 6-month period. Records from patients with at least one administration of MSN were reviewed. For each administration, the first documented vital signs pre- and post-administration were compared. Administrations were excluded if pre- or post-administration vital signs were missing. One hundred case-patients had at least one MSN administration by an advanced provider during the study period. Twenty-five case-patients were excluded due to incomplete vital signs. Seventy-five case-patients with 95 individual MSN administrations were included for analysis. There were 65 administrations of two tabs, 29 administrations of three tabs, and one administration of four tabs. The mean change in SBP following MSN was -14.7 mm Hg (SD = 30.7; range, +59 to -132). Three administrations had documented systolic hypotension in the post-administration vital signs (97/71, 78/50 and 66/47). All three patients were over 65 years old, were administered two tabs, had documented improved respiratory status, and had repeat SBP of at least 100. The incidence of hypotension following MSN

  1. [Arterial hypertension due to altitude].

    Science.gov (United States)

    Domej, Wolfgang; Trapp, Michael; Miggitsch, Eva Maria; Krakher, Tiziana; Riedlbauer, Rita; Roher, Peter; Schwaberger, Günther

    2008-01-01

    The behavior of blood pressure under hypoxic conditions depends on individual factors, altitude and duration of stay at altitude. While most humans are normotensive at higher altitudes, a few will react with moderate hypertension or hypotension. Excessive elevation of arterial blood pressure is not even to be expected below 4,000 m. Rather, several weeks' stay at higher altitude will decrease systolic and diastolic blood pressure at rest as well as during physical exertion. A high-altitude treatment for rehabilitation purposes at moderate altitude may be recommended for patients with cardio-circulatory disorders. Improvements can last several months even after returning to accustomed altitudes. Furthermore, endurance-trained hypertensive patients with pharmacologically controlled arterial blood pressure might be able to participate in mountain treks without additional health risk.

  2. Relationship between Aortic Compliance and Impact of Cerebral Blood Flow Fluctuation to Dynamic Orthostatic Challenge in Endurance Athletes.

    Science.gov (United States)

    Tomoto, Tsubasa; Imai, Tomoko; Ogoh, Shigehiko; Maeda, Seiji; Sugawara, Jun

    2018-01-01

    Aorta effectively buffers cardiac pulsatile fluctuation generated from the left ventricular (LV) which could be a mechanical force to high blood flow and low-resistance end-organs such as the brain. A dynamic orthostatic challenge may evoke substantial cardiac pulsatile fluctuation via the transient increases in venous return and stroke volume (SV). Particularly, this response may be greater in endurance-trained athletes (ET) who exhibit LV eccentric remodeling. The aim of this study was to determine the contribution of aortic compliance to the response of cerebral blood flow fluctuation to dynamic orthostatic challenge in ET and age-matched sedentary (SED) young healthy men. ET ( n = 10) and SED ( n = 10) underwent lower body negative pressure (LBNP) (-30 mmHg for 4 min) stimulation and release the pressure that initiates a rapid regain of limited venous return and consequent increase in SV. The recovery responses of central and middle cerebral arterial (MCA) hemodynamics from the release of LBNP (~15 s) were evaluated. SV (via Modeflow method) and pulsatile and systolic MCA (via transcranial Doppler) normalized by mean MCA velocity (MCAv) significantly increased after the cessation of LBNP in both groups. ET exhibited the higher ratio of SV to aortic pulse pressure (SV/ Ao PP), an index of aortic compliance, at the baseline compared with SED ( P < 0.01). Following the LBNP release, SV was significantly increased in SED by 14 ± 7% (mean ± SD) and more in ET by 30 ± 15%; nevertheless, normalized pulsatile, systolic, and diastolic MCAv remained constant in both groups. These results might be attributed to the concomitant with the increase in aortic compliance assessed by SV/ Ao PP. Importantly, the increase in SV/ Ao PP following the LBNP release was greater in ET than in SED ( P < 0.01), and significantly correlated with the baseline SV/ Ao PP ( r = 0.636, P < 0.01). These results suggest that the aortic compliance in the endurance athletes is able to

  3. New proline-rich oligopeptides from the venom of African adders: Insights into the hypotensive effect of the venoms.

    Science.gov (United States)

    Kodama, Roberto T; Cajado-Carvalho, Daniela; Kuniyoshi, Alexandre K; Kitano, Eduardo S; Tashima, Alexandre K; Barna, Barbara F; Takakura, Ana Carolina; Serrano, Solange M T; Dias-Da-Silva, Wilmar; Tambourgi, Denise V; Portaro, Fernanda V

    2015-06-01

    The snakes from the Bitis genus are some of the most medically important venomous snakes in sub Saharan Africa, however little is known about the composition and effects of these snake venom peptides. Considering that the victims with Bitis genus snakes have exacerbate hypotension and cardiovascular disorders, we investigated here the presence of angiotensin-converting enzyme modulators on four different species of venoms. The peptide fractions from Bitis gabonica gabonica, Bitis nasicornis, Bitis gabonica rhinoceros and Bitis arietans which showed inhibitory activity on angiotensin-converting enzyme were subjected to mass spectrometry analysis. Eight proline-rich peptides were synthetized and their potencies were evaluated in vitro and in vivo. The MS analysis resulted in over 150 sequences, out of which 32 are new proline-rich oligopeptides, and eight were selected for syntheses. For some peptides, inhibition assays showed inhibitory potentials of cleavage of angiotensin I ten times greater when compared to bradykinin. In vivo tests showed that all peptides decreased mean arterial pressure, followed by tachycardia in 6 out of 8 of the tests. We describe here some new and already known proline-rich peptides, also known as bradykinin-potentiating peptides. Four synthetic peptides indicated a preferential inhibition of angiotensin-converting enzyme C-domain. In vivo studies show that the proline-rich oligopeptides are hypotensive molecules. Although proline-rich oligopeptides are known molecules, we present here 32 new sequences that are inhibitors of the angiotensin-converting enzyme and consistent with the symptoms of the victims of Bitis spp, who display severe hypotension. Copyright © 2015 Elsevier B.V. All rights reserved.

  4. Comparison of clinical efficacy among remifentanil, nicardipine, and remifentanil plus nicardipine continuous infusion for hypotensive anesthesia during arthroscopic shoulder surgery.

    Science.gov (United States)

    Kim, Joon Yub; Song, Seong Hun; Cho, Jae Ho; Cho, Hyung Rae

    2017-01-01

    Hypotensive anesthesia is crucial during arthroscopic shoulder surgery to reduce bleeding and allow for clear visibility. The aim of this study was to compare the clinical efficacy of continuous infusion of remifentanil, nicardipine, and remifentanil plus nicardipine to control hypotensive anesthesia in arthroscopic shoulder surgery. For this study, we enrolled 45 consecutive patients who were scheduled to have arthroscopic rotator cuff repair surgery and randomly allocated them into remifentanil (group R, n = 15), nicardipine (group N, n = 15), and remifentanil plus nicardipine (group RN, n = 15) groups. During the surgeries, these drugs were administered with continuous infusion. We analyzed the mean arterial pressure (MAP) and heart rate during surgery, stay time in the recovery room, visual analogue scale (VAS) scores, use of antiemetics in the recovery room, and postoperative blood urea nitrogen and creatinine changes. The VAS score in the recovery room was higher for group R (mean 5.6, SD 1.4) than for groups N (mean 3.9, SD 0.9) and RN (mean 4.0, SD 1.1; p = 0.000). There were no statistical differences regarding other clinical variables among the three groups (all p > 0.05) except for MAP at 120 min of surgery between groups N and RN (N: 84.67 (SD 10.7) mmHg, RN: 65.4 (SD 9.2) mmHg, p = 0.027). The continuous infusion of remifentanil plus nicardipine appeared to be advantageous for maintaining hypotensive anesthesia until 120 min of arthroscopic shoulder surgery without rebound pain in a postanesthesia care unit.

  5. Computer simulation studies in fluid and calcium regulation and orthostatic intolerance

    Science.gov (United States)

    1985-01-01

    The systems analysis approach to physiological research uses mathematical models and computer simulation. Major areas of concern during prolonged space flight discussed include fluid and blood volume regulation; cardiovascular response during shuttle reentry; countermeasures for orthostatic intolerance; and calcium regulation and bone atrophy. Potential contributions of physiologic math models to future flight experiments are examined.

  6. Delta space plot analysis of cardiovascular coupling in vasovagal syncope during orthostatic challenge.

    Science.gov (United States)

    Reulecke, S; Charleston-Villalobos, S; Voss, A; Gonzalez-Camarena, R; Gaitan-Gonzalez, M; Gonzalez-Hermosillo, J; Hernandez-Pacheco, G; Aljama-Corrales, T

    2016-08-01

    In this work, a graphical method to study cardiovascular coupling, called delta space plot analysis (DSPA), was introduced. The graphical representation is susceptible to be parameterized in shape and orientation. The usefulness of this technique was studied on cardiovascular data from patients with vasovagal syncope (VVS) and from controls. The study included 15 female patients diagnosed with VVS and 11 age-matched healthy female subjects. All subjects were enrolled in a head-up tilt (HUT) test, breathing normally, including 5 minutes of supine position (baseline) and 18 minutes of 70° orthostatic phase. The DSPA parameters were obtained at different times during the HUT test, i.e., at baseline, early (first 5 min) and late (10-15 min) orthostatic phases. In baseline there were no considerable differences between female controls and female patients. During the late orthostatic phase, parameters from DSPA showed highly significantly (p=0.000003) reduced cardiovascular coupling in patients. Findings indicated a loss of control on cardiovascular coupling in female patients susceptible to vasovagal syncope during orthostatic challenge. In addition, this study provided promising results for a new graphical method to investigate cardiovascular coupling.

  7. Clinical improvement in patients with orthostatic intolerance after treatment with bisoprolol and fludrocortisone.

    Science.gov (United States)

    Freitas, J; Santos, R; Azevedo, E; Costa, O; Carvalho, M; de Freitas, A F

    2000-10-01

    Orthostatic intolerance is the development of disabling symptoms upon assuming an upright posture that are relieved partially by resuming the supine position. Postural tachycardia syndrome (POTS) is an orthostatic intolerance syndrome characterized by palpitations because of excessive orthostatic sinus tachycardia, lightheadedness, tremor, and near-syncope. Patients usually undergo extensive medical, cardiac, endocrine, neurologic, and psychiatric evaluation, which usually fails to identify a specific abnormality. The authors investigated the autonomic and hemodynamic profile of patients with POTS and the effectiveness of bisoprolol and fludrocortisone. The authors evaluated 11 female patients with POTS before and after medical treatment with a cardioselective bisoprolol beta-blocker or fludrocortisone, or both, and 11 age-matched control patients. Variability of heart rate and systolic blood pressure was assessed by fast Fourier transform, and spontaneous baroreceptor gain was assessed by use of the temporal sequences slope and alpha index. Modelflow was used to quantify hemodynamics. Symptoms in all patients improved greatly after medication. The autonomic and hemodynamic impairment observed in patients with POTS, particularly after orthostatic stress, is treated effectively with bisoprolol or fludrocortisone or both. These results need further confirmation in a controlled double-blind study. Proper medical treatment improves dramatically the clinical and autonomic-hemodynamic disturbances observed in patients with POTS. The data support the hypothesis that POTS is the result of a hyperadrenergic activation or hypovolemia during orthostasis.

  8. Blood pressure and heart rate during orthostatic stress and walking with continuous postoperative thoracic epidural bupivacaine/morphine

    DEFF Research Database (Denmark)

    Møiniche, S; Hjortsø, N C; Blemmer, T

    1993-01-01

    lower heart rate (approximately 10 bpm) 48 h after surgery at rest and during orthostatic stress in the epidural group. There was no significant difference between groups in number of patients with a reduction > 20 mmHg (2.7 kPa) in systolic blood pressure during orthostatic stress (two in each group...... and during mobilisation was superior compared to systemic morphine and NSAID. There were no significant differences between groups in haemodynamic responses (BP and heart rate) during rest, orthostatic stress and after walking assessed before, 24 and 48 h after operation except for a clinically unimportant...... position....

  9. Isometric handgrip does not elicit cardiovascular overload or post-exercise hypotension in hypertensive older women

    Directory of Open Access Journals (Sweden)

    Olher RR

    2013-06-01

    Full Text Available Rafael dos Reis Vieira Olher,1,2,* Danilo Sales Bocalini,3,* Reury Frank Bacurau,4 Daniel Rodriguez,5 Aylton Figueira Jr,5 Francisco Luciano Pontes Jr,4 Francisco Navarro,6 Herbert Gustavo Simões,1 Ronaldo Carvalho Araujo,7 Milton Rocha Moraes8 1Universidade Católica de Brasília, Distrito Federal, 2Universidade Gama Filho, Rio de Janeiro, 3Universidade Nove de Julho (UNINOVE, São Paulo, 4Universidade de São Paulo – Escola de Artes, Ciências e Humanidades, São Paulo, 5Universidade São Judas Tadeu (USJT, São Paulo, Brazil, 6Universidade Federal do Maranhão, Maranhão, 7Universidade de São Paulo, Instituto de Ciências Biomédicas, São Paulo, 8Universidade Federal de São Paulo – Escola Paulista de Medicina, São Paulo, Brazil *These authors contributed equally to this work Background: Arterial hypertension is a serious health problem affecting mainly the elderly population. Recent studies have considered both aerobic and resistance exercises as a non-pharmacological aid for arterial hypertension treatment. However, the cardiovascular responses of the elderly to isometric resistance exercise (eg, isometric handgrip [IHG] have not yet been documented. Objective: The purpose of this study was to investigate cardiovascular responses to different intensities of isometric exercise, as well as the occurrence of post-isometric exercise hypotension in hypertensive elderly people under antihypertensive medication treatment. Patients and methods: Twelve women volunteered to participate in the study after a maximal voluntary contraction test (MVC and standardization of the intervention workload consisting of two sessions of IHG exercise performed in four sets of five contractions of a 10-second duration. Sessions were performed both at 30% of the MVC and 50% of the MVC, using a unilateral IHG protocol. Both intensities were compared with a control session without exercise. Systolic blood pressure (SBP and diastolic blood pressure (DBP at rest

  10. Occurrence of hypotension in older participants. Which 24-hour ABPM parameter better correlate with?

    Science.gov (United States)

    Scuteri, Angelo; Modestino, Anna; Frattari, Alessandra; Di Daniele, Nicola; Tesauro, Manfredi

    2012-06-01

    The aim of the present study was to investigate the prevalence of hypotension in older participants and to identify which 24-hour ambulatory blood pressure monitoring parameter better correlated with the occurrence of hypotension. We studied 588 elderly participants (mean age 78.7 ± 7.1 years; 70% women) who underwent a 24-hour ambulatory blood pressure (BP) monitoring, without moderate-to-severe cognitive impairment, myocardial infarction, or stroke within the previous 6 months; renal (serum creatinine > 2.5 mg/dL), respiratory, or liver insufficiency; and atrial fibrillation. In older participants, the occurrence of systolic hypotension is very common (≈55% presenting at least one episode of systolic blood pressure (SBP) < 100 mmHg and about 20% presenting ≥10% of the SBP registrations < 100 mmHg). More than 30% of participants with 24-hour SBP, daytime, and nighttime above the reference threshold had hypotension. Hypotension did not correlated with BP variability indices (standard deviation of BPs). None of the parameters commonly present in 24-hour ambulatory BP monitoring clinical reports is able to accurately identify those older participants with episode of hypotension. Episodes of SBP hypotension are extremely common in older participants and do not appear to relate to BP variability indices. Indeed, no parameter of 24-hour ambulatory BP monitoring was capable to accurately identify the occurrence of hypotension. We expect that ongoing studies will contribute to identification of specific factors predicting hypotensive episodes in the older participants.

  11. Hypotension following patent ductus arteriosus ligation: the role of adrenal hormones.

    Science.gov (United States)

    Clyman, Ronald I; Wickremasinghe, Andrea; Merritt, T Allen; Solomon, Tabitha; McNamara, Patrick; Jain, Amish; Singh, Jaideep; Chu, Alison; Noori, Shahab; Sekar, Krishnamurthy; Lavoie, Pascal M; Attridge, Joshua T; Swanson, Jonathan R; Gillam-Krakauer, Maria; Reese, Jeff; DeMauro, Sara; Poindexter, Brenda; Aucott, Sue; Satpute, Monique; Fernandez, Erika; Auchus, Richard J

    2014-06-01

    To test the hypothesis that an impaired adrenal response to stress might play a role in the hypotension that follows patent ductus arteriosus (PDA) ligation. We performed a multicenter study of infants born at 15. Of 95 infants enrolled, 43 (45%) developed hypotension and 14 (15%) developed catecholamine-resistant hypotension. Low postoperative cortisol levels were not associated with the overall incidence of hypotension after ligation. However, low cortisol levels were associated with the refractoriness of the hypotension to catecholamine treatment. In a multivariate analysis: the OR for developing catecholamine-resistant hypotension was OR 36.6, 95% CI 2.8-476, P = .006. Low cortisol levels (in infants with catecholamine-resistant hypotension) were not attributable to adrenal immaturity or impairment; their cortisol precursor concentrations were either low or unchanged, and their response to cosyntropin was similar to infants without catecholamine-resistant hypotension. Infants with low cortisol concentrations after PDA ligation are likely to develop postoperative catecholamine-resistant hypotension. We speculate that decreased adrenal stimulation, rather than an impaired adrenal response to stimulation, may account for the decreased production. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Spontaneous intracranial hypotension syndrome: magnetic resonance findings in two patients

    International Nuclear Information System (INIS)

    Ortega, R.; Pastor, J.; Escamilla, F.; Romero, M. I.

    1999-01-01

    The postural headache syndrome associated with a decrease in the cerebrospinal fluid (CSF) pressure is generally secondary to the CSF leakage that usually occurs after diagnostic lumbar puncture. Spontaneous intracranial hypotension can not be attributed to any known cause or previous diagnostic or therapeutic intervention. The syndrome is characterized by severe headache that is relieved by lying supine. During lumbar puncture, the CSF pressure is normally low. We present two patients in whom gadolinium-enhanced magnetic resonance imaging showed widespread thickening and enhancement of the dura mater and subdural fluid collections. (Author) 13 refs

  13. Hypotensive and vasorelaxant effects of citronellol, a monoterpene alcohol, in rats.

    Science.gov (United States)

    Bastos, Joana F A; Moreira, Italo J A; Ribeiro, Thaís P; Medeiros, Isac A; Antoniolli, Angelo R; De Sousa, Damião P; Santos, Márcio R V

    2010-04-01

    Citronellol is an essential oil constituent from the medicinal plants Cymbopogon citratus, Cymbopogon winterianus and Lippia alba which are thought to possess antihypertensive properties. Citronellol-induced cardiovascular effects were evaluated in this study. In rats, citronellol (1-20 mg/kg, i.v.) induced hypotension, which was not affected by pre-treatment with atropine, hexamethonium, N(omega)-nitro-L-arginine methyl ester hydrochloride or indomethacin, and tachycardia, which was only attenuated by pre-treatment with atropine and hexamethonium. These responses were less than those obtained for nifedipine, a reference drug. In intact rings of rat mesenteric artery pre-contracted with 10 microM phenylephrine, citronellol induced relaxations (pD(2) = 0.71 +/- 0.11; E(max) = 102 +/- 5%; n = 6) that were not affected by endothelium removal, after tetraethylamonium in rings without endothelium pre-contracted with KCl 80 mM. Citronellol strongly antagonized (maximal inhibition = 97 +/- 4%; n = 6) the contractions induced by CaCl(2) (10(-6) to 3 x 10(-3 )M) and did not induce additional effects on the maximal response of nifedipine (10 microM). Finally, citronellol inhibited the contractions induced by 10 microM phenylephrine or 20 mM caffeine. The present results suggest that citronellol lowers blood pressure by a direct effect on the vascular smooth muscle leading to vasodilation.

  14. Comparison of colloid (polygeline) over crystalloid (lactated ringer) preloading in preventing hypotension in patients undergoing caesarean-section under spinal anaesthesia

    International Nuclear Information System (INIS)

    Boota, M.; Haq, I.

    2012-01-01

    Objective: To assess efficacy of colloid (Polygeline) over crystalloid (Lactated Ringer) preloading in preventing hypotension in patients undergoing caesarean-section under spinal anaesthesia. Study design: Randomized control trial. Settings: The study was conducted in department of Anesthesiology and Intensive care Combined Military Hospital Peshawar over a period of 6 months from 01 March 2007 to 31 August 2007. Material and Methods: One hundred patients fulfilling the inclusion criteria were selected for study and divided into two groups of 50 each. Group A was given 500 ml Polygeline as preloading solution while group B received 1 liter of Ringer's Lactate as preloading solution just before administration of spinal anaesthesia. Heart rate and systolic blood pressure were recorded at 01 min, 05 mins, 10 mins, 15 mins, 20 mins, 30 mins and 45 mins after the performance of spinal block. Dose of ephedrine given to treat hypotension after the block was also recorded. Results: There was significant difference in terms of heart rate and systolic arterial pressure 1 and 5 minutes after block between both the groups. There was also significant difference in terms of dose of ephedrine between both the groups. Conclusion: Polygeline is more effective than Ringer's Lactate as preloading fluid in preventing hypotension for caesarean section under spinal anaesthesia. (author)

  15. Resolution of Postural Orthostatic Tachycardia Syndrome After CT-Guided, Percutaneous T2 Ethanol Ablation for Hyperhidrosis

    Energy Technology Data Exchange (ETDEWEB)

    Brock, Malcolm, E-mail: mabrock@jhmni.edu [Johns Hopkins University, Department of Thoracic Surgery, Center for Sweat Disorders (United States); Chung, Tae Hwan, E-mail: Tchang7@jhmi.edu [Johns Hopkins University, Physical Medicine and Rehabilitation (United States); Gaddam, Sathvika Reddy, E-mail: drsathvikareddy@yahoo.com; Kathait, Anjaneya Singh, E-mail: askathait@gmail.com [Johns Hopkins University, Vascular & Interventional Radiology (United States); Ober, Cecily, E-mail: ceober21@gmail.com [Johns Hopkins University, Department of Thoracic Surgery (United States); Georgiades, Christos, E-mail: cgeorgi@jhmi.edu [Johns Hopkins University, Vascular & Interventional Radiology (United States)

    2016-12-15

    Postural orthostatic tachycardia syndrome is characterized by orthostatic intolerance. Orthostasis (or other mild physical stress) triggers a cascade of inappropriate tachycardia, lightheadedness, palpitations, and often fainting. The underlying defect is sympathetic dysregulation of the heart, which receives its sympathetic tone from the cervical and upper thoracic sympathetic ganglia. Primary hyperhidrosis is also thought to be the result of sympathetic dysregulation. We present the case of a patient treated with CT-guided, percutaneous T2 EtOH sympatholysis for craniofacial hyperhidrosis. The patient also suffered from postural orthostatic tachycardia syndrome for many years and was unresponsive to treatment. Immediately after sympatholysis, the patient experienced resolution of both craniofacial hyperhidrosis and postural orthostatic tachycardia syndrome.

  16. PRES- and orthostatic-induced heart-rate changes as markers of labile hypertension : magnitude and reliability measures.

    OpenAIRE

    Rau, Harald; Furedy, John J.; Elbert, Thomas

    1996-01-01

    Split-half and test-retest reliabilities of heart-rate responses to a baroreceptor manipulation and an orthostatic manoeuver were compared between subjects with either normal or elevated blood-pressure. Ten subjects showing elevated resting blood-pressure and 11 normotensive subjects participated in two experimental sessions, each including heart-rate recordings during baroreceptor manipulation and orthostatic challenge. Carotid baroreceptors were manipulated by applying the baroreceptor-spec...

  17. High Intensity Exercise Countermeasures does not Prevent Orthostatic Intolerance Following Prolonged Bed Rest

    Science.gov (United States)

    Platts, Steven H.; Stenger, Michael B.; Ploutz-Snyder, Lori L.; Lee, Stuart M. C.

    2014-01-01

    Approximately 20% of Space Shuttle astronauts became presyncopal during operational stand and 80deg head-up tilt tests, and the prevalence of orthostatic intolerance increases after longer missions. Greater than 60% of the US astronauts participating in Mir and early International Space Station missions experienced presyncope during post-flight tilt tests, perhaps related to limitations of the exercise hardware that prevented high intensity exercise training until later ISS missions. The objective of this study was to determine whether an intense resistive and aerobic exercise countermeasure program designed to prevent cardiovascular and musculoskeletal deconditioning during 70 d of bed rest (BR), a space flight analog, would protect against post-BR orthostatic intolerance. METHODS Twenty-six subjects were randomly assigned to one of three groups: non-exercise controls (n=11) or one of two exercise groups (ExA, n=8; ExB, n=7). Both ExA and ExB groups performed the same resistive and aerobic exercise countermeasures during BR, but one exercise group received testosterone supplementation while the other received a placebo during BR in a double-blinded fashion. On 3 d/wk, subjects performed lower body resistive exercise and 30 min of continuous aerobic exercise (=75% max heart rate). On the other 3 d/wk, subjects performed only highintensity, interval-style aerobic exercise. Orthostatic intolerance was assessed using a 15-min 80? head-up tilt test performed 2 d (BR-2) before and on the last day of BR (BR70). Plasma volume was measured using carbon monoxide rebreathing on BR-3 and before rising on the first recovery day (BR+0). The code for the exercise groups has not been broken, and results are reported here without group identification. RESULTS Only one subject became presyncopal during tilt testing on BR-2, but 7 of 11 (63%) controls, 3 of 8 (38%) ExA, and 4 of 7 (57%) ExB subjects were presyncopal on BR70. Survival analysis of post-BR tilt tests revealed no

  18. Prevalence of hypotension and its association with cognitive function among older adults.

    Science.gov (United States)

    Momtaz, Yadollah Abolfathi; Hamid, Tengku Aizan; Haron, Sharifah Azizah; Bagat, Mohamad Fazdillah; Mohammadi, Fatemeh

    2018-04-01

    The negative effect of hypertension has overshadowed possible health problems associated with hypotension. The purposes of this study were to describe the prevalence of hypotension in older adults and to determine the association between hypotension and cognitive function, after adjusting for possible covariates. The data for the study consisting of 1067 community-dwelling older adults were obtained from a national survey entitled "Identifying Psychosocial and Identifying Economic Risk Factor of Cognitive Impairment among Elderly", conducted in Malaysia. The hypotension was considered as blood pressure age of the respondents was 68.27 (SD = 5.93). Mean score of cognitive function as measured by MMSE was 22.70 (SD = 4.95). The prevalence of hypotension was 29.3%. The prevalence of cognitive impairment for hypotension group was 25.6%. Results of multiple linear regression analysis revealed that hypotension is negatively associated with cognitive function (Beta = -0.11, page, gender, education, marital status, employment status, diabetes, heart disease, stroke and gastritis. The study showing hypotension is significantly associated with decreased cognitive function in later life, implies more attention to low blood pressure in old age.

  19. Catecholamine-resistant hypotension and myocardial performance following patent ductus arteriosus ligation.

    LENUS (Irish Health Repository)

    Noori, S

    2014-08-14

    Objective:We performed a multicenter study of preterm infants, who were about to undergo patent ductus arteriosus ligation, to determine whether echocardiographic indices of impaired myocardial performance were associated with subsequent development of catecholamine-resistant hypotension following ligation.Study Design:A standardized treatment approach for hypotension was followed at each center. Infants were considered to have catecholamine-resistant hypotension if their dopamine infusion was >15 μg kg(-1)min(-1). Echocardiograms and cortisol measurements were obtained between 6 and 14 h after the ligation (prior to the presence of catecholamine-resistant hypotension).Result:Forty-five infants were enrolled, 10 received catecholamines (6 were catecholamine-responsive and 4 developed catecholamine-resistant hypotension). Catecholamine-resistant hypotension was not associated with decreased preload, shortening fraction or ventricular output. Infants with catecholamine-resistant hypotension had significantly lower levels of systemic vascular resistance and postoperative cortisol concentration.Conclusion:We speculate that low cortisol levels and impaired vascular tone may have a more important role than impaired cardiac performance in post-ligation catecholamine-resistant hypotension.Journal of Perinatology advance online publication, 14 August 2014; doi:10.1038\\/jp.2014.151.

  20. Preliminary application of a novel algorithm to monitor changes in pre-flight total peripheral resistance for prediction of post-flight orthostatic intolerance in astronauts

    Science.gov (United States)

    Arai, Tatsuya; Lee, Kichang; Stenger, Michael B.; Platts, Steven H.; Meck, Janice V.; Cohen, Richard J.

    2011-04-01

    Orthostatic intolerance (OI) is a significant challenge for astronauts after long-duration spaceflight. Depending on flight duration, 20-80% of astronauts suffer from post-flight OI, which is associated with reduced vascular resistance. This paper introduces a novel algorithm for continuously monitoring changes in total peripheral resistance (TPR) by processing the peripheral arterial blood pressure (ABP). To validate, we applied our novel mathematical algorithm to the pre-flight ABP data previously recorded from twelve astronauts ten days before launch. The TPR changes were calculated by our algorithm and compared with the TPR value estimated using cardiac output/heart rate before and after phenylephrine administration. The astronauts in the post-flight presyncopal group had lower pre-flight TPR changes (1.66 times) than those in the non-presyncopal group (2.15 times). The trend in TPR changes calculated with our algorithm agreed with the TPR trend calculated using measured cardiac output in the previous study. Further data collection and algorithm refinement are needed for pre-flight detection of OI and monitoring of continuous TPR by analysis of peripheral arterial blood pressure.

  1. Changes in superior mesenteric artery Doppler waveform during reduction of cardiac stroke volume and hypotension

    DEFF Research Database (Denmark)

    Perko, M J; Perko, Grazyna; Just, S

    1996-01-01

    the hypovolemia. Alterations in pV and pulsatility indices were closely related to changes in stroke volume, and a negative correlation was found between diastolic velocities and stroke volume. regression analysis showed no significant relation between variations in velocity parameters and blood pressure. Results...

  2. Effect of pre operative heart rate on post spinal hypotension in obsteric patients

    International Nuclear Information System (INIS)

    Khan, S.; Zahoor, M.U.; Zaid, A.Y.; Buland, K.

    2010-01-01

    The purpose of the study was to determine the association between of preoperative heart rate and post spinal hypotension in women undergoing cesarean section, Two hundred patients undergoing caesarean were included in the study selected on non probability convenience sampling technique, The patients were divided into two groups depending upon their pre operative heart rate. Spinal anesthesia was administered and number of patients developing hypotension was noted. Among 200 patients, who were included in the study; 112 were placed in group A and 88 were placed in group B depending on mean heart rate of 90 beats per minute or less or 91 beats per minute or more respectively. In group A 14 (11.86%) patients developed hypotension where as in group B 28 (31,82%) patients developed hypotension. Pre operative heart rate is significantly associated with post spinal hypotension in obstetric patients undergoing cesarean section. (author)

  3. Hypotensive response after water-walking and land-walking exercise sessions in healthy trained and untrained women

    Directory of Open Access Journals (Sweden)

    Bocalini DS

    2011-08-01

    Full Text Available Daniel Rodriguez1, Valter Silva2, Jonato Prestes3, Roberta Luksevicius Rica4, Andrey Jorge Serra5, Danilo Sales Bocalini6, Francisco Luciano Pontes Junior71São Judas Tadeu University, São Paulo, SP, Brazil; 2College of Physical Education of Sorocaba, Sorocaba, SP, Brazil; 3Graduation Program in Physical Education, Catholic University of Brasilia, Brasilia-DF, Brazil; 4Department of Physical Education, Arbos College, São Bernardo do Campo, SP, Brazil; 5Department of Physical Education and Laboratory of Rehabilitation Science, Nove de Julho University, São Paulo, SP, Brazil; 6Department of Medicine, Federal University of São Paulo – Escola Paulista de Medicina, São Paulo, SP, Brazil; 7School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, SP, BrazilBackground: The aim of this study was to compare post-exercise hypotension after acute sessions of water-walking and land-walking in healthy trained and untrained women.Methods: Twenty-three untrained (n = 12 and trained (n = 11 normotensive women performed two walking sessions in water and on land at 40% of peak VO2 for 45 minutes. Systolic and diastolic blood pressure and mean arterial pressure were measured 15, 30, 45, and 60 minutes after the exercise sessions.Results: No differences were found between the groups for age and anthropometric parameters, but peak VO2 for the trained women (45 ± 8 mL/kg/minute was higher than for the untrained women (31 ± 3 mL/kg/minute. No differences were found between the groups with regard to systolic and diastolic blood pressure and mean arterial pressure after water immersion. The heart rate in the trained group (62 ± 3 beats per minute [bpm] was significantly lower (P < 0.05 than in the untrained group (72 ± 4 bpm on land, and after water immersion, this difference disappeared (58 ± 5 bpm in the trained women and 66 ± 5 bpm in the untrained women. Sixty minutes after water-walking, systolic blood pressure (108 ± 8 mmHg vs

  4. Nondipping in Parkinson's Disease

    Directory of Open Access Journals (Sweden)

    Sita Sommer

    2011-01-01

    Full Text Available Objective. The aim of this study was to identify patients with Parkinson's disease who showed loss or decrease of nocturnal blood pressure fall (nondipper patients as a marker of autonomic dysfunction. Presence or absence of orthostatic hypotension was considered to investigate whether alterations in circadian blood pressure pattern are associated with posture-related dysregulation of blood pressure. Methods. 40 patients with Parkinson's disease underwent 24-hour blood pressure monitoring. 21 patients were diagnosed with arterial hypertension and received anti-hypertensive drugs. Nondipper patients were defined as having nocturnal decrease of mean systolic and diastolic blood pressure less than 10%. Presence or absence of orthostatic hypotension was determined by Schellong's test. Results. We identified 35 nondipper patients (88%. Nondipping was detected in 20 patients with orthostatic hypotension (95% and in 15 patients without orthostatic hypotension (79%. 18 patients with hypertensive and 22 patients with normal blood pressure values were detected. Conclusions. In conclusion 24-hour blood pressure monitoring showed a high prevalence of nondipping in 40 patients with Parkinson's disease with and without orthostatic hypotension independent of coexisting arterial hypertension and antihypertensive treatment. 24-hour blood pressure monitoring may be useful to identify non-dipping as a marker of autonomic dysfunction in patients with Parkinson's disease.

  5. Unexplored relationship of sleep disturbances linked to suicidal ideation and behavior in postural orthostatic tachycardia syndrome

    Directory of Open Access Journals (Sweden)

    Shafqat MN

    2017-07-01

    Full Text Available Muhammad Nabeel Shafqat,1 Muhammad Aadil,2 Maria Shoaib31Department of Medicine, University of Medical Sciences “Serafin Ruiz de Zarate” Villa Clara (UCMVC, Villa Clara, Cuba; 2Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA; 3Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, PakistanWe read with great interest the currently published article written by Pederson and Brook1 entitled “Sleep disturbance linked to suicidal ideation in postural orthostatic tachycardia syndrome”. Awareness of postural orthostatic tachycardia syndrome (POTS has increased in recent years. However, sleep disturbance has not been thoroughly investigated as a cause of increased suicidal risk in patients with POTS. We would like to applaud the authors on conducting this novel cross-sectional study to understand and highlight the potential relationship between sleep disturbances and increased risk of suicide in patients suffering from POTS.1View the original paper by Pederson and Brook.

  6. Orthostatic leg blood volume changes assessed by near-infrared spectroscopy

    DEFF Research Database (Denmark)

    Truijen, J; Kim, Y S; Krediet, C T P

    2012-01-01

    posture, volume accumulation in small blood vessels contributes significantly to the total fluid volume accumulated in the legs. Considering that near-infrared spectroscopy (NIRS) tracks postural blood volume changes within the small blood vessels of the lower leg, we evaluated the NIRS-determined changes......-linear accumulation of blood volume in the small vessels of the leg, with an initial fast phase followed by a more gradual increase at least partly contributing to the relocation of fluid during orthostatic stress....

  7. Orthostatic Tremor: A Spectrum of Fast and Slow Frequencies or Distinct Entities?

    OpenAIRE

    Rigby, Heather B.; Rigby, Matthew H.; Caviness, John N.

    2015-01-01

    Background: Orthostatic tremor (OT) is defined by the presence of a high-frequency (13–18 Hz) tremor of the legs upon standing associated with a feeling of unsteadiness. However, some patients have discharge frequencies of <13 Hz, so-called “slow OT”. The aim of this study was to characterize patients with unsteadiness upon standing found to have <13 Hz tremor discharges on neurophysiologic testing. Methods: A retrospective review was performed on all subjects with a d...

  8. Central haemodynamics in patients with severe postural hypotension

    DEFF Research Database (Denmark)

    Mehlsen, J; Haedersdal, C; Trap-Jensen, J

    1991-01-01

    Central haemodynamics in the supine and head-up tilted positions were studied in 24 patients with severe postural hypotension with and without supine hypertension. Results were compared with those obtained in eight normotensive and eight untreated hypertensive controls. In the supine position...... the patients had higher vascular resistances, lower stroke volumes and longer left ventricular ejection time indexes compared to controls, whereas left ventricular ejection fractions did not differ significantly. The patients with supine hypertension had significantly higher vascular resistance compared...... to those with supine normotension. The highest supine blood pressure levels were found in patients with multiple system atrophy. During tilt, vascular resistance and heart rates were increased and stroke volumes and left ventricular ejection time indexes were decreased in the controls. The patients were...

  9. Intracranial hypotension accompanied by trauma. A prospective study in Japan

    International Nuclear Information System (INIS)

    Maeda, Takeshi; Dohi, Kenji; Katayama, Yoichi

    2010-01-01

    To clarify the clinical characteristics of definite and non-definite diagnosis groups in intracranial hypotension accompanied by trauma (IHAT), we undertook investigations of registered patients (n=23) prospectively. The results revealed the following features of IHAT: definite diagnosis group, 4 cases; they had long periods from injury to onset (5.5±5.7 days), but these were markedly shorter than in the non-definite group; 75% of definite cases showed typical postural headache; 75% of definite cases showed dural enhancement on Gd-MRI; all 4 cases had confirmed cerebrospinal fluid (CFS) leakage based on imaging diagnosis with cervical lesions in 2 cases and cervical-thoracic lesions in 2 cases; and 6) good recovery was achieved in them by conservative therapy and blood patch, with a cure rate of 100%. These findings suggest that confirmed CFS leakage is indispensable for reaching definite diagnosis of IHAT. (author)

  10. Epidural anesthesia, hypotension, and changes in intravascular volume

    DEFF Research Database (Denmark)

    Holte, Kathrine; Foss, Nicolai B; Svensén, Christer

    2004-01-01

    receiving hydroxyethyl starch. RESULTS: Plasma volume did not change per se after thoracic epidural anesthesia despite a decrease in blood pressure. Plasma volume increased with fluid administration but remained unchanged with vasopressors despite that both treatments had similar hemodynamic effects...... constant was 56 ml/min. CONCLUSIONS: Thoracic epidural anesthesia per se does not lead to changes in blood volumes despite a reduction in blood pressure. When fluid is infused, there is a dilution, and the fluid initially seems to be located centrally. Because administration of hydroxyethyl starch......BACKGROUND: The most common side effect of epidural or spinal anesthesia is hypotension with functional hypovolemia prompting fluid infusions or administration of vasopressors. Short-term studies (20 min) in patients undergoing lumbar epidural anesthesia suggest that plasma volume may increase when...

  11. Ultrasound for critical care physicians: hypotension after a MVA

    Directory of Open Access Journals (Sweden)

    Schmitz E

    2014-03-01

    Full Text Available No abstract available. Article truncated after first page. A 25 year old woman was a restrained driver in a rollover motor vehicle accident (MVA and suffered a C5-C6 fracture-dislocation with spinal cord injury. She was lucid and able to follow commands and could move her upper extremities but not her lower extremities. She was given approximately 6 liters of fluid but required vasopressors to maintain her blood pressure. Initial ECG revealed a normal sinus rhythm without significant ST changes (Figure 1. Upon initial evaluation her blood pressure was low. Bedside ultrasound of the left anterior second intercostal space revealed a sliding lung sign and a 4 chamber view of her heart was performed (Figure 2. Which of the following is the most likely cause of her hypotension? 1. Blunt cardiac injury; 2. Intravascular volume depletion; 3. Neurogenic stunned myocardium; 4. Pericardial tamponade; 5. Pneumothorax ...

  12. Reversible Holmes' tremor due to spontaneous intracranial hypotension.

    Science.gov (United States)

    Iyer, Rajesh Shankar; Wattamwar, Pandurang; Thomas, Bejoy

    2017-07-27

    Holmes' tremor is a low-frequency hand tremor and has varying amplitude at different phases of motion. It is usually unilateral and does not respond satisfactorily to drugs and thus considered irreversible. Structural lesions in the thalamus and brainstem or cerebellum are usually responsible for Holmes' tremor. We present a 23-year-old woman who presented with unilateral Holmes' tremor. She also had hypersomnolence and headache in the sitting posture. Her brain imaging showed brain sagging and deep brain swelling due to spontaneous intracranial hypotension (SIH). She was managed conservatively and had a total clinical and radiological recovery. The brain sagging with the consequent distortion of the midbrain and diencephalon was responsible for this clinical presentation. SIH may be considered as one of the reversible causes of Holmes' tremor. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. Diagnosis and treatment of traumatic intracranial hypotension (cerebrospinal fluid hypovolemia)

    International Nuclear Information System (INIS)

    Shinonaga, Masamichi; Suzuki, Shinichi

    2003-01-01

    Patients who complain headache, neck pain, dizziness or vertigo, tinnitus, blurred vision, loss of concentration, memory disturbance and fatigue for over one year after mild head injury and whiplash injury are diagnosed as post-traumatic syndrome. Mechanism and treatment of post-traumatic syndrome are not well established. We studied radioisotope (RI) cisternography and enhanced brain magnetic resonance imaging (MRI) for the patient of post-traumatic syndrome. Of 175 cases in post-traumatic syndrome 141 cases (120 cases of motor vehicle accident, 21 cases of sports injury) were diagnosed, as intracranial hypotension (cerebrospinal fluid hypovolemia). RI cisternography showed 86% positive findings (early accumulation of RI in bladder and leakage). Prominent findings in MRI were dilatation of subdural space and venous dilatation. In every case epidural blood patch was performed and symptoms were improved in almost 70% of patients. This study revealed cerebrospinal fluid hypovolemia might be one cause of post-traumatic syndrome. (author)

  14. Diagnosis and treatment of traumatic intracranial hypotension (cerebrospinal fluid hypovolemia)

    Energy Technology Data Exchange (ETDEWEB)

    Shinonaga, Masamichi [Hiratsuka Kyousai Hospital, Kanagawa (Japan); Suzuki, Shinichi [Inadanoborito Hospital, Kawasaki, Kanagawa (Japan)

    2003-11-01

    Patients who complain headache, neck pain, dizziness or vertigo, tinnitus, blurred vision, loss of concentration, memory disturbance and fatigue for over one year after mild head injury and whiplash injury are diagnosed as post-traumatic syndrome. Mechanism and treatment of post-traumatic syndrome are not well established. We studied radioisotope (RI) cisternography and enhanced brain magnetic resonance imaging (MRI) for the patient of post-traumatic syndrome. Of 175 cases in post-traumatic syndrome 141 cases (120 cases of motor vehicle accident, 21 cases of sports injury) were diagnosed, as intracranial hypotension (cerebrospinal fluid hypovolemia). RI cisternography showed 86% positive findings (early accumulation of RI in bladder and leakage). Prominent findings in MRI were dilatation of subdural space and venous dilatation. In every case epidural blood patch was performed and symptoms were improved in almost 70% of patients. This study revealed cerebrospinal fluid hypovolemia might be one cause of post-traumatic syndrome. (author)

  15. Dialysis Hypotension : A Role for Inadequate Increase in Arginine Vasopressin Levels? A Systematic Literature Review and Meta-Analysis

    NARCIS (Netherlands)

    Ettema, Esmee M.; Zittema, Debbie; Kuipers, Johanna; Gansevoort, Ron T.; Vart, Priya; de Jong, Paul E.; Westerhuis, Ralf; Franssen, Casper F. M.

    2014-01-01

    Background: Intradialytic hypotension is a common complication of hemodialysis (HD). Some studies have suggested that inadequate arginine vasopressin (AVP) increase could play a role in the pathogenesis of intradialytic hypotension. However, AVP levels during HD and its relation to hypotension has

  16. Per-operative cerebral near-infrared spectroscopy (NIRS) predicts maternal hypotension during elective caesarean delivery in spinal anaesthesia

    DEFF Research Database (Denmark)

    Berlac, P A; Rasmussen, Yvonne Hovmann

    2005-01-01

    ) (median 8%, interquartile range 5-11%) in all 22 patients who developed hypotension, whereas only 2 of 13 women who did not develop hypotension had a 5% decrease in ScO(2). Median time from a 5% decrease in ScO(2) to hypotension was 81 (interquartile range 30-281) s. The sensitivity of near...

  17. Techniques for Non-Invasive Monitoring of Arterial Blood Pressure

    Directory of Open Access Journals (Sweden)

    Agnes S. Meidert

    2018-01-01

    Full Text Available Since both, hypotension and hypertension, can potentially impair the function of vital organs such as heart, brain, or kidneys, monitoring of arterial blood pressure (BP is a mainstay of hemodynamic monitoring in acutely or critically ill patients. Arterial BP can either be obtained invasively via an arterial catheter or non-invasively. Non-invasive BP measurement provides either intermittent or continuous readings. Most commonly, an occluding upper arm cuff is used for intermittent non-invasive monitoring. BP values are then obtained either manually (by auscultation of Korotkoff sounds or palpation or automatically (e.g., by oscillometry. For continuous non-invasive BP monitoring, the volume clamp method or arterial applanation tonometry can be used. Both techniques enable the arterial waveform and BP values to be obtained continuously. This article describes the different techniques for non-invasive BP measurement, their advantages and limitations, and their clinical applicability.

  18. Tilt angles and positive response of head-up tilt test in children with orthostatic intolerance.

    Science.gov (United States)

    Lin, Jing; Wang, Yuli; Ochs, Todd; Tang, Chaoshu; Du, Junbao; Jin, Hongfang

    2015-01-01

    This study aimed at examining three tilt angle-based positive responses and the time to positive response in a head-up tilt test for children with orthostatic intolerance, and the psychological fear experienced at the three angles during head-up tilt test. A total of 174 children, including 76 boys and 98 girls, aged from 4 to 18 years old (mean 11.3±2.8 years old), with unexplained syncope, were randomly divided into three groups, to undergo head-up tilt test at the angles of 60°, 70° and 80°, respectively. The diagnostic rates and times were analysed, and Wong-Baker face pain rating scale was used to access the children's psychological fear. There were no significant differences in diagnostic rates of postural orthostatic tachycardia syndrome and vasovagal syncope at different tilt angles during the head-up tilt test (p>0.05). There was a significant difference, however, in the psychological fear at different tilt angles utilising the Kruskal-Wallis test (χ2=36.398, ptest (ptest for vasovagal syncope or for postural orthostatic tachycardia syndrome. Hence, it is suggested that a tilt angle of 60° and head-up tilt test time of 45 minutes should be suitable for children with vasovagal syncope.

  19. Using Concurrent Cardiovascular Information to Augment Survival Time Data for Evaluating Orthostatic Tilt Test Performance

    Science.gov (United States)

    Feiveson, Alan H.; Fiedler, James; Lee, Stuart M. C.; Koslovsky, Matthew D.; Stenger, Michael B.; Platts, Steven H.

    2018-01-01

    Head-up tilt (HUT) tests often are used in research to measure orthostatic intolerance (OI) (inability to appropriately control blood pressure while upright) in clinical populations and otherwise healthy individuals after interventions. Post-space flight orthostatic intolerance is a well-known phenomenon, and countermeasures to its development has been an active area of research at NASA. In the NASA HUT protocol, subjects lie horizontally on an automatic tilt table for baseline measurements before being raised to 80deg head-up tilt for a defined period of time or until signs or symptoms of presyncope ensues (light-headedness, nausea, dizziness, sweating, weakness or fainting). Multiple measures are collected to evaluate the cardiovascular system's ability to respond appropriately to the orthostatic challenge. However if the intended duration of the HUT is short, the ability to detect changes in OI due to an intervention or its prevention by a countermeasure may be limited by a small number of failures to permit comparisons based on survival time alone. Thus, the time-trajectory of the cardiovascular data becomes an important additional source of information. In particular, we will show how various measures of trajectory variability can effectively augment survival analysis for the assessment of OI in a joint model when high censoring rates are present.

  20. Why do patients with severe arterial insufficiency get pain during sleep?

    DEFF Research Database (Denmark)

    Jelnes, Rolf; Bülow, J; Tønnesen, K H

    1987-01-01

    Simultaneous measurement during 24 h of mean arterial blood pressure (MABP) and forefoot subcutaneous adipose tissue blood flow (SBF) was undertaken in eight patients (15 feet) with different degrees of arterial insufficiency. The recordings were undertaken with the patients in the supine positio...... was reduced by 32 +/- 12% during sleep. It is concluded that nocturnal hypotension is the major aethiological factor for the symptom ischaemic nocturnal rest pain....

  1. Heart rate variability and short duration spaceflight: relationship to post-flight orthostatic intolerance

    Directory of Open Access Journals (Sweden)

    Blaber Andrew P

    2004-04-01

    Full Text Available Abstract Background Upon return from space many astronauts experience symptoms of orthostatic intolerance. Research has implicated altered autonomic cardiovascular regulation due to spaceflight with further evidence to suggest that there might be pre-flight autonomic indicators of post-flight orthostatic intolerance. We used heart rate variability (HRV to determine whether autonomic regulation of the heart in astronauts who did or did not experience post-flight orthostatic intolerance was different pre-flight and/or was differentially affected by short duration (8 – 16 days spaceflight. HRV data from ten-minute stand tests collected from the 29 astronauts 10 days pre-flight, on landing day and three days post-flight were analysed using coarse graining spectral analysis. From the total power (PTOT, the harmonic component was extracted and divided into high (PHI: >0.15 Hz and low (PLO: = 0.15 Hz frequency power regions. Given the distribution of autonomic nervous system activity with frequency at the sinus node, PHI/PTOT was used as an indicator of parasympathetic activity; PLO/PTOT as an indicator of sympathetic activity; and, PLO/PHI as an estimate of sympathovagal balance. Results Twenty-one astronauts were classified as finishers, and eight as non-finishers, based on their ability to remain standing for 10 minutes on landing day. Pre-flight, non-finishers had a higher supine PHI/PTOT than finishers. Supine PHI/PTOT was the same pre-flight and on landing day in the finishers; whereas, in the non-finishers it was reduced. The ratio PLO/PHI was lower in non-finishers compared to finishers and was unaffected by spaceflight. Pre-flight, both finishers and non-finishers had similar supine values of PLO/PTOT, which increased from supine to stand. Following spaceflight, only the finishers had an increase in PLO/PTOT from supine to stand. Conclusions Both finishers and non-finishers had an increase in sympathetic activity with stand on pre

  2. A case of hypotension after intranasal adrenaline infiltration causing a clinical dilemma during the intraoperative period

    Directory of Open Access Journals (Sweden)

    Shyam Bhandari

    2011-01-01

    Full Text Available Solutions containing adrenaline are widely used for presurgical infiltration. Haemodynamic changes associated with its use are well documented in the literature. Prolonged intraoperative hypotension after subcutaneous infiltration of diluted adrenaline is an uncommon scenario. We believe that our case of the prolonged episode of hypotension was secondary to infiltration of nasal septum with a high concentration of adrenaline. As β2 receptor activation leads to skeletal muscle vasodilation, a decrease in preload may have lead to profound hypotension. Postoperatively, the patient was examined and any autonomic or endocrinological pathology was ruled out.

  3. The impact of left ventricular preload reduction on cardiac pulsed doppler indices during hemodialysis and its relation to intra-dialysis hypotension: A pulsed doppler study

    International Nuclear Information System (INIS)

    Alarrayed, Sameer; Garadah Taysir Said; Alawdi, Abdulhai Ali

    2009-01-01

    Fluid status in the body plays an important role on left ventricular (LV) filling in patients with end-stage renal disease (ESRD) on regular hemodialysis (HD), and plays a role in intra-dialysis hemodynamic derangement. Fifty-two patients with ESRD on regular HD, including 34 males with a mean age of 45.5 +- 13 years (range 18-72 years), were studied. All patients underwent Echo-pulsed Doppler study before and immediately after a HD session. The Echo Doppler indices noted were: LV cavity dimension and wall thickness, LV ejection fraction (LVEF%), trans-mitral early diastolic filling velocity (E wave), atrial filling diastolic velocity (A wave), E/A ratio, Deceleration Time (DT) of E wave, Isovolumic relaxation time (IVRT), Aortic Velocity Integral (AVI) and Inferior Vena Cava Diameter (VCD) at expiration. Patients were divided into two groups according to the amount of net ultra filtrate loss after HD. Group I comprised of 25 patients with fluid loss of 2 liters. During the HD session, each patient was observed for the development of acute clinical events such as arterial hypotension (systolic BP less than 90 mmHg), chest pain and arrhythmias. There was a significant difference between the two groups in the mean values, pre- and post- HD, of reduction of E wave velocity (p < 0.01), the reduction of E/A ratio (p< 0.05), the increment in DT of E wave (p< 0.05), the reduction in AVI (p< 0.01) and the reduction of VCD (p< 0.05). There was no significant difference between the groups in the reduction of A wave velocity and the reduction of IVRT. Among the study patients, 11 (21%) developed systolic hypo-tension during HD. The pre-dialysis mean values of E/A ratio and DT of E wave in patients who developed hypotension compared to those who did not was 0.7 +- 0.2 vs 1.1 +- 0.2.1 (p< 0.001) and 246 +- 40 vs 224 +- 34 msec (p< 0.05), respectively. Our study suggests that preload reduction in patients with ESRD on regular HD is directly proportional to the reduction of left

  4. Pneumatic Compression, But Not Exercise, Can Avoid Intradialytic Hypotension: A Randomized Trial.

    Science.gov (United States)

    Álvares, Valeria R C; Ramos, Camila D; Pereira, Benedito J; Pinto, Ana Lucia; Moysés, Rosa M A; Gualano, Bruno; Elias, Rosilene M

    2017-01-01

    Conventional hemodialysis (HD) is associated with dialysis-induced hypotension (DIH) and ineffective phosphate removal. As the main source of extracellular fluid removed during HD are the legs, we sought to reduce DIH and increase phosphate removal by using cycling and pneumatic compression, which would potentially provide higher venous return, preserving central blood flow and also offering more phosphate to the dialyzer. We evaluated 21 patients in a randomized crossover fashion in which each patient underwent 3 different HD: control; cycling exercise during the first 60 min; and pneumatic compression during the first 60 min. Data obtained included bioelectrical impedance, hourly blood pressure measurement, biochemical parameters, and direct quantification of phosphate through the dialysate. DIH was defined as a drop in mean arterial pressure (MAP) ≥20 mm Hg. There was no difference in the ultrafiltration rate (p = 0.628), delta weight (p = 0.415), delta of total, intra and extracellular body water among the control, cycling, and pneumatic compression (p = 0.209, p = 0.348, and p = 0.467 respectively). Delta MAP was less changed by pneumatic compression when compared to control, cycling, and pneumatic compression respectively (-4.7 [-17.2, 8.2], -4.7 [-20.5, -0.2], and -2.3 [-8.1, 9.0] mm Hg; p = 0.021). DIH occurred in 43, 38, and 24% of patients in control, cycling, and pneumatic compression respectively (p = 0.014). Phosphate removal did not increase in any intervention (p = 0.486). Higher phosphate removal was dependent on ultrafiltration, pre dialysis serum phosphate, and higher parathyroid hormone. Pneumatic compression during the first hour of dialysis was associated with less DIH, albeit there was no effect on fluid parameters. Neither exercise nor pneumatic compression increased phosphate removal. © 2017 S. Karger AG, Basel.

  5. Cortisol-induced inhibition of ovine renin and aldosterone responses to hypotension

    International Nuclear Information System (INIS)

    Wood, C.E.; Silbiger, J.

    1987-01-01

    Previous studies from this laboratory have demonstrated that in preterm fetal sheep increases in plasma cortisol (F) concentration equal in amplitude to fetal F stress responses suppress plasma renin activity (PRA). The purpose of this study was to investigate the possibility that this negative interaction exists in adult sheep. Cortisol was measured by radioimmunoassay. Five conscious ewes with chronically prepared carotid arterial loops were infused intravenously with F or vehicle for 5 h. One hour after the end of F or vehicle infusion, renin secretion was stimulated by hypotension produced by infusion of sodium nitroprusside. F infusion increased plasma F; during vehicle infusion plasma F did not change. F infusion decreased hematocrit from 29 +/- 2 to 26 +/- 1%. Basal PRA in vehicle- and F-infused groups were 0.4 +/- 0 and 0.2 +/- 0.1 ng angiotensin I-ml -1 -h -1 and did not change. In vehicle-infused ewes, PRA increased from 0.4 +/- 0 to 4.6 +/- 0.4 and plasma aldosterone from 26.0 +/- 1.0 to 173.1 +/- 21.8 pg/ml, while in F-infused ewes, PRA increased from 0.2 +/- 1 to 3.3 +/- 0.4 ng angiotensin I-ml -1 -h -1 and aldosterone from 25.0 +/- 0 to 48.2 +/- 23.2 pg/ml, significantly smaller responses. These results suggest that repeated stress may modulate the responses of the renin-angiotensin system in this species

  6. Study on cardiac output in children with orthostatic disturbances measured by the external dilution method with a radioisotope

    Energy Technology Data Exchange (ETDEWEB)

    Hattori, K [Nippon Medical School, Tokyo

    1975-04-01

    As one of the studies on circulation dynamics which possibly contributed to orthostatic disturbance, application to children of the external measurement of cardiac output with /sup 131/I labeled human serum albumin was examined. The effect of orthostatic load was then studied by this method on the children with orthostatic disturbances and the patients improving from other diseases, and the following results were obtained: (1) As in the external method with radioisotope, the head of the scintillation detector was easily oriented, and the diversion of orientation was examined by circulation dilution curve, and the cardiac output was easily and safely measured without causing severe pain to the subjects. This method was performed on 40 children in the recumbent position and 27 in orthostatic load, and it was confirmed that the method was fully applicable to the pediatric field. (2) In half of the 20 patients with orthostatic disturbances and 20 control subjects, the cardiac index in the recumbent position was between 3 l/min/m/sup 2/ and 5 l/min/m/sup 2/. Mean cardiac index was 4.45 l/min/m/sup 2/ in male children, while 4.72 l/min/m/sup 2/ in female children. This mean value was the same or a little higher than the reported adult value.

  7. [Effects of the renal blood flow at different levels by transcutaneous electrical acupoint stimulation combined general anesthesia induced controlled hypotension].

    Science.gov (United States)

    Fang, Jian-Qiao; Zhang, Le-Le; Shao, Xiao-Mei

    2012-11-01

    To observe the intervention of transcutaneous electrical acupoint stimulation (TEAS) on the renal blood flow at different levels of mean arterial pressure (MAP) in controlled hypotension. Forty-two male beagle dogs were randomly divided into seven groups, i. e., the general anesthesia group, the 50% controlled group, the 40% controlled group, the 30% controlled group, the 50% experimental group, the 40% experimental group, and the 30% experimental group, 6 in each group. Beagles in the general anesthesia group were not treated with controlled hypotension, and the target MAP was achieved in those of the rest groups and maintained for 60 min. In the experimental groups, TEAS was applied to bilateral Hegu (LI4), Zusanli (ST36), Sanyinjiao (SP6), and Quchi (LI11) at 2/100 Hz with the stimulation strength of (4 +/- 1) mA starting from the stability of their physiological conditions to 60 min of maintaining the target MAP level. The changes of the renal blood flow were monitored at different time points using laser Doppler. From starting pressure control to the target MAP level, the renal blood flow was significantly lower in the 30% controlled group than in the general anesthesia group and the basic level of the same group (P blood pressure, the renal blood flow was significantly lower in the 50% controlled group, the 40% controlled group, the 30% controlled group, and the 30% experimental group than in the general anesthesia group (P blood pressure recovery, the renal blood flow restored to the basic level in the 50% controlled group, the 50% experimental group, and the 40% experimental group (P > 0.05), while it was not restored to the basic level in the 40% controlled group, the 30% controlled group, and the 30% experimental group (P renal blood flow, thus protecting the kidney.

  8. Preload versus coload and vasopressor requirement for the prevention of spinal anesthesia induced hypotension in non-obstetric patients

    International Nuclear Information System (INIS)

    Khan, M.U.; Aqil, M.

    2015-01-01

    To compare the effectiveness of preload and coload for the prevention of Spinal Induced Hypotension (SIH) and vasopressor requirements. Study Design: Randomized trial. Place and Duration of Study: Department of Anesthesia, The Aga Khan University Hospital, Karachi, Pakistan, from June 2007 - June 2010. Methodology: Sixty patients were randomly divided into preload and coload group of 30 each. Patients with ASA1 - 3, aged 20 - 60 years were included. Patients with history of IHD, COPD, BMI > 30 and surgical procedure TURP were excluded. All patients received crystalloid 10 ml/kg before induction of spinal anesthesia in preload group and at the time of spinal anesthesia in coload group. Blood pressure and heart rate were recorded at different time intervals till 45 minutes. Patients received ephedrine 5 mg when systolic blood pressure dropped below 90 mmHg and heart rate was less than 60 beats/minute and/or phenylephrine 50 micrograms when systolic blood pressure dropped below 90 mmHg and heart rate was more than 60 beats/minute. Results: There was no statistically significant difference at different time intervals in heart rate, systolic and mean arterial pressure between the groups. Diastolic blood pressure was significantly different in both groups at 6 - 15 minutes after spinal anesthesia. SIH occurred (21) 70% and (15) 50% in preload and coload groups, respectively (p=0.187). Ephedrine requirement for SIH was significantly high in preload group (p=0.017). Phenylephrine requirement for SIH was high in preload group which was statistically non-significant (p=0.285). Conclusion: Coload group has lower incidence of spinal induced hypotension and significantly less vasopressor requirement than the preload group. (author)

  9. Tamsulosin-induced severe hypotension during general anesthesia: a case report

    Directory of Open Access Journals (Sweden)

    Khan Fauzia

    2010-11-01

    Full Text Available Abstract Introduction Tamsulosin, a selective α1-adrenergic receptor (α1-AR antagonist, is a widely prescribed first-line agent for benign prostatic hypertrophy (BPH. Its interaction with anesthetic agents has not been described. Case presentation We report the case of 54-year-old Asian man undergoing elective left thyroid lobectomy. The only medication the patient was taking was tamsulosin 0.4 mg for the past year for BPH. He developed persistent hypotension during the maintenance phase of anesthesia while receiving oxygen, nitrous oxide and 1% isoflurane. The hypotension could have been attributable to a possible interaction between inhalational anesthetic and tamsulosin. Conclusion Vigilance for unexpected hypotension is important in surgical patients who are treated with selective α1-AR blockers. If hypotension occurs, vasopressors that act directly on adrenergic receptors could be more effective.

  10. Chemical Composition and Hypotensive Effect of Campomanesia xanthocarpa

    Directory of Open Access Journals (Sweden)

    Liane Santariano Sant’Anna

    2017-01-01

    Full Text Available Campomanesia xanthocarpa is known in Brazil as Guabiroba and is popularly used for various diseases, such as inflammatory, renal, and digestive diseases and dyslipidemia. The aim of the study was to analyze the chemical composition and investigate the effects of aqueous extract of C. xanthocarpa on the blood pressure of normotensive rats, analyzing the possible action mechanism using experimental and in silico procedures. The extract was evaluated for total phenolic compounds and total flavonoid content. The chemical components were determined by HPLC analyses. Systolic and diastolic blood pressure and heart rate were measured with extract and drugs administration. The leaves of C. xanthocarpa presented the relevant content of phenolics and flavonoids, and we suggested the presence of chlorogenic acid, gallic acid, quercetin, and theobromine. The acute administration of aqueous extract of C. xanthocarpa has a dose-dependent hypotensive effect in normotensive rats, suggesting that the action mechanism may be mediated through the renin-angiotensin system by AT1 receptor blockade and sympathetic autonomic response. Docking studies showed models that indicated an interaction between chlorogenic acid and quercetin with the AT1 receptor (AT1R active site. The findings of these docking studies suggest the potential of C. xanthocarpa constituents for use as preventive agents for blood pressure.

  11. The Effect of Hypotensive Anesthesia on Hepatic Function in Hip Replacement

    OpenAIRE

    Zagrekov V.I.; Zhirova T.A.; Ezhov I.Y.; Taranyuk А.V.

    2011-01-01

    The objective of the work is to assess the influence of spinal and epidural anesthesia with controlled hypotensive effect on hepatic function in patients in total hip replacement. Materials and Methods. There has been studied the dynamics of hepatic enzymes and bilirubin indexes in 80 patients in hip replacement. Depending on the anesthesia method, three groups were considered: with spinal and epidural anesthesia with controlled hypotensive effect and normotensive spinal anesthesia using ...

  12. Extrusion of the medial meniscus in knee osteoarthritis assessed with a rotating clino-orthostatic permanent-magnet MRI scanner.

    Science.gov (United States)

    Paparo, Francesco; Revelli, Matteo; Piccazzo, Riccardo; Astengo, Davide; Camellino, Dario; Puntoni, Matteo; Muda, Alessandro; Rollandi, Gian Andrea; Garlaschi, Giacomo; Cimmino, Marco Amedeo

    2015-04-01

    The objectives of this study were to assess the influence of weight-bearing on tibiofemoral osteoarthritis, including medial meniscal extrusion, by using a low-field (0.25 T) rotating clino-orthostatic permanent-magnet magnetic resonance (MR) scanner, and to analyse correlations of medial meniscal extrusion with the patient's Kellgren-Lawrence score, body mass index, and all the osteoarthritis features of the WORMS scoring system. Twenty-six patients (69.2% women and 30.8% men; mean age 67 ± 9.7 years) with medial tibiofemoral knee osteoarthritis were prospectively enrolled and MR sequences were acquired in both clino- and orthostatic position. MR images were assessed by two independent radiologists, according to the WORMS scale. Medial meniscal extrusion was measured and its clino-orthostatic difference (∆MME) was calculated. Intra- and inter-observer agreement of the WORMS Global Score readings was high by Cohen's K test (>0.81). No significant clino-orthostatic changes in the scoring parameters of the medial tibiofemoral joint were shown by Wilcoxon's test. Medial meniscal extrusion measured on orthostatic images was significantly higher than that measured in clinostatic position (p < 0.0001). At univariate analysis, the Kellgren-Lawrence score, WORMS Global Score, cartilage loss, meniscal damage, and osteophytes were significantly correlated to ∆MME (p < 0.005). Using a multiple regression model, tibiofemoral cartilage loss was found to correlate independently with ∆MME (p = 0.0499). Medial meniscal extrusion, evaluated with an open-configuration, rotating MR scanner, increased from the clinostatic to the orthostatic position. ∆MME, a new meniscal parameter, correlated with several important features of medial tibiofemoral osteoarthritis.

  13. More hypotension in patients taking antihypertensives preoperatively during shoulder surgery in the beach chair position.

    Science.gov (United States)

    Trentman, Terrence L; Fassett, Sharon L; Thomas, Justin K; Noble, Brie N; Renfree, Kevin J; Hattrup, Steven J

    2011-11-01

    Hypotension is common in patients undergoing surgery in the sitting position under general anesthesia, and the risk may be exacerbated by the use of antihypertensive drugs taken preoperatively. The purpose of this study was to compare hypotensive episodes in patients taking antihypertensive medications with normotensive patients during shoulder surgery in the beach chair position. Medical records of all patients undergoing shoulder arthroscopy during a 44-month period were reviewed retrospectively. The primary endpoint was the number of moderate hypotensive episodes (systolic blood pressure ≤ 85 mmHg) during the intraoperative period. Secondary endpoints included the frequency of vasopressor administration, total dose of vasopressors, and fluid administered. Values are expressed as mean (standard deviation). Of 384 patients who underwent shoulder surgery, 185 patients were taking no antihypertensive medication, and 199 were on at least one antihypertensive drug. The antihypertensive medication group had more intraoperative hypotensive episodes [1.7 (2.2) vs 1.2 (1.8); P = 0.01] and vasopressor administrations. Total dose of vasopressors and volume of fluids administered were similar between groups. The timing of the administration of angiotensin-converting enzyme inhibitors and of angiotensin receptor antagonists (≤ 10 hr vs > 10 hr before surgery) had no impact on intraoperative hypotension. Preoperative use of antihypertensive medication was associated with an increased incidence of intraoperative hypotension. Compared with normotensive patients, patients taking antihypertensive drugs preoperatively are expected to require vasopressors more often to maintain normal blood pressure.

  14. Arterial embolization therapy of traumatic renal hemorrhage

    International Nuclear Information System (INIS)

    Wu Changxu; Chen Xiaolin; Huang Changhai; Pu Ge

    2000-01-01

    Objective: To study the angiographic manifestations and arterial embolizatin for traumatic renal hemorrhage when conservative treatment had failed. methods: 5 cases, all male, ranging in age from 12-29 years. All cases had history of injury. the main symptoms included severe abdominal pain, hematuria or coffee colored urine, rapid heart rate, hypotension. 3 suffered hemorrhagic shock. All cases underwent angiographic exam and the diagnosis was confirmed. Embolization materials were mainly self-blood clot and gelfoam. Results: Symptoms in all cases subsided quickly after embolization. Blood pressure recovered to normal within 12 hours; Hematuresis and abdominal pain disappeared or reduced in 1-2 days. One month later, intravenous urographic exam revealed recovered function of the injured kidneys. Conclusion: Renal arterial embolization in treating traumatic renal hemorrhage can control the bleeding while preserving the injured kidneys

  15. Comparative Clinical Profile of Postural Orthostatic Tachycardia Patients With and Without Joint Hypermobility Syndrome

    Directory of Open Access Journals (Sweden)

    Blair P Grubb

    2010-04-01

    Full Text Available Background: Autonomic dysfunction is common in patients with the joint hypermobility syndrome (JHS. However, there is a paucity of reported data on clinical features of Postural orthostatic tachycardia syndrome (POTS in patients suffering from JHS.Methods: This retrospective study was approved by our local Institutional Review Board (IRB. Over a period of 10 years, 26 patients of POTS were identified for inclusion in this study. All these patients had features of Joint Hypermobility Syndrome (by Brighton criterion. A comparison group of 39 patients with other forms of POTS were also followed in the autonomic clinic during the same time. We present a descriptive report on the comparative clinical profile of the clinical features of Postural Orthostatic Tachycardia patients with and without Joint Hypermobility syndrome. The data is presented as a mean±SD and percentages wherever applicable.Results: Out of 65 patients, 26 patients (all females, 20 Caucasians had POTS and JHS. The mean age at presentation of POTS was 24±13 (range 10-53 years vs 41±12 (range 19-65 years, P=0.0001, Migraine was a common co morbidity 73 vs 29% p=0,001. In two patients POTS was precipitated by pregnancy, and in three by surgery, urinary tract infection and a viral syndrome respectively. The common clinical features were fatigue (58%, orthostatic palpitations (54%, presyncope (58%, and syncope (62%.Conclusion: Patients with POTS and JHS appear to become symptomatic at an earlier age compared to POTS patients without JHS. In addition patients with JHS had a greater incidence of migraine and syncope than their non JHS counterparts.

  16. Clinical characteristics of a novel subgroup of chronic fatigue syndrome patients with postural orthostatic tachycardia syndrome.

    Science.gov (United States)

    Lewis, I; Pairman, J; Spickett, G; Newton, J L

    2013-05-01

    A significant proportion of patients with chronic fatigue syndrome (CFS) also have postural orthostatic tachycardia syndrome (POTS). We aimed to characterize these patients and differentiate them from CFS patients without POTS in terms of clinical and autonomic features. A total of 179 patients with CFS (1994 Centers for Disease Control and Prevention criteria) attending one of the largest Department of Health-funded CFS clinical services were included in this study. Outcome measures were as follows: (i) symptom assessment tools including the fatigue impact scale, Chalder fatigue scale, Epworth sleepiness scale (ESS), orthostatic grading scale (OGS) and hospital anxiety and depression scale (HADS-A and -D, respectively), (ii) autonomic function analysis including heart rate variability and (iii) haemodynamic responses including left ventricular ejection time and systolic blood pressure drop upon standing. CFS patients with POTS (13%, n = 24) were younger (29 ± 12 vs. 42 ± 13 years, P fatigued (Chalder fatigue scale, 8 ± 4 vs. 10 ± 2, P = 0.002), less depressed (HADS-D, 6 ± 4 vs. 9 ± 4, P = 0.01) and had reduced daytime hypersomnolence (ESS, 7 ± 6 vs. 10 ± 5, P = 0.02), compared with patients without POTS. In addition, they exhibited greater orthostatic intolerance (OGS, 11 ± 5; P < 0.0001) and autonomic dysfunction. A combined clinical assessment tool of ESS ≤9 and OGS ≥9 identifies accurately CFS patients with POTS with 100% positive and negative predictive values. The presence of POTS marks a distinct clinical group of CFS patents, with phenotypic features differentiating them from those without POTS. A combination of validated clinical assessment tools can determine which CFS patients have POTS with a high degree of accuracy, and thus potentially identify those who require further investigation and consideration for therapy to control heart rate. © 2013 The Association for the Publication of the Journal of Internal Medicine.

  17. Orthostatic hypertension as a predisposing factor for masked hypertension: the J-SHIPP study.

    Science.gov (United States)

    Tabara, Yasuharu; Igase, Michiya; Miki, Tetsuro; Ohyagi, Yasumasa; Matsuda, Fumihiko; Kohara, Katsuhiko

    2016-09-01

    Masked hypertension (HT) is a known risk factor for cardiovascular outcomes. Postural blood pressure (BP) dysregulation is another BP phenomenon representing cardiovascular frailty. Given their several shared risk factors, we suspected an inter-relationship between these two BP phenomena. Here we investigated a possible relationship between masked HT and postural BP dysregulation in a general population. Study subjects were 884 apparently healthy individuals (aged 66.3±8.9 years). Masked HT was assessed on the basis of the ambulatory monitored average awake BP and office-measured BP values. Orthostatic BP change was measured at our office after a subject was asked to actively stand up. A strong inverse relationship was noted for orthostatic systolic BP (SBP) change and office-to-awake SBP differences (office-awake BP) (r=-0.422, P10 mm Hg, 3 min after standing (P=0.001), but not transient HT at only 1 min (P=0.767), was associated with greater office-to-awake SBP differences than in orthostatic normotensive subjects. Among apparently normotensive subjects, the frequency of masked HT was therefore significantly greater in subjects who showed OHT 3 min after standing (52.1%) compared with controls (27.5%) (odds ratio=3.01, P=0.001). We observed an intra-individual relationship between the postural BP change and the office-to-awake BP differences, and subjects who showed OHT were likely to have masked HT irrespective of antihypertensive treatment.

  18. Marked exacerbation of orthostatic intolerance after long- vs. short-duration spaceflight in veteran astronauts

    Science.gov (United States)

    Meck, J. V.; Reyes, C. J.; Perez, S. A.; Goldberger, A. L.; Ziegler, M. G.

    2001-01-01

    OBJECTIVE: The incidence of postflight orthostatic intolerance after short-duration spaceflight is about 20%. However, the incidence after long-duration spaceflight was unknown. The purpose of this study was to test the hypothesis that orthostatic intolerance is more severe after long-duration than after short-duration flight. METHODS: We performed tilt tests on six astronauts before and after long-duration (129-190 days) spaceflights and compared these data with data obtained during stand tests before and after previous short-duration missions. RESULTS: Five of the six astronauts studied became presyncopal during tilt testing after long-duration flights. Only one had become presyncopal during stand testing after short-duration flights. We also compared the long-duration flight tilt test data to tilt test data from 20 different astronauts who flew on the short-duration Shuttle missions that delivered and recovered the astronauts to and from the Mir Space Station. Five of these 20 astronauts became presyncopal on landing day. Heart rate responses to tilt were no different between astronauts on long-duration flights and astronauts on short-duration flights, but long-duration subjects had lower stroke volumes and cardiac outputs than short-duration presyncopal subjects, suggesting a possible decrease in cardiac contractile function. One subject had subnormal norepinephrine release with upright posture after the long flight but not after the short flight. Plasma volume losses were not greater after long flights. CONCLUSION: Long-duration spaceflight markedly increases orthostatic intolerance, probably with multiple contributing factors.

  19. Optimal Fluid Use of Hypotensive Resuscitation and Transport

    Science.gov (United States)

    2017-05-01

    vascular resistance TBI traumatic brain injury Temp temperature TNFα tumor necrosis factor ...pressure (CVP), cardiac index, mean pulmonary artery (PA) pressure, and systemic vascular resistance (SVR, calculated). 3 DISTRIBUTION STATEMENT A...isolated and assayed for the cytokines tumor necrosis factor alpha (TNFα), interleukin (IL) 6 (R&D Systems, Minneapolis, MN), and IL-10 (Life Technologies

  20. Custom Gradient Compression Stockings May Prevent Orthostatic Intolerance in Astronauts After Space Flight

    Science.gov (United States)

    Stenger, Michael B.; Lee, Stuart M. C.; Westby, Christian M.; Platts, Steven H.

    2010-01-01

    Orthostatic intolerance after space flight is still an issue for astronauts as no in-flight countermeasure has been 100% effective. NASA astronauts currently wear an inflatable anti-gravity suit (AGS) during re-entry, but this device is uncomfortable and loses effectiveness upon egress from the Shuttle. We recently determined that thigh-high, gradient compression stockings were comfortable and effective after space flight, though to a lesser degree than the AGS. We also recently showed that addition of splanchnic compression to this thigh-high compression stocking paradigm improved orthostatic tolerance to a level similar to the AGS, in a ground based model. Purpose: The purpose of this study was to evaluate a new, three-piece breast-high gradient compression garment as a countermeasure to post-space flight orthostatic intolerance. Methods: Eight U.S. astronauts have volunteered for this experiment and were individually fitted for a three-piece, breast-high compression garment to provide 55 mmHg compression at the ankle which decreased to approximately 20 mmHg at the top of the leg and provides 15 mmHg over the abdomen. Orthostatic testing occurred 30 days pre-flight (w/o garment) and 2 hours after flight (w/ garment) on landing day. Blood pressure (BP), Heart Rate (HR) and Stroke Volume (SV) were acquired for 2 minutes while the subject lay prone and then for 3.5 minutes after the subject stands up. To date, two astronauts have completed pre- and post-space flight testing. Data are mean SD. Results: BP [pre (prone to stand): 137+/-1.6 to 129+/-2.5; post: 130+/-2.4 to 122+/-1.6 mmHg] and SV [pre (prone to stand): 61+/-1.6 to 38+/-0.2; post: 58+/-6.4 to 37+/-6.0 ml] decreased with standing, but no differences were seen post-flight w/ compression garments compared to pre-flight w/o garments. HR [pre (prone to stand): 66+/-1.6 to 74+/-3.0, post: 67+/-5.6 to 78+/-6.8 bpm] increased with standing, but no differences were seen pre- to post-flight. Conclusion: After space

  1. Circulatory response evoked by a 3 s bout of dynamic leg exercise in humans

    NARCIS (Netherlands)

    Wieling, W.; Harms, M. P.; ten Harkel, A. D.; van Lieshout, J. J.; Sprangers, R. L.

    1996-01-01

    1. The mechanisms underlying the pronounced transient fall in arterial blood pressure evoked by a 3 s bout of bicycle exercise were investigated in twenty healthy young adults and four patients with hypoadrenergic orthostatic hypotension. 2. In healthy subjects a 3 s bout of upright cycling induced

  2. Nitroglycerine, esmolol and dexmedetomidine for induced hypotension during functional endoscopic sinus surgery: A comparative evaluation

    Directory of Open Access Journals (Sweden)

    Sukhminder Jit Singh Bajwa

    2016-01-01

    Full Text Available Background and Aim: Induced hypotension limits intra-operative blood loss to provide better visibility of the surgical field and diminishes the incidence of major complications during functional endoscopic sinus surgery (FESS. We aimed at comparing nitroglycerine, esmolol and dexmedetomidine for inducing controlled hypotension in patients undergoing FESS. Material and Methods: One hundred and fifty American Society of Anesthesiologists physical status I or II adult patients undergoing FESS under general anesthesia were randomly allocated to three groups of 50 patients each. Group E received esmolol in a loading and maintenance dose of 1 mg/kg over 1 min and 0.5-1.0 mg/kg/h, respectively. Group D received a loading dose of dexmedetomidine 1 μg/kg over 10 min followed by an infusion 0.5-1.0 μg/kg/h, and group N received nitroglycerine infusion at a dose of 0.5-2 μg/kg/min so as to maintain mean arterial pressure (MAP between 60 and 70 mmHg in all the groups. The visibility of the surgical field was assessed by surgeon using Fromme and Boezaart scoring system. Hemodynamic variables, total intra-operative fentanyl consumption, emergence time and time to first analgesic request were recorded. Any side-effects were noted. The postoperative sedation was assessed using Ramsay Sedation Score. Result: The desired MAP (60-70 mmHg could be achieved in all the three study groups albeit with titration of study drugs during intra-operative period. No significant intergroup difference was observed in Fromme′s score during the intra-operative period. The mean total dose of fentanyl (μg/kg used was found to be significantly lower in group D compared to groups E and N (1.2 ± 0.75 vs. 3.6 ± 1.3 and 2.9 ± 1.1 respectively. The mean heart rate was significantly lower in group D compared to groups E and N at all times of measurement (P < 0.05. The MAP was found to be significantly lower in group D compared to groups E and N after infusion of study drugs

  3. Spinal radiological findings in nine patients with spontaneous intracranial hypotension

    Energy Technology Data Exchange (ETDEWEB)

    Chiapparini, L.; Farina, L.; D' Incerti, L.; Erbetta, A.; Savoiardo, M. [Department of Neuroradiology, Istituto Nazionale Neurologico, Milan (Italy); Pareyson, D.; Carriero, M.R. [Department of Neurology, Istituto Nazionale Neurologico, Milan (Italy)

    2002-02-01

    Cranial magnetic resonance imaging (MRI) findings in spontaneous intracranial hypotension (SIH) are well known, while spinal studies have received less attention. Radiological spinal findings in nine patients with SIH are presented, looking for possible characteristic features. Five of the nine patients had histories of previous minor trauma, one of previous surgery; in three patients possible relevant preceding events were completely absent. All nine patients had cervical, seven thoracic, and four lumbar spine MRI studies; post-contrast studies were obtained in seven cases, MRI myelograms in five. Radioisotope myelocisternography was performed in four patients and myelo-CT in four. Epidural fluid collections were found in seven patients. In six cases the dural sac had collapsed, with a festooned appearance; intense epidural enhancement on post-contrast studies demonstrated marked dilatation of the epidural venous plexus. In three cases an irregular root sleeve suggested a possible point of cerebrospinal fluid (CSF) leakage. Myelo-CT demonstrated the CSF fistula in two cases, radioisotope myelocisternography in three. The pattern of spinal abnormalities is different from that seen in cranial MRI for anatomical reasons: in the spinal canal the dura is not adherent to the bone; therefore, collapse of the dural sac and dilatation of epidural venous plexus occur, rather than subdural hematomas. In most cases the search for the dural tear is difficult. Radioisotope cisternography is probably the most sensitive examination for documenting the leakage of CSF out of the subarachnoid space; myelo-CT may precisely demonstrate the point of the CSF fistula, whereas MRI may only suggest it. (orig.)

  4. Effect of the exercise of walkers performed in public squares with spontaneous or prescribed intensity on post-exercise hypotension.

    Science.gov (United States)

    Silva, Taís Feitosa da; Souza, Alesandra Araújo de; Lima, Fabiano Ferreira de; Suassuna, Jennifer Ariely Sales; Couto, Henrique Eduardo Paiva Lira do; Tenório, Gustavo Roque; Silva, Maria Irene de Andrade Gomes; Dias, Guilherme Leandebal Bonifácio; Silva, Alexandre Sérgio

    2017-07-20

    To quantify the intensity adopted by walkers in public squares and check the occurrence and magnitude of post-exercise hypotension in the spontaneously adopted intensity and in a prescribed intensity. In 98 volunteers (38 of them being hypertensive), walkers in public squares of the city of João Pessoa, State of Paraíba, Brazil, we have identified the intensity of a usual training monitored by heart rate and we have investigated the occurrence and magnitude of post-exercise hypotension. Subsequently, participants were instructed to walk with moderate intensity. Blood pressure was measured after rest and during post-exercise recovery. Of the total participants, 41% of the hypertensive and 36% of the normotensive individuals walked with light intensity. With the prescription, intensity increased to 55% and 52%, for the hypertensive and normotensive individuals, respectively. In the usual and prescribed intensity, the hypertensive individuals had post-exercise hypotension of -3.7±11.6 mmHg and -4.72±12.8 mmHg, respectively. There was no correlation between post-exercise hypotension and the initial systolic component of the hypertensive individuals (r2 = 0.2; p < 0.002). Walkers in public squares choose light intensity for walking. When they exercise with the prescribed intensity, they increase the intensity, but the magnitude of the PEH is not increase with this guidance. Quantificar a intensidade adotada por caminhantes em praças públicas e verificar a ocorrência e a magnitude da hipotensão pós-exercício na intensidade espontaneamente adotada e em uma intensidade prescrita. Em 98 voluntários (38 hipertensos), caminhantes em praças públicas da cidade de João Pessoa, PB, identificamos a intensidade de um treino habitual monitorada por meio da frequência cardíaca e averiguamos a ocorrência e magnitude de hipotensão pós-exercício. Posteriormente, os participantes foram instruídos a caminhar com intensidade moderada. A pressão arterial foi aferida ap

  5. Massive tumor pulmonary embolism following transcatheter arterial chemoembolization of hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Kim, Jeong Ho; Ko, Gi Young; Yoon, Hyun Ki; Sung, Kyu Bo

    2002-01-01

    Pulmonary embolism complicated by transcatheter arterial chemoembolization (TACE) in known to be due to the use of large amount of lipiodol as an embolic agent. To our knowledge, massive tumoral pulmonary embolism following TACE and confirmed by surgery has not been described in the literature. In this report, we detail the cas of a 49-year-old man in whom cyanosis and hypotension developed abruptly on the day of TACE.. Chest CT revealed diffuse low-attenuated lesions in both pulmonary arteries. Histopathological specimens after emergent pulmonary arterial embolectomy confirmed the presence of massive tumor emboli of hepatocellular carcinoma

  6. Massive tumor pulmonary embolism following transcatheter arterial chemoembolization of hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Kim, Jeong Ho; Ko, Gi Young; Yoon, Hyun Ki; Sung, Kyu Bo

    2002-01-01

    Pulmonary embolism complicated by transcatheter arterial chemoembolization (TACE) is known to be due to the use of large amount of lipiodol as an embolic agent. To our knowledge, massive tumoral pulmonary embolism following TACE and confirmed by surgery has not been described in the literature. In this report, we detail the case of a 49-year-old man in whom cyanosis and hypotension developed abruptly on the day of TACE. Chest CT revealed diffuse low-attenuated lesions in both pulmonary arteries. Histopathological specimens after emergent pulmonary arterial embolectomy confirmed the presence of massive tumor emboli of hepatocellular carcinoma

  7. Outcomes following trauma laparotomy for hypotensive trauma patients: a UK military and civilian perspective.

    Science.gov (United States)

    Marsden, Max; Carden, Rich; Navaratne, Lalin; Smith, Iain M; Penn-Barwell, Jowan G; Kraven, Luke M; Brohi, Karim; Tai, Nigel R M; Bowley, Douglas M

    2018-05-25

    The management of trauma patients has changed radically in the last decade and studies have shown overall improvements in survival. However, reduction in mortality for the many may obscure a lack of progress in some high-risk patients. We sought to examine the outcomes for hypotensive patients requiring laparotomy in UK military and civilian cohorts. We undertook a review of two prospectively maintained trauma databases; the UK Joint Theatre Trauma Registry (JTTR) for the military cohort (4th February 2003 to 21st September 2014), and the trauma registry of the Royal London Hospital MTC (1st January 2012 to 1st January 2017) for civilian patients. Adults undergoing trauma laparotomy within 90 minutes of arrival at the Emergency Department (ED) were included. Hypotension was present on arrival at the ED in 155/761 (20.4%) military patients. Mortality was higher in hypotensive casualties 25.8% vs 9.7% normotensive casualties (p<0.001). Hypotension was present on arrival at the ED in 63/176 (35.7%) civilian patients. Mortality was higher in hypotensive patients 47.6% vs 12.4% normotensive patients (p<0.001). In both cohorts of hypotensive patients neither the average injury severity, the prehospital time, the ED arrival SBP, nor mortality rate changed significantly during the study period. Despite improvements in survival after trauma for patients overall, the mortality for patients undergoing laparotomy who arrive at the Emergency Department with hypotension has not changed and appears stubbornly resistant to all efforts. Specific enquiry and research should continue to be directed at this high-risk group of patients. IV; Observational Cohort Study.

  8. Drug-induced hypotension SEP test and acetazolamide test using sup 133 Xe SPECT in patients with occlusive carotid disease; Selection of candidates for extracranial-intracranial bypass

    Energy Technology Data Exchange (ETDEWEB)

    Kuroda, Satoshi; Kamiyama, Hiroyasu; Abe, Hiroshi; Takigawa, Shugo [Hokkaido Univ., Sapporo (Japan). School of Medicine; Mitsumori, Kenji; Nomura, Mikio; Saitoh, Hisatoshi

    1991-01-01

    The correlation between the drug-induced hypotension somatosensory evoked potential (SEP) test and regional cerebral blood flow changes after acetazolamide administration was studied. Fourteen patients presenting with transient ischemic attack, reversible ischemic neurological deficits, or minor completed stroke were evaluated. All patients had no or only localized low-density areas on computed tomographic scans, and unilateral occlusion or severe stenosis of the internal carotid or middle cerebral artery on cerebral angiograms. The Diamox asymmetry enhancement (DAE) was studied to detect reduced cerebral perfusion reserve in the affected hemispheres. The DAE was 7.9+-5.8% in seven patients positive in the SEP test, significantly higher than -1.5+-2.9% in patients negative in the SEP test. Postoperative SEP tests were negative in all five patients who underwent extracranial-intracranial (EC-IC) bypass surgery, suggesting that the EC-IC bypass improved the cerebral perfusion reserve in the affected hemispheres. The DAE decreased significantly in four of these patients. This study disclosed a significant correlation between the drug-induced hypotension SEP test and DAE. These parameters are considered important for evaluating patients with hemodynamic compromise and/or suitable candidates for EC-IC bypass. (author).

  9. A Potential Treatment for Post-Flight Orthostatic Intolerance in Aero-Space Crews: Autogenic-Feedback Training

    Science.gov (United States)

    Cowings, P. S.; Toscano, W. B.; Miller, N. E.; Pickering, T. G.; Shapiro, D.

    1994-01-01

    Postflight orthostatic intolerance has been identified as a serious biomedical problem associated with long duration exposure to microgravity in space. High priority has been given to the development of countermeasures for this disorder which are both effective and practical. A considerable body of clinical research has demonstrated that people can be taught to increase their own blood pressure voluntarily and that this is an effective treatment for chronic Orthostatic intolerance in paralyzed patients. The present pilot study was designed to examine the feasibility of adding training in control of blood pressure to an existing preflight training program designed to facilitate astronaut adaptation to microgravity. Using in operant conditioning procedure, Autogenic-Feedback Training (AFT), three men and two women participated in four to nine (15-30 training sessions). At the end of training ranged between 20 and 50 mm Hg under both supine and 450 head-up tilt conditions. These findings suggest that AFT may be a useful alternative treatment or supplement to existing approaches for preventing postflight Orthostatic intolerance. Further, the use of operant conditioning methods for training cardiovascular responses may contribute to the general understanding of the mechanisms of orthostatic intolerance.

  10. Arterial stick

    Science.gov (United States)

    ... be some throbbing. Why the Test Is Performed Blood transports oxygen, nutrients, waste products, and other materials within ... venous blood) mainly in its content of dissolved gases . Testing arterial blood shows the makeup of the blood before any ...

  11. Permissive hypotension in extremely low birth weight infants (≤1000 gm).

    Science.gov (United States)

    Ahn, So Yoon; Kim, Eun Sun; Kim, Jin Kyu; Shin, Jeong Hee; Sung, Se In; Jung, Ji Mi; Chang, Yun Sil; Park, Won Soon

    2012-07-01

    We performed this study to evaluate the safety of permissive hypotension management in extremely low birth weight infants (ELBWIs). Medical records of all inborn ELBWIs admitted to Samsung Medical Center from January 2004 to December 2008 were reviewed retrospectively. Of a total of 261 ELBWIs, 47 (18%) required treatment for hypotension (group T), 110 (42%) remained normotensive (group N), and 104 (40%) experienced more than one episode of hypotension without treatment (group P) during the first 72 hours of life. Treatment of hypotension included inotropic support and/or fluid loading. Birth weight and Apgar scores were significantly lower in the T group than the other two groups. In the N group, the rate of pathologically confirmed maternal chorioamnionitis was significantly higher than other two groups, and the rate was higher in the P group than the T group. After adjusting for covariate factors, no significant differences in mortality and major morbidities were found between the N and P groups. However, the mortality rate and the incidence of intraventricular hemorrhage (≥stage 3) and bronchopulmonary dysplasia (≥moderate) were significantly higher in the T group than the other two groups. Long term neurodevelopmental outcomes were not significantly different between the N and P groups. Close observation of hypotensive ELBWIs who showed good clinical perfusion signs without intervention allowed to avoid unnecessary medications and resulted in good neurological outcomes.

  12. Opportunities for Web-based Drug Repositioning: Searching for Potential Antihypertensive Agents with Hypotension Adverse Events.

    Science.gov (United States)

    Wang, Kejian; Wan, Mei; Wang, Rui-Sheng; Weng, Zuquan

    2016-04-01

    Drug repositioning refers to the process of developing new indications for existing drugs. As a phenotypic indicator of drug response in humans, clinical side effects may provide straightforward signals and unique opportunities for drug repositioning. We aimed to identify drugs frequently associated with hypotension adverse reactions (ie, the opposite condition of hypertension), which could be potential candidates as antihypertensive agents. We systematically searched the electronic records of the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) through the openFDA platform to assess the association between hypotension incidence and antihypertensive therapeutic effect regarding a list of 683 drugs. Statistical analysis of FAERS data demonstrated that those drugs frequently co-occurring with hypotension events were more likely to have antihypertensive activity. Ranked by the statistical significance of frequent hypotension reporting, the well-known antihypertensive drugs were effectively distinguished from others (with an area under the receiver operating characteristic curve > 0.80 and a normalized discounted cumulative gain of 0.77). In addition, we found a series of antihypertensive agents (particularly drugs originally developed for treating nervous system diseases) among the drugs with top significant reporting, suggesting the good potential of Web-based and data-driven drug repositioning. We found several candidate agents among the hypotension-related drugs on our list that may be redirected for lowering blood pressure. More important, we showed that a pharmacovigilance system could alternatively be used to identify antihypertensive agents and sustainably create opportunities for drug repositioning.

  13. Shengmai Injection, a Traditional Chinese Patent Medicine, for Intradialytic Hypotension: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Chao-yang Chen

    2013-01-01

    Full Text Available Intradialytic hypotension (IDH is a global public health problem. A rising number of IDH sufferers resort to Chinese patent medicine, Shengmai Injection (SMI in China. The objectives of present study are to assess the effectiveness and safety of SMI as an adjunct therapy for IDH. A systematic search of 6 medical databases was performed up to December 2011. Randomized trials involving SMI adjuvant therapy versus conventional therapy were identified. RevMan 5.0 was used for data analysis. Ten randomized clinical trials with 437 participants were identified. Methodological quality was considered inadequate in all trials. Compared with conventional therapy, SMI adjunct therapy showed significant effects in improving the clinic effective rate (P<0.01, decreasing the incidence of IDH episode (P<0.01, decreasing the frequency of nursing interventions (P<0.01, and increasing diastolic blood pressure (P<0.01. There was no statistical significance in the improvement of mean arterial pressure (P=0.22 and systolic blood pressure (P=0.08 between two groups. Four studies had mentioned adverse events, but no serious adverse effects were reported in any of the included trials. In conclusion, SMI adjunct therapy appears to be potentially effective in treatment of IDH and is generally safe. However, further rigorous designed trials are needed.

  14. Shengmai injection, a traditional chinese patent medicine, for intradialytic hypotension: a systematic review and meta-analysis.

    Science.gov (United States)

    Chen, Chao-Yang; Lu, Ling-Yan; Chen, Peng; Ji, Kang-Ting; Lin, Jia-Feng; Yang, Peng-Lin; Tang, Ji-Fei; Wang, Yan

    2013-01-01

    Intradialytic hypotension (IDH) is a global public health problem. A rising number of IDH sufferers resort to Chinese patent medicine, Shengmai Injection (SMI) in China. The objectives of present study are to assess the effectiveness and safety of SMI as an adjunct therapy for IDH. A systematic search of 6 medical databases was performed up to December 2011. Randomized trials involving SMI adjuvant therapy versus conventional therapy were identified. RevMan 5.0 was used for data analysis. Ten randomized clinical trials with 437 participants were identified. Methodological quality was considered inadequate in all trials. Compared with conventional therapy, SMI adjunct therapy showed significant effects in improving the clinic effective rate (P < 0.01), decreasing the incidence of IDH episode (P < 0.01), decreasing the frequency of nursing interventions (P < 0.01), and increasing diastolic blood pressure (P < 0.01). There was no statistical significance in the improvement of mean arterial pressure (P = 0.22) and systolic blood pressure (P = 0.08) between two groups. Four studies had mentioned adverse events, but no serious adverse effects were reported in any of the included trials. In conclusion, SMI adjunct therapy appears to be potentially effective in treatment of IDH and is generally safe. However, further rigorous designed trials are needed.

  15. Renal denervation decreases blood pressure and renal tyrosine hydroxylase but does not augment the effect of hypotensive drugs.

    Science.gov (United States)

    Skrzypecki, Janusz; Gawlak, Maciej; Huc, Tomasz; Szulczyk, Paweł; Ufnal, Marcin

    2017-01-01

    The effect of renal denervation on the efficacy of antihypertensive drugs has not yet been elucidated. Twenty-week-old spontaneously hypertensive rats were treated with metoprolol, losartan, indapamide, or saline (controls) and assigned to renal denervation or a sham procedure. Acute hemodynamic measurements were performed ten days later. Series showing a significant interaction between renal denervation and the drugs were repeated with chronic telemetry measurements. In the saline series, denervated rats showed a significantly lower mean arterial blood pressure (blood pressure) than the sham-operated rats. In contrast, in the metoprolol series denervated rats showed a significantly higher blood pressure than sham rats. There were no differences in blood pressure between denervated and sham rats in the losartan and indapamide series. In chronic studies, a 4-week treatment with metoprolol caused a decrease in blood pressure. Renal denervation and sham denervation performed 10 days after the onset of metoprolol treatment did not affect blood pressure. Denervated rats showed markedly reduced renal nerve tyrosine hydroxylase levels. In conclusion, renal denervation decreases blood pressure in hypertensive rats. The hypotensive action of metoprolol, indapamide, and losartan is not augmented by renal denervation, suggesting the absence of synergy between renal denervation and the drugs investigated in this study.

  16. Arterial stiffness

    Directory of Open Access Journals (Sweden)

    Ursula Quinn

    2012-09-01

    Full Text Available Measurements of biomechanical properties of arteries have become an important surrogate outcome used in epidemiological and interventional cardiovascular research. Structural and functional differences of vessels in the arterial tree result in a dampening of pulsatility and smoothing of blood flow as it progresses to capillary level. A loss of arterial elastic properties results a range of linked pathophysiological changes within the circulation including increased pulse pressure, left ventricular hypertrophy, subendocardial ischaemia, vessel endothelial dysfunction and cardiac fibrosis. With increased arterial stiffness, the microvasculature of brain and kidneys are exposed to wider pressure fluctuations and may lead to increased risk of stroke and renal failure. Stiffening of the aorta, as measured by the gold-standard technique of aortic Pulse Wave Velocity (aPWV, is independently associated with adverse cardiovascular outcomes across many different patient groups and in the general population. Therefore, use of aPWV has been proposed for early detection of vascular damage and individual cardiovascular risk evaluation and it seems certain that measurement of arterial stiffness will become increasingly important in future clinical care. In this review we will consider some of the pathophysiological processes that result from arterial stiffening, how it is measured and factors that may drive it as well as potential avenues for therapy. In the face of an ageing population where mortality from atheromatous cardiovascular disease is falling, pathology associated with arterial stiffening will assume ever greater importance. Therefore, understanding these concepts for all clinicians involved in care of patients with cardiovascular disease will become vital.

  17. Carotid artery surgery

    Science.gov (United States)

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  18. A Case of Ruptured Splenic Artery Aneurysm in Pregnancy

    Directory of Open Access Journals (Sweden)

    Elizabeth K. Corey

    2014-01-01

    Full Text Available Background. Rupture of a splenic artery aneurysm is rare complication of pregnancy that is associated with a significant maternal and fetal mortality. Case. A multiparous female presented in the third trimester with hypotension, tachycardia, and altered mental status. A ruptured splenic artery aneurysm was discovered at the time of laparotomy and cesarean delivery. The patient made a full recovery following resection of the aneurysm. The neonate survived but suffered severe neurologic impairment. Conclusion. The diagnosis of ruptured splenic artery aneurysm should be considered in a pregnant woman presenting with signs of intra-abdominal hemorrhage. Early intervention by a multidisciplinary surgical team is key to preserving the life of the mother and fetus.

  19. Changes of Pituitary Hormones after Injection of Naloxone in the Hypotensive Phase of Korean Hemorrhagic Fever

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Sang Moo; Cho, Bo Youn; Lee, Hong Gyu; Lee, Jung Sang; Koh, Chang Soon [Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Byung Tae [Hallym Medical College, Seoul (Korea, Republic of)

    1986-09-15

    The opiate antagonist, naloxone, was injected for the reversal of hypotension due to Korean hemorrhagic fever, and the authors observed changes in pituitary hormones. In the hypotensive phase of the Korean hemorrhagic fever, the beta-endorphin was high, and normalized gradually in the diuretic and convalescent period. The naloxone raised the pulse rate and the blood pressure within 30 minutes without change in the central venous pressure. Around 30 minuted after the injection of the naloxone, the beta-endorphin, ACTH and cortisol rose. The prolactin fell down 60 minutes after the naloxone injection.

  20. Harmane produces hypotension following microinjection into the RVLM: possible role of I1-imidazoline receptors

    OpenAIRE

    Musgrave, I F; Badoer, E

    2000-01-01

    The β-carboline, harmane (0.1–1.0 nmol) produces dose dependent hypotension when microinjected unilaterally into the rostral ventrolateral medulla (RVLM) of the anaesthetized rat. The potency of harmane on blood pressure is similar to that of the imidazoline, clonidine. The hypotensive effects of both clonidine and harmane are reversed by microinjection of the relatively I1-receptor selective antagonist efaroxan (20 nmol). These results are consistent with harmane acting at an I1-receptor in ...

  1. Harmane produces hypotension following microinjection into the RVLM: possible role of I1-imidazoline receptors

    Science.gov (United States)

    Musgrave, I F; Badoer, E

    2000-01-01

    The β-carboline, harmane (0.1–1.0 nmol) produces dose dependent hypotension when microinjected unilaterally into the rostral ventrolateral medulla (RVLM) of the anaesthetized rat. The potency of harmane on blood pressure is similar to that of the imidazoline, clonidine. The hypotensive effects of both clonidine and harmane are reversed by microinjection of the relatively I1-receptor selective antagonist efaroxan (20 nmol). These results are consistent with harmane acting at an I1-receptor in the RVLM. This is the first report of an endogenous ligand for I1-receptors that has central effects on blood pressure. PMID:10725251

  2. Harmane produces hypotension following microinjection into the RVLM: possible role of I(1)-imidazoline receptors.

    Science.gov (United States)

    Musgrave, I F; Badoer, E

    2000-03-01

    The beta-carboline, harmane (0.1 - 1.0 nmol) produces dose dependent hypotension when microinjected unilaterally into the rostral ventrolateral medulla (RVLM) of the anaesthetized rat. The potency of harmane on blood pressure is similar to that of the imidazoline, clonidine. The hypotensive effects of both clonidine and harmane are reversed by microinjection of the relatively I(1)-receptor selective antagonist efaroxan (20 nmol). These results are consistent with harmane acting at an I(1)-receptor in the RVLM. This is the first report of an endogenous ligand for I(1)-receptors that has central effects on blood pressure.

  3. Using Concurrent Cardiovascular Information to Augment Survival Time Data from Orthostatic Tilt Tests

    Science.gov (United States)

    Feiveson, Alan H.; Fiedler, James; Lee, Stuart M. M.; Westby, Christian M.; Stenger, Michael B.; Platts, Steven H.

    2014-01-01

    Orthostatic Intolerance (OI) is the propensity to develop symptoms of fainting during upright standing. OI is associated with changes in heart rate, blood pressure and other measures of cardiac function. Problem: NASA astronauts have shown increased susceptibility to OI on return from space missions. Current methods for counteracting OI in astronauts include fluid loading and the use of compression garments. Multivariate trajectory spread is greater as OI increases. Pairwise comparisons at the same time within subjects allows incorporation of pass/fail outcomes. Path length, convex hull area, and covariance matrix determinant do well as statistics to summarize this spread Missing data problems Time series analysis need many more time points per OTT session treatment of trend? how incorporate survival information?

  4. Orthostatic changes in the blood volumes of the lower extremities in practically healthy humans

    Energy Technology Data Exchange (ETDEWEB)

    Frolov, V K; Koshkin, V M; Karalkin, A V [Vtoroj Moskovskij Gosudarstvennyj Meditsinskij Inst. (USSR)

    1979-07-01

    The method and the results of measuring the blood volumes in the lower extremities in the horizontal and vertical position of the body are given. A combination of a single-sensor counter of the whole body and a gamma-chamber with the use of two nondiffuse active radioindicators, erythrocytes labelled with /sup 51/Cr and albumin-sup(99m)Tc in certain sequence, is found to be the most optimal for quantitative evaluation of the regional volumes of the blood. To raise the informativeness of the studies the authors recommend distinguishing ''rapid'' and ''slow'' fractions of the blood volume progressive growth in the crus since the correlation of these fractions reflect the specific features of an individual orthostatic reaction for each examinee.

  5. Entropy Analysis of RR and QT Interval Variability during Orthostatic and Mental Stress in Healthy Subjects

    Directory of Open Access Journals (Sweden)

    Mathias Baumert

    2014-12-01

    Full Text Available Autonomic activity affects beat-to-beat variability of heart rate and QT interval. The aim of this study was to explore whether entropy measures are suitable to detect changes in neural outflow to the heart elicited by two different stress paradigms. We recorded short-term ECG in 11 normal subjects during an experimental protocol that involved head-up tilt and mental arithmetic stress and computed sample entropy, cross-sample entropy and causal interactions based on conditional entropy from RR and QT interval time series. Head-up tilt resulted in a significant reduction in sample entropy of RR intervals and cross-sample entropy, while mental arithmetic stress resulted in a significant reduction in coupling directed from RR to QT. In conclusion, measures of entropy are suitable to detect changes in neural outflow to the heart and decoupling of repolarisation variability from heart rate variability elicited by orthostatic or mental arithmetic stress.

  6. A definition of normovolaemia and consequences for cardiovascular control during orthostatic and environmental stress

    DEFF Research Database (Denmark)

    Truijen, Jasper; Bundgaard-Nielsen, Morten; van Lieshout, Johannes J

    2010-01-01

    that a given central blood volume may be associated with markedly different central vascular pressures. The central blood volume varies with posture and, consequently, stroke volume and cardiac output (Q) are affected, but with the increased central blood volume during head-down tilt, stroke volume and Q do...... not increase further indicating that in the supine resting position the heart operates on the plateau of the Frank-Starling curve which, therefore, may be taken as a functional definition of normovolaemia. Since the capacity of the vascular system surpasses the blood volume, orthostatic and environmental...... stress including bed rest/microgravity, exercise and training, thermal loading, illness, and trauma/haemorrhage is likely to restrict venous return and Q. Consequently the cardiovascular responses are determined primarily by their effect on the central blood volume. Thus during environmental stress, flow...

  7. The hydrostatic pressure indifference point underestimates orthostatic redistribution of blood in humans

    DEFF Research Database (Denmark)

    Petersen, L G; Carlsen, Jonathan F.; Nielsen, Michael Bachmann

    2014-01-01

    The hydrostatic indifference point (HIP; where venous pressure is unaffected by posture) is located at the level of the diaphragm and is believed to indicate the orthostatic redistribution of blood, but it remains unknown whether HIP coincides with the indifference point for blood volume (VIP......). During graded (± 20°) head-up (HUT) and head-down tilt (HDT) in 12 male volunteers, we determined HIP from central venous pressure and VIP from redistribution of both blood, using ultrasound imaging of the inferior caval vein (VIPui), and fluid volume, by regional electrical admittance (VIPadm...... of pressure and filling of the inferior caval vein as well as fluid distribution, we found HIP located corresponding to the diaphragm while VIP was placed low in the abdomen, and that medical antishock trousers elevated both HIP and VIP. The low indifference point for volume shows that the gravitational...

  8. Improvement of quality of reporting in randomised controlled trials to prevent hypotension after spinal anaesthesia for caesarean section

    NARCIS (Netherlands)

    A. Herdan; R. Roth; D. Grass; M. Klimek (Markus); S. Will; B. Schauf; R. Rossaint; M. Heesen

    2011-01-01

    textabstractHypotension is a frequent complication of spinal anaesthesia for caesarean section and can threaten the well-being of the unborn child. Numerous randomised controlled trials (RCTs) dealt with measures to prevent hypotension. The aim of this study was to determine the reporting quality of

  9. The effect of orthostatic stress on multiscale entropy of heart rate and blood pressure

    International Nuclear Information System (INIS)

    Turianikova, Zuzana; Javorka, Kamil; Calkovska, Andrea; Javorka, Michal; Baumert, Mathias

    2011-01-01

    Cardiovascular control acts over multiple time scales, which introduces a significant amount of complexity to heart rate and blood pressure time series. Multiscale entropy (MSE) analysis has been developed to quantify the complexity of a time series over multiple time scales. In previous studies, MSE analyses identified impaired cardiovascular control and increased cardiovascular risk in various pathological conditions. Despite the increasing acceptance of the MSE technique in clinical research, information underpinning the involvement of the autonomic nervous system in the MSE of heart rate and blood pressure is lacking. The objective of this study is to investigate the effect of orthostatic challenge on the MSE of heart rate and blood pressure variability (HRV, BPV) and the correlation between MSE (complexity measures) and traditional linear (time and frequency domain) measures. MSE analysis of HRV and BPV was performed in 28 healthy young subjects on 1000 consecutive heart beats in the supine and standing positions. Sample entropy values were assessed on scales of 1–10. We found that MSE of heart rate and blood pressure signals is sensitive to changes in autonomic balance caused by postural change from the supine to the standing position. The effect of orthostatic challenge on heart rate and blood pressure complexity depended on the time scale under investigation. Entropy values did not correlate with the mean values of heart rate and blood pressure and showed only weak correlations with linear HRV and BPV measures. In conclusion, the MSE analysis of heart rate and blood pressure provides a sensitive tool to detect changes in autonomic balance as induced by postural change

  10. Orthostatic stress is necessary to maintain the dynamic range of cardiovascular control in space

    Science.gov (United States)

    Baisch, J. F.; Wolfram, G.; Beck, L.; Drummer, C.; Stormer, I.; Buckey, J.; Blomqvist, G.

    2000-01-01

    In the upright position, gravity fills the low-pressure systems of human circulation with blood and interstitial fluid in the sections below the diaphragm. Without gravity one pressure component in the vessels disappears and the relationship between hydrostatic pressure and oncotic pressure, which regulates fluid passage across the capillary endothelium in the terminal vascular bed, shifts constantly. The visible consequences of this are a puffy face and "bird" legs. The plasma volume shrinks in space and the range of cardiovascular control is reduced. When they stand up for the first time after landing, 30-50% of astronauts suffer from orthostatic intolerance. It remains unclear whether microgravity impairs cardiovascular reflexes, or whether it is the altered volume status that causes the cardiovascular instability following space flight. Lower body negative pressure was used in several space missions to stimulate the cardiovascular reflexes before, during and after a space flight. The results show that cardiovascular reflexes are maintained in microgravity. However, the astronauts' volume status changed in space, towards a volume-retracted state, as measurements of fluid-regulating hormones have shown. It can be hypothesized that the control of circulation and body fluid homeostasis in humans is adapted to their upright posture in the Earth's gravitational field. Autonomic control regulates fluid distribution to maintain the blood pressure in that posture, which most of us have to cope with for two-thirds of the day. A determined amount of interstitial volume is necessary to maintain the dynamic range of cardiovascular control in the upright posture; otherwise orthostatic intolerance may occur more often.

  11. Lessons I have learned from my patients: everyday life with primary orthostatic tremor.

    Science.gov (United States)

    Vidailhet, Marie; Roze, Emmanuel; Maugest, Lucie; Gallea, Cécile

    2017-01-01

    Primary orthostatic tremor is a rare disorder that is still under-diagnosed or misdiagnosed. Motor symptoms are fairly characteristics but the real impact on the patient's every day life and quality of life is under-estimated. The "how my patients taught me" format describes the impact on the patients' every day life with their own words, which is rarely done. A 46 year old lady was diagnosed primary orthostatic tremor (POT) based on the cardinal symptoms: feelings of instability, leg tremor and fear of falling in the standing position, improvement with walking and disappearance while sitting, frequency of Tremor in the 13-18Hz range, normal neurological examination. She gives illustrative examples of her disability in every day life activity (shower, public transportation, shopping). She reports how she felt stigmatized by her "invisible disorder". As a consequence, she developed anxiety depression and social phobia. All these troubles are unknown or under recognized by doctors and family. We review the clinical signs of POT that may help to increase the awareness of doctors and improve the diagnosis accuracy, based on the motor symptoms and description of the every day life disability, as reported by the patient. Non-motor symptoms (including somatic concerns, anxiety, depression, and social phobia) should be better considered in POT as they have a major impact on quality of life. Pharmacological treatments (clonazepam, gabapentin) may be helpful but have a limited effect over the years as the patients experience a worsening of their condition. On the long term follow-up, there are still unmet needs in POT, and new therapeutic avenues may be based on the pathophysiology by modulating the cerebello-thalamo-cortical network.

  12. [Modern approaches to the use of neurotropic physical therapy in arterial hypertension].

    Science.gov (United States)

    Orekhova, E M; Konchugova, T V; Kul'chitskaya, D B; Korchazhkina, N B; Egorova, L A; Chuich, N G

    2016-01-01

    The development and introduction into clinical practice of non-pharmacological methods for the prevention and treatment of arterial hypertension is a primary objective of modern physical therapy, especially as regards the neurotropic influences. This article was designed to report the results of the investigation into the hypotensive effect of transcerebral magnetic therapy obtained during the treatment of 60 patients presenting with arterial hypertension. The study included the comparative examination of two randomly formed groups containing 30 patients each. The patients of the main group received transcerebral magnetic therapy (to the frontal region) while those in the group of comparison were given magnetotherapy at the collar region. The study has demonstrated that transcerebral magnetic therapy given to the patients of the main group was a more efficient treatment than magnetotherapy at the collar region since it produced a more pronounced hypotensive effect irrespective of the initial hemodynamic type.

  13. Protein kinase Cα deletion causes hypotension and decreased vascular contractility.

    Science.gov (United States)

    Wynne, Brandi M; McCarthy, Cameron G; Szasz, Theodora; Molina, Patrick A; Chapman, Arlene B; Webb, R Clinton; Klein, Janet D; Hoover, Robert S

    2018-03-01

    Protein kinase Cα (PKCα) is a critical regulator of multiple cell signaling pathways including gene transcription, posttranslation modifications and activation/inhibition of many signaling kinases. In regards to the control of blood pressure, PKCα causes increased vascular smooth muscle contractility, while reducing cardiac contractility. In addition, PKCα has been shown to modulate nephron ion transport. However, the role of PKCα in modulating mean arterial pressure (MAP) has not been investigated. In this study, we used a whole animal PKCα knock out (PKC KO) to test the hypothesis that global PKCα deficiency would reduce MAP, by a reduction in vascular contractility. Radiotelemetry measurements of ambulatory blood pressure (day/night) were obtained for 18 h/day during both normal chow and high-salt (4%) diet feedings. PKCα mice had a reduced MAP, as compared with control, which was not normalized with high-salt diet (14 days). Metabolic cage studies were performed to determine urinary sodium excretion. PKC KO mice had a significantly lower diastolic, systolic and MAP as compared with control. No significant differences in urinary sodium excretion were observed between the PKC KO and control mice, whether fed normal chow or high-salt diet. Western blot analysis showed a compensatory increase in renal sodium chloride cotransporter expression. Both aorta and mesenteric vessels were removed for vascular reactivity studies. Aorta and mesenteric arteries from PKC KO mice had a reduced receptor-independent relaxation response, as compared with vessels from control. Vessels from PKC KO mice exhibited a decrease in maximal contraction, compared with controls. Together, these data suggest that global deletion of PKCα results in reduced MAP due to decreased vascular contractility.

  14. Impact of Diabetes Type 1 in Children on Autonomic Modulation at Rest and in Response to the Active Orthostatic Test.

    Science.gov (United States)

    Giacon, Thais Roque; Vanderlei, Franciele Marques; Christofaro, Diego Giulliano Destro; Vanderlei, Luiz Carlos Marques

    2016-01-01

    Cardiovascular autonomic neuropathy is one of the most common complications of diabetes mellitus type 1 (DM1), of which one of the first subclinical manifestations is changes in heart rate variability (HRV). Thus, analysis of HRV associated with the autonomic active orthostatic test is important in this population. To analyze the autonomic modulation responses induced by the implementation of the active orthostatic test, in children with DM1, and study the autonomic modulation by means of HRV indices. Data of 35 children were analyzed, of both sexes, aged between 7 and 15 years, who were divided into two groups: Diabetic (n = 16) and Control (n = 19). The following variables were collected initially: weight, height, body fat percentage, heart rate, blood pressure and casual blood glucose. Subsequently, for analysis of autonomic modulation, the beat-to-beat heart rate was captured by a heart rate monitor in the supine position for 30 minutes and after 10 minutes standing during performance of the active orthostatic test. HRV indices were calculated in the time and frequency domains. For data analysis, covariance analysis was used to compare groups and ANOVA for repeated measures to compare the effects of the active orthostatic test. These data were adjusted for age, sex, ethnicity, body fat percentage and casual blood glucose, with a 5% significance level. The results suggested that diabetic children at rest present a decrease in SDNN (50.4 vs. 75.2), rMSSD (38.7 vs 57.6) and LF [ms2] (693.6 vs 1874.6). During the active orthostatic test the children in both groups demonstrated a reduction in SDNN, RMSSD and LF [ms2] compared to the resting position, and this response was less pronounced in the diabetic group. We conclude that regardless of age, sex, ethnicity, body fat percentage and casual blood glucose, performing the active orthostatic test promoted increased sympathetic modulation and reduced parasympathetic modulation in both groups, and this response was less

  15. Impact of Diabetes Type 1 in Children on Autonomic Modulation at Rest and in Response to the Active Orthostatic Test.

    Directory of Open Access Journals (Sweden)

    Thais Roque Giacon

    Full Text Available Cardiovascular autonomic neuropathy is one of the most common complications of diabetes mellitus type 1 (DM1, of which one of the first subclinical manifestations is changes in heart rate variability (HRV. Thus, analysis of HRV associated with the autonomic active orthostatic test is important in this population.To analyze the autonomic modulation responses induced by the implementation of the active orthostatic test, in children with DM1, and study the autonomic modulation by means of HRV indices.Data of 35 children were analyzed, of both sexes, aged between 7 and 15 years, who were divided into two groups: Diabetic (n = 16 and Control (n = 19. The following variables were collected initially: weight, height, body fat percentage, heart rate, blood pressure and casual blood glucose. Subsequently, for analysis of autonomic modulation, the beat-to-beat heart rate was captured by a heart rate monitor in the supine position for 30 minutes and after 10 minutes standing during performance of the active orthostatic test. HRV indices were calculated in the time and frequency domains. For data analysis, covariance analysis was used to compare groups and ANOVA for repeated measures to compare the effects of the active orthostatic test. These data were adjusted for age, sex, ethnicity, body fat percentage and casual blood glucose, with a 5% significance level.The results suggested that diabetic children at rest present a decrease in SDNN (50.4 vs. 75.2, rMSSD (38.7 vs 57.6 and LF [ms2] (693.6 vs 1874.6. During the active orthostatic test the children in both groups demonstrated a reduction in SDNN, RMSSD and LF [ms2] compared to the resting position, and this response was less pronounced in the diabetic group.We conclude that regardless of age, sex, ethnicity, body fat percentage and casual blood glucose, performing the active orthostatic test promoted increased sympathetic modulation and reduced parasympathetic modulation in both groups, and this response

  16. High Intensity Resistive and Rowing Exercise Countermeasures Do Not Prevent Orthostatic Intolerance Following 70 Days of Bed Rest

    Science.gov (United States)

    Lee, Stuart M. C.; Stenger, Michael B.; Laurie, Steven S.; Ploutz-Snyder, Lori L.; Platts, Steven H.

    2015-01-01

    More than 60% of US astronauts participating in Mir and early International Space Station missions (greater than 5 months) were unable to complete a 10-min 80 deg head-up tilt test on landing day. This high incidence of post-spaceflight orthostatic intolerance may be related to limitations of the inflight exercise hardware that prevented high intensity training. PURPOSE: This study sought to determine if a countermeasure program that included intense lower-body resistive and rowing exercises designed to prevent cardiovascular and musculoskeletal deconditioning during 70 days of 6 deg head-down tilt bed rest (BR), a spaceflight analog, also would protect against post- BR orthostatic intolerance. METHODS: Sixteen males participated in this study and performed no exercise (Control, n=10) or performed an intense supine exercise protocol with resistive and aerobic components (Exercise, n=6). On 3 days/week, exercise subjects performed lower body resistive exercise and a 30-min continuous bout of rowing (greater than or equal to 75% max heart rate). On 3 other days/week, subjects performed only high-intensity, interval-style rowing. Orthostatic intolerance was assessed using a 15-min 80 deg head-up tilt test performed 2 days (BR-2) before and on the last day of BR (BR70). Plasma volume was measured using a carbon monoxide rebreathing technique on BR-3 and before rising on the first recovery day (BR+0). RESULTS: Following 70 days of BR, tilt tolerance time decreased significantly in both the Control (BR-2: 15.0 +/- 0.0, BR70: 9.9 +/- 4.6 min, mean +/- SD) and Exercise (BR-2: 12.2 +/- 4.7, BR70: 4.9 +/- 1.9 min) subjects, but the decreased tilt tolerance time was not different between groups (Control: -34 +/- 31, Exercise: -56 +/- 16%). Plasma volume also decreased (Control: -0.56 +/- 0.40, Exercise: -0.48 +/- 0.33 L) from pre to post-BR, with no differences between groups (Control: -18 +/- 11%, Exerciser: -15 +/-1 0%). CONCLUSIONS: These findings confirm previous reports

  17. Estimation of Individual-specific Progression to Impending Cardiovascular Instability using Arterial Waveforms

    Science.gov (United States)

    2013-08-08

    electrocardiogram, respiratory rate, pulse oximetry). As a result, many clinicians have wrongly assumed that hypotension and other signs and symptoms of...loss during the early com- pensatory phase of hemorrhage can quickly lead to poor tissue perfusion, progressive acidosis , and sudden, unexpected hemo...arterial blood (SpO2) was measured by standard pulse oximetry. Respiratory rate and end-tidal CO2 were measured from a nasal CO2 capnograph. With the

  18. Arterial embolism

    Science.gov (United States)

    ... when a clot in a vein enters the right side of the heart and passes through a hole into the left side. The clot can then move to an artery and block blood flow to the brain (stroke) or other organs. If a clot involves ...

  19. The Microcirculation is Preserved in Emergency Department Low‐acuity Sepsis Patients Without Hypotension

    DEFF Research Database (Denmark)

    Skibsted, Simon; Filbin, Michael; Hou, Peter

    2014-01-01

    -acuity sepsis patients. The hypothesis was that patients with sepsis, but without hypotension, will demonstrate signs of flow abnormalities compared to noninfected control patients. Methods This was a prospective, observational study in a convenience sample of patients with sepsis and noninfected controls...

  20. Effects of exercise intensity and creatine loading on post-resistance exercise hypotension

    Directory of Open Access Journals (Sweden)

    Moreno Rodrigues Moreno

    2009-09-01

    Full Text Available Postexercise hypotension plays an important role in the non-pharmacological treat-ment of hypertension and is characterized by a decrease in blood pressure after a single exercise bout in relation to pre-exercise levels. This study investigated the effects of exercise intensity and creatine monohydrate supplementation on postexercise hypotension, as well as the possible role of blood lactate in this response. Ten normotensive subjects underwent resistance exercise sessions before (BC and after (AC creatine supplementation: 1 muscle endurance (ME consisting of 30 repetitions at 30% of one-repetition maximum; 2 hypertrophy (HP consisting of 8 repetitions at 75% of one-repetition maximum. Blood pressure was measured before and after the exercise bout. Blood lactate was measured after the exercise bout. The HP and ME sessions promoted a decrease in systolic blood pressure (∆ -19 ± 1.0 mmHg; ∆ -15 ± 0.9 mmHg, respectively, P 0.05. In conclusion, resistance exercise intensity did not influence postexercise hypotension. Creatine supplementation attenuated the decrease in blood pressure after resistance exercise. The results suggest the involvement of blood lactate in post-resistance exercise hypotension.

  1. Effects of exercise intensity and creatine loading on post-resistance exercise hypotension

    Directory of Open Access Journals (Sweden)

    Moreno Rodrigues Moreno

    2009-01-01

    Postexercise hypotension plays an important role in the non-pharmacological treat-ment of hypertension and is characterized by a decrease in blood pressure after a single exercise bout in relation to pre-exercise levels. This study investigated the effects of exercise intensity and creatine monohydrate supplementation on postexercise hypotension, as well as the possible role of blood lactate in this response. Ten normotensive subjects underwent resistance exercise sessions before (BC and after (AC creatine supplementation: 1 muscle endurance (ME consisting of 30 repetitions at 30% of one-repetition maximum; 2 hypertrophy (HP consisting of 8 repetitions at 75% of one-repetition maximum. Blood pressure was measured before and after the exercise bout. Blood lactate was measured after the exercise bout. The HP and ME sessions promoted a decrease in systolic blood pressure (∆ -19 ± 1.0 mmHg; ∆ -15 ± 0.9 mmHg, respectively, P 0.05. In conclusion, resistance exercise intensity did not influence postexercise hypotension. Creatine supplementation attenuated the decrease in blood pressure after resistance exercise. The results suggest the involvement of blood lactate in post-resistance exercise hypotension.

  2. A thin line between Meniere’s disease and spontaneous intracranial hypotension syndrome

    Directory of Open Access Journals (Sweden)

    Iva Botica

    2016-02-01

    Full Text Available Aim To point out the similarity of Meniere disease and spontaneous intracranial hypotension and difference of their treatment. Methods A case of a 54-year-old male patient with previously diagnosed Meniere’s disease and newly diagnosed spontaneous intracranial hypotension syndrome is presented. Additional neuroradiological examination, Brain contrast-enhanced MRI and MR myelography were used for diagnosis. Results Due to deterioration of vertigo, hearing loss and tinnitus in the right ear the patient was referred to the additional neuroradiological examination which confirmed the diagnosis of spontaneous intracranial hypotension syndrome. Brain contrast-enhanced MRI showed increased pachymeningeal contrast enhancement, and MR myelography identified the location of CSF leak. The patient was successfully treated conservatively. Conclusion According to our knowledge this is the fifth case report of Meniere’s disease and spontaneous intracranial hypotension coexistence. Both diseases have similar clinical presentation and initial treatment. We suggest procedures of additional examination when the treatment fails and initial diagnosis becomes questionable.

  3. Tight intra-operative blood pressure control versus standard care for patients undergoing hip fracture repair - Hip Fracture Intervention Study for Prevention of Hypotension (HIP-HOP) trial: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Moppett, Iain Keith; White, Stuart; Griffiths, Richard; Buggy, Donal

    2017-07-25

    Hypotension during anaesthesia for hip fracture surgery is common. Recent data suggest that there is an association between the lowest intra-operative blood pressure and mortality, even when adjusted for co-morbidities. This is consistent with data derived from the wider surgical population, where magnitude and duration of hypotension are associated with mortality and peri-operative complications. However, there are no trial to data to support more aggressive blood pressure control. We are conducting a three-centre, randomised, double-blinded pilot study in three hospitals in the United Kingdom. The sample size will be 75 patients (25 from each centre). Randomisation will be done using computer-generated concealed tables. Both participants and investigators will be blinded to group allocation. Participants will be aged >70 years, cognitively intact (Abbreviated Mental Test Score 7 or greater), able to give informed consent and admitted directly through the emergency department with a fractured neck of the femur requiring operative repair. Patients randomised to tight blood pressure control or avoidance of intra-operative hypotension will receive active treatment as required to maintain both of the following: systolic arterial blood pressure >80% of baseline pre-operative value and mean arterial pressure >75 mmHg throughout. All participants will receive standard hospital care, including spinal or general anaesthesia, at the discretion of the clinical team. The primary outcome is a composite of the presence or absence of defined cardiovascular, renal and delirium morbidity within 7 days of surgery (myocardial injury, stroke, acute kidney injury, delirium). Secondary endpoints will include the defined individual morbidities, mortality, early mobility and discharge to usual residence. This is a small-scale pilot study investigating the feasibility of a trial of tight intra-operative blood pressure control in a frail elderly patient group with known high morbidity

  4. [The antigravity suit, chamberless type, as a means of increasing orthostatic tolerance after water immersion hypokinesis and acceleration].

    Science.gov (United States)

    Shul'zhenko, E B; Kozlova, V G; Kurdin, K A; Iarov, A S; Plokhova, V G

    1983-01-01

    Orthostatic tolerance after 7-day dry immersion and head-to-feet acceleration was investigated on test subjects with and without an antigravity suit of bladderless type. With the suit on, the 20 min tilt test at 70 degrees prior to immersion induced less marked changes than without the suit. When the suit was on, cardiovascular reactions to tilt tests after immersion and acceleration improved. The maximum heart rate decreased from 135 +/- 4 to 101 +/- 5 beats/min (p less than 0.01), minimum stroke volume increased from 29 +/- 2 to 41 +/- 3 ml (p less than 0.05), and pulse pressure grew. Thus, an antigravity suit may help increase initial orthostatic tolerance and maintain it after the combined effect of simulated hypogravity and acceleration.

  5. A nationwide survey of factors influencing adherence to ocular hypotensive eyedrops in Japan.

    Science.gov (United States)

    Tsumura, Toyoaki; Kashiwagi, Kenji; Suzuki, Yasuyuki; Yoshikawa, Keiji; Suzumura, Hirotaka; Maeda, Toshine; Takeda, Ryuji; Saito, Hitomi; Araie, Makoto

    2018-01-12

    Few reports have investigated the status of adherence in Japan on a large scale. We aimed to investigate the status of adherence to topical glaucoma treatment and its associated factors. A nationwide survey was conducted as a prospective fashion. Participants in this survey were subjects with primary open-angle glaucoma, normal-tension glaucoma, or ocular hypertension or pseudoexfoliation glaucoma who had been prescribed anti-glaucoma ophthalmic eyedrops and whose ophthalmologist considered prescribing any fixed combination of ocular hypotensive eyedrops for the first time between 2011 and 2012. Subjects and their attending ophthalmologists independently completed a questionnaire by utilizing a fixed combination of ocular hypotensive eyedrops. A total of 1358 ophthalmologists from 1071 medical institutions participated in this survey. We registered 4430 subjects (2049 males and 2381 females). In total, data from 3853 subjects (87.6%) were analyzed after inclusion of subjects based on inclusion and exclusion criteria. Good adherence was defined as not forgetting instillation during the past week. Rates of good adherence reported by subjects and ophthalmologists were 72.4 and 78.5%, respectively (P < 0.0001). The consistency of adherence evaluation between subjects and ophthalmologists was moderate [kappa score 0.5025 (95% confidence interval 0.4740-0.5309)]. Significant factors associated with adherence were size of clinic, age, gender, number of types of ocular hypotensive eyedrops, ease of instillation, preferred number of eyedrops, preferred frequency of instillation of eyedrops, and knowledge of glaucoma. Adherence to ocular hypotensive eyedrops among Japanese subjects was relatively good. Concordance of adherence between subjects' reports and ophthalmologists' responses was moderate. Size of clinic, number of types of ocular hypotensive eyedrops, ease of instillation, preferred number of eyedrops, preferred frequency of instillation of eyedrops, and knowledge

  6. Hypotension Risk Prediction via Sequential Contrast Patterns of ICU Blood Pressure.

    Science.gov (United States)

    Ghosh, Shameek; Feng, Mengling; Nguyen, Hung; Li, Jinyan

    2016-09-01

    Acute hypotension is a significant risk factor for in-hospital mortality at intensive care units. Prolonged hypotension can cause tissue hypoperfusion, leading to cellular dysfunction and severe injuries to multiple organs. Prompt medical interventions are thus extremely important for dealing with acute hypotensive episodes (AHE). Population level prognostic scoring systems for risk stratification of patients are suboptimal in such scenarios. However, the design of an efficient risk prediction system can significantly help in the identification of critical care patients, who are at risk of developing an AHE within a future time span. Toward this objective, a pattern mining algorithm is employed to extract informative sequential contrast patterns from hemodynamic data, for the prediction of hypotensive episodes. The hypotensive and normotensive patient groups are extracted from the MIMIC-II critical care research database, following an appropriate clinical inclusion criteria. The proposed method consists of a data preprocessing step to convert the blood pressure time series into symbolic sequences, using a symbolic aggregate approximation algorithm. Then, distinguishing subsequences are identified using the sequential contrast mining algorithm. These subsequences are used to predict the occurrence of an AHE in a future time window separated by a user-defined gap interval. Results indicate that the method performs well in terms of the prediction performance as well as in the generation of sequential patterns of clinical significance. Hence, the novelty of sequential patterns is in their usefulness as potential physiological biomarkers for building optimal patient risk stratification systems and for further clinical investigation of interesting patterns in critical care patients.

  7. The organizational structure of an intensive care unit influences treatment of hypotension among critically ill patients: A retrospective cohort study

    Science.gov (United States)

    Boone, M. Dustin; Massa, Jennifer; Mueller, Ariel; Jinadasa, Sayuri P; Lee, Joon; Kothari, Rishi; Scott, Daniel J.; Callahan, Julie; Celi, Leo Anthony; Hacker, Michele R.

    2016-01-01

    Purpose Prior studies report that weekend admission to an intensive care unit is associated with increased mortality, potentially attributed to the organizational structure of the unit. This study aims to determine whether treatment of hypotension, a risk factor for mortality, differs according to level of staffing. Methods Using the Multiparameter Intelligent Monitoring in Intensive Care database, we conducted a retrospective study of patients admitted to an intensive care unit at Beth Israel Deaconess Medical Center who experienced one or more episodes of hypotension. Episode(s) were categorized according to the staffing level, defined as high during weekday daytime (7am–7pm) and low during weekends or nighttime (7pm–7am). Results Patients with a hypotensive event on a weekend were less likely to be treated compared to those that occurred during the weekday daytime (p=0.02). No association between weekday daytime versus weekday nighttime staffing levels and treatment of hypotension was found (RR 1.02; 95% CI 0.98–1.07). Conclusion Patients with a hypotensive event on a weekend were less likely to be treated than patients with an event during high-staffing periods. No association between weekday nighttime staffing and hypotension treatment was observed. We conclude that treatment of a hypotensive episode relies on more than solely staffing levels. PMID:26975737

  8. Splanchnic Compression Improves the Efficacy of Compression Stockings to Prevent Orthostatic Intolerance

    Science.gov (United States)

    Platts, Steven H.; Brown, A. K.; Lee, S. M.; Stenger, M. B.

    2009-01-01

    Purpose: Post-spaceflight orthostatic intolerance (OI) is observed in 20-30% of astronauts. Previous data from our laboratory suggests that this is largely a result of decreased venous return. Currently, NASA astronauts wear an anti-gravity suit (AGS) which consists of inflatable air bladders over the calves, thighs and abdomen, typically pressurized from 26 to 78 mmHg. We recently determined that, thigh-high graded compression stockings (JOBST , 55 mmHg at ankle, 6 mmHg at top of thigh) were effective, though to a lesser degree than the AGS. The purpose of this study was to evaluate the addition of splanchnic compression to prevent orthostatic intolerance. Methods: Ten healthy volunteers (6M, 4F) participated in three 80 head-up tilts on separate days while (1) normovolemic (2) hypovolemic w/ breast-high compression stockings (BS)(JOBST(R), 55 mmHg at the ankle, 6 mmHg at top of thigh, 12 mmHg over abdomen) (3) hypovolemic w/o stockings. Hypovolemia was induced by IV infusion of furosemide (0.5 mg/kg) and 48 hrs of a low salt diet to simulate plasma volume loss following space flight. Hypovolemic testing occurred 24 and 48 hrs after furosemide. One-way repeated measures ANOVA, with Bonferroni corrections, was used to test for differences in blood pressure and heart rate responses to head-up tilt, stand times were compared using a Kaplan-Meyer survival analysis. Results: BS were effective in preventing OI and presyncope in hypovolemic test subjects ( p = 0.015). BS prevented the decrease in systolic blood pressure seen during tilt in normovolemia (p < 0.001) and hypovolemia w/o countermeasure (p = 0.005). BS also prevented the decrease in diastolic blood pressure seen during tilt in normovolemia (p = 0.006) and hypovolemia w/o countermeasure (p = 0.041). Hypovolemia w/o countermeasure showed a higher tilt-induced heart rate increase (p = 0.022) than seen in normovolemia; heart rate while wearing BS was not different than normovolemia (p = 0.353). Conclusion: BS may

  9. Orthostatic intolerance and fatigue in the hypermobility type of Ehlers-Danlos Syndrome.

    Science.gov (United States)

    De Wandele, Inge; Rombaut, Lies; De Backer, Tine; Peersman, Wim; Da Silva, Hellen; De Mits, Sophie; De Paepe, Anne; Calders, Patrick; Malfait, Fransiska

    2016-08-01

    To investigate whether orthostatic intolerance (OI) is a significant predictor for fatigue in Ehlers-Danlos Syndrome, hypermobility type (EDS-HT). Eighty patients with EDS-HT and 52 controls participated in the first part of the study, which consisted of questionnaires. Fatigue was evaluated using the Checklist Individual Strength (CIS). As possible fatigue determinants OI [Autonomic Symptom Profile (ASP)], habitual physical activity (Baecke), affective distress [Hospital Anxiety and Depression Scale (HADS)], pain (SF36), medication use and generalized hypermobility (5-point score of Grahame and Hakim regarding generalized joint hypermobility) were studied. Next, a 20 min head-up tilt (70°) was performed in a subsample of 39 patients and 35 controls, while beat-to-beat heart rate and blood pressure were monitored (Holter, Finometer Pro). Before and after tilt, fatigue severity was assessed using a numeric rating scale. Patients scored significantly higher on the CIS [total score: EDS: 98.2 (18.63) vs controls: 45.8 (16.62), P < 0.001] and on the OI domain of the ASP [EDS: 22.78 (7.16) vs controls: 6.5 (7.78)]. OI was prevalent in EDS-HT (EDS: 74.4%, controls: 34.3%, P = 0.001), and frequently expressed as postural orthostatic tachycardia (41.0% of the EDS group). Patients responded to tilt with a higher heart rate and lower total peripheral resistance (p < 0.001; p = 0.032). This altered response correlated with fatigue in daily life (CIS). In the EDS-HT group, tilt provoked significantly more fatigue [numeric rating scale increase: EDS: +3.1 (1.90), controls: +0.5 (1.24), P < 0.001]. Furthermore, the factors OI, pain, affective distress, decreased physical activity and sedative use explained 47.7% of the variance in fatigue severity. OI is an important determinant of fatigue in EDS-HT. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  10. Development of Gradient Compression Garments for Protection Against Post Flight Orthostatic Intolerance

    Science.gov (United States)

    Stenger, M. B.; Lee, S. M. C.; Westby, C. M.; Platts, S. H.

    2010-01-01

    Orthostatic intolerance after space flight is still an issue for astronaut health. No in-flight countermeasure has been 100% effective to date. NASA currently uses an inflatable anti-gravity suit (AGS) during reentry, but this device is uncomfortable and loses effectiveness upon egress from the Shuttle. The Russian Space Agency currently uses a mechanical counter-pressure garment (Kentavr) that is difficult to adjust alone, and prolonged use may result in painful swelling at points where the garment is not continuous (feet, knees, and groin). To improve comfort, reduce upmass and stowage requirements, and control fabrication and maintenance costs, we have been evaluating a variety of gradient compression, mechanical counter-pressure garments, constructed from spandex and nylon, as a possible replacement for the current AGS. We have examined comfort and cardiovascular responses to knee-high garments in normovolemic subjects; thigh-high garments in hypovolemic subjects and in astronauts after space flight; and 1-piece, breast-high garments in hypovolemic subjects. These gradient compression garments provide 55 mmHg of compression over the ankle, decreasing linearly to 35 mmHg at the knee. In thigh-high versions the compression continues to decrease to 20 mmHg at the top of the leg, and for breast-high versions, to 15 mmHg over the abdomen. Measures of efficacy include increased tilt survival time, elevated blood pressure and stroke volume, and lower heart-rate response to orthostatic stress. Results from these studies indicate that the greater the magnitude of compression and the greater the area of coverage, the more effective the compression garment becomes. Therefore, we are currently testing a 3-piece breast-high compression garment on astronauts after short-duration flight. We chose a 3-piece garment consisting of thigh-high stockings and shorts, because it is easy to don and comfortable to wear, and should provide the same level of protection as the 1-piece

  11. Effect of Transient Maternal Hypotension on Apoptotic Cell Death in Foetal Rat Brain

    Directory of Open Access Journals (Sweden)

    Hamit Özyürek

    2014-03-01

    Full Text Available Background: Intrauterine perfusion insufficiency induced by transient maternal hypotension has been reported to be associated with foetal brain malformations. However, the effects of maternal hypotension on apoptotic processes in the foetal brain have not been investigated experimentally during the intrauterine period. Aims: The aim of this study was to investigate the effects of transient maternal hypotension on apoptotic cell death in the intrauterine foetal brain. Study Design: Animal experimentation. Methods: Three-month-old female Wistar albino rats were allocated into four groups (n=5 each. The impact of hypoxic/ischemic injury induced by transient maternal hypotension on the 15th day of pregnancy (late gestation in rats was investigated at 48 (H17 group or 96 hours (H19 group after the insult. Control groups underwent the same procedure except for induction of hypotension (C17 and H17 groups. Brain sections of one randomly selected foetus from each pregnant rat were histopathologically evaluated for hypoxic/ischemic injury in the metencephalon, diencephalon, and telencephalon by terminal transferase-mediated dUTP nick end labelling and active cysteine-dependent aspartate-directed protease-3 (caspase-3 positivity for cell death. Results: The number of terminal transferase-mediated dUTP nick end labelling (+ cells in all the areas examined was comparable in both hypotension and control groups. The H17 group had active caspase-3 (+ cells in the metencephalon and telencephalon, sparing diencephalon, whereas the C19 and H19 groups had active caspase-3 (+ cells in all three regions. The number of active caspase-3 (+ cells in the telencephalon in the H19 group was higher compared with the metencephalon and diencephalon and compared with H17 group (p<0.05. Conclusion: Our results suggest that prenatal hypoxic/ischemic injury triggers apoptotic mechanisms. Therefore, blockade of apoptotic pathways, considering the time pattern of the insult, may

  12. Double profunda brachii artery

    Directory of Open Access Journals (Sweden)

    Gavishiddappa A Hadimani

    2016-01-01

    Full Text Available Brachial artery (BA is a continuation of the axillary artery at the lower border of teres major. In the cubital fossa, BA divides into radial artery and ulnar artery as terminal branches. Large branch given from the BA in the upper part is profunda brachii artery. In the present case, we noticed double profunda brachii that arises from the BA. They are profunda brachii artery 1 and profunda brachii artery 2. Profunda brachii artery 1 arises in the proximal part of the BA and profunda brachii artery 2 arises distal to the profunda brachii artery 1. Both the arteries run inferolaterally in the spiral groove along with radial nerve. Variations of profunda brachii artery are important during harvesting of the lateral arm flaps and may lead to inadvertent injury during percutaneous arterial catheterization or injection of drugs.

  13. Magnitude of Hypotension Based on Office and Ambulatory Blood Pressure Monitoring: Results From a Cohort of 5066 Treated Hypertensive Patients Aged 80 Years and Older.

    Science.gov (United States)

    Divisón-Garrote, Juan A; Ruilope, Luis M; de la Sierra, Alejandro; de la Cruz, Juan J; Vinyoles, Ernest; Gorostidi, Manuel; Escobar-Cervantes, Carlos; Velilla-Zancada, Sonsoles M; Segura, Julián; Banegas, José R

    2017-05-01

    Elderly patients can be particularly susceptible to the adverse effects of excessive blood pressure (BP) lowering by antihypertensive treatment. The identification of hypotension is thus especially important. Ambulatory BP monitoring (ABPM) is a more accurate technique than office for classifying BP status. This study examined the prevalence of hypotension and associated demographic and clinical factors among very old treated hypertensive patients undergoing ABPM. Cross-sectional study in which 5066 patients aged 80 years and older with treated hypertension drawn from the Spanish ABPM Registry were included. Office BP and 24-hour ambulatory BP were determined using validated devices under standardized conditions. Based on previous studies, hypotension was defined as systolic/diastolic BP ABPM, ABPM, and ABPM. Participants' mean age was 83.2 ± 3.1 years (64.4% women). Overall, 22.8% of patients had office hypotension, 33.7% daytime hypotension, 9.2% nighttime hypotension, and 20.5% 24-hour ABPM hypotension. Low diastolic BP values were responsible for 90% of cases of hypotension. In addition, 59.1% of the cases of hypotension detected by daytime ABPM did not correspond to hypotension according to office BP. The variables independently associated with office and ABPM hypotension were diabetes, coronary heart disease, and a higher number of antihypertensive medications. One in 3 very elderly treated hypertensive patients attended in usual clinical practice were potentially at risk of having hypotension according to daytime ABPM. More than half of them had masked hypotension; that is, they were not identified if relying on office BP alone. Thus, ABPM could be especially helpful for identifying ambulatory hypotension and avoiding overtreatment, in particular, in patients with diabetes, heart disease, or on antihypertensive polytherapy. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  14. Acute arterial occlusion - kidney

    Science.gov (United States)

    ... main artery to the kidney is called the renal artery. Reduced blood flow through the renal artery can hurt kidney function. ... need include: Duplex Doppler ultrasound exam of the renal arteries to test blood flow MRI of the kidney arteries, which can show ...

  15. Percutaneous transluminal angioplasty in the region of the renal artery: indications, technique and results

    Energy Technology Data Exchange (ETDEWEB)

    Olbert, F; Ogris, E; Muzika, N; Schlegl, A; Vacariu, O; Diez, W

    1985-01-01

    The paper reports the results obtained by percutaneous transluminal angioplasty (PTA) in the treatment of renal artery stenosis in 25 patients with secondary hypertension and discusses indications and the technique used. The follow-up period ranged from 0.5 to 12 months. All interventions were performed with the Olbert catheter system. Following PTA a significant decrease in systolic, diastolic and mean arterial pressure was observed in nearly all patients. The response of the plasma renin activity (PRA) to orthostatic stimulation and pharmacological stimulation by furosemide was determined in a subset of 15 patients before and after PTA. A significant decrease in both basal and stimulated PRA values was observed subsequent to PTA. The decrease in PRA values after successful PTA did not, however, correlate with the extent of the blood pressure changes. (Author).

  16. Percutaneous transluminal angioplasty in the region of the renal artery: indications, technique and results

    International Nuclear Information System (INIS)

    Olbert, F.; Ogris, E.; Muzika, N.; Schlegl, A.; Vacariu, O.; Diez, W.

    1985-01-01

    The paper reports the results obtained by percutaneous transluminal angioplasty (PTA) in the treatment of renal artery stenosis in 25 patients with secondary hypertension and discusses indications and the technique used. The follow-up period ranged from 0.5 to 12 months. All interventions were performed with the Olbert catheter system. Following PTA a significant decrease in systolic, diastolic and mean arterial pressure was observed in nearly all patients. The response of the plasma renin activity (PRA) to orthostatic stimulation and pharmacological stimulation by furosemide was determined in a subset of 15 patients before and after PTA. A significant decrease in both basal and stimulated PRA values was observed subsequent to PTA. The decrease in PRA values after successful PTA did not, however, correlate with the extent of the blood pressure changes. (Author)

  17. Rehabilitation of atrophic anophthalmic cavity with orthostatic ocular prosthesis: A clinical report.

    Science.gov (United States)

    Amaral, C F; Cordeiro, J M; Emídio, T C S; Presotto, A G C; Barbosa, C M R

    2016-10-01

    The absence of the eyeball can generate psychosocial and facial harmony changes, such as atrophy of the muscles around it. In these cases, the use of an orthostatic prosthesis with expanding function fosters distension of the tissues for subsequent rehabilitation. This technique consists of making individual ocular prostheses with gradual enlargement of size. The aim of this following clinical report was to describe the technique used in the standing prosthetic rehabilitation of a patient, 73 years old, who underwent enucleation of the right eye as a result of glaucoma. Clinical and laboratory procedures were performed such as impression, adjusting curvature of the sclera, centering the pupil area and processing in heat-cured acrylic resin three prostheses made according to the expansion of the anophthalmic cavity. At the end of treatment, there was a considerable increase of the cavity, allowing for volume replacement similar to that existing in the patient's contralateral orbit, thus generating a satisfactory facial harmony. Copyright © 2016 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

  18. A definition of normovolaemia and consequences for cardiovascular control during orthostatic and environmental stress.

    Science.gov (United States)

    Truijen, Jasper; Bundgaard-Nielsen, Morten; van Lieshout, Johannes J

    2010-05-01

    The Frank-Starling mechanism describes the relationship between stroke volume and preload to the heart, or the volume of blood that is available to the heart--the central blood volume. Understanding the role of the central blood volume for cardiovascular control has been complicated by the fact that a given central blood volume may be associated with markedly different central vascular pressures. The central blood volume varies with posture and, consequently, stroke volume and cardiac output (Q) are affected, but with the increased central blood volume during head-down tilt, stroke volume and Q do not increase further indicating that in the supine resting position the heart operates on the plateau of the Frank-Starling curve which, therefore, may be taken as a functional definition of normovolaemia. Since the capacity of the vascular system surpasses the blood volume, orthostatic and environmental stress including bed rest/microgravity, exercise and training, thermal loading, illness, and trauma/haemorrhage is likely to restrict venous return and Q. Consequently the cardiovascular responses are determined primarily by their effect on the central blood volume. Thus during environmental stress, flow redistribution becomes dependent on sympathetic activation affecting not only skin and splanchnic blood flow, but also flow to skeletal muscles and the brain. This review addresses the hypothesis that deviations from normovolaemia significantly influence these cardiovascular responses.

  19. Gabapentin can improve postural stability and quality of life in primary orthostatic tremor.

    Science.gov (United States)

    Rodrigues, Julian P; Edwards, Dylan J; Walters, Susan E; Byrnes, Michelle L; Thickbroom, Gary; Stell, Rick; Mastaglia, Frank L

    2005-07-01

    Primary orthostatic tremor (OT) is characterized by leg tremor and instability on standing. High frequency (13-18 Hz) tremor bursting is present in leg muscles during stance, and posturography has shown greater than normal sway. We report on an open-label add-on study of gabapentin in 6 patients with OT. Six patients were studied with surface electromyography, force platform posturography, and a modified Parkinson's disease questionnaire (PDQ-39) quality of life (QOL) scale before and during treatment with gabapentin 300 mg t.d.s. If on other medications for OT, these were continued unchanged. Of the 6 patients, 4 reported a subjective benefit of 50 to 75% with gabapentin, 3 of whom showed reduced tremor amplitude and postural sway of up to 70%. Dynamic balance improved in all 3 patients who completed the protocol. QOL data from 5 patients showed improvement in all cases. No adverse effects were noted. Gabapentin may improve tremor, stability, and QOL in patients with OT, and symptomatic response correlated with a reduction in tremor amplitude and postural sway. The findings confirm previous reports of symptomatic benefit with gabapentin and provide justification for larger controlled clinical trials. Further work is required to establish the optimal dosage and to validate the methods used to quantify the response to treatment. Copyright 2005 Movement Disorder Society.

  20. Determination of Hemodynamic Changes on Heart Rate for Assessment of Orthostatic Intolerance in Older People

    Energy Technology Data Exchange (ETDEWEB)

    Hortelano Rubio, M.; Reilly, R.B.; Cervigón Abad, R.

    2016-07-01

    Introduction.- The aim of our study was to assess the hemodynamic changes that occur in symptomatic Orthostatic Intolerance (OI) patients, at the starting of exercise and recovery stages during six minutes walking distance test. Materials.- We analysed 65 older subjects, of whom 42 were women. The participants were carried out the Active Stand Protocol. The records were divided into: Phase 1 (pre-exercise), Phase 2 (starting of exercise), Phase 3 (active), Phase 4 (recovery) and Phase 5 (prost-exercise). Methods.- The averages and differences of heart rate (HR) between Phase 1, Phase 3 and Phase 5 were calculated. In the same way, duration before stabilization from passive to active stages (Phase 2) and from active to passive stages (Phase 4) were calculated. The máximum and mínimum values achieved in these time series and the difference between these values were also calculated. Results.- Results showed that the symptomatic OI patients employed more time to reach the active phase tan the asymptomatic OI participants. Moreover, the symptomatic OI participants showed higher mínimum heart rate values at the starting of exercise and recovery stages. However, the asymptomatic OI group illustrated a higher difference between the máximum and mínimum heart rate values in these stages with a significance p=0.003 and p=0.007, respectivecly. Conclusion.- This study provides important information on hemodynamic parameters and can be helpful for description of the hemodynamic changes that occur during OI. (Author)

  1. An Unusual Case of Post-Traumatic Headache Complicated by Intracranial Hypotension

    Directory of Open Access Journals (Sweden)

    Sara Siavoshi

    2016-12-01

    Full Text Available We present a case of post-traumatic headache complicated by intracranial hypotension resulting in an acquired Chiari malformation and myelopathy with syringomyelia. This constellation of findings suggest a possible series of events that started with a traumatic cerebral spinal fluid (CSF leak, followed by descent of the cerebellar tonsils and disruption of CSF circulation that caused spinal cord swelling and syrinx. This unusual presentation of post-traumatic headache highlights the varying presentations and the potential sequelae of intracranial hypotension. In addition, the delayed onset of upper motor neuron symptoms along with initially normal head computerized tomography scan (CT findings, beg the question of whether or not a post-traumatic headache warrants earlier magnetic resonance imaging (MRI.

  2. Detection of organ dysfunction by hypotension and/or hyperlactemia in septic patients

    DEFF Research Database (Denmark)

    Nissen, Janet Yde; Dynesen, Jens Jacob Østergaard; Pedersen, Marie Kristine Jessen

    physician documented a suspicion/confirmation of infection within the first 24h of admission. Diagnoses were confirmed by expert proof reading, and calculation of inter-rater agreement. Severe sepsis-defining organ dysfunction cut-offs were adapted from SSC-2012 (Gold Standard). “Simple tool” hypotension...... fulfilling the inclusion criteria. 494 patients (51%) were suspected to have infection within the first 24h of admission. Inter-rater agreement regarding suspected infection was 81% (pSimple tool” detected 73......BackgroundThe definitions of sepsis were updated February 2016[1] - organ dysfunctions remain the turning point between “simple infection” and sepsis (previously severe sepsis). Hypotension and hyperlactatemia define two of many organ dysfunctions presented in the most recent Surviving Sepsis...

  3. X-ray examination of the microstructure of the gastric mucosa under induced hypotension in chromic gastritis

    International Nuclear Information System (INIS)

    Pruchanskij, V.S.; Novikov, V.I.

    1981-01-01

    The possibility of using artificial stomach hypotension to decrease the dynamic obscurity and a better examination of stomach mucosa microrelief in cases when X-ray exposures exceed 0.1 s, is shown. 75 patients with various forms of chronic gastritis both under normal conditions and in the case of stomach hypotension are investigated. The ''Diagnomax-M-125'' X-ray diagnostic device with the DR tube 125/30/50 kWt (and a small focus of 1.2x1.2 mm) is used. Optimum exposures during the roentgenography of stomach fields are increased up to 0.16 s. Under conditions of artificial stomach hypotension a clear image of microrelief is obtained 2 times more often, while the absence of the image of stomach field takes place 4 times more seldom than when using the conventional technique. In the case of stomach hypotension the picture of areola is less seldom unclear [ru

  4. Noncardiogenic Pulmonary Edema after Amlodipine Overdose without Refractory Hypotension and Bradycardia

    Directory of Open Access Journals (Sweden)

    M. Hedaiaty

    2015-01-01

    Full Text Available Amlodipine overdose can be life-threatening when manifesting as noncardiogenic pulmonary edema. Treatment remains challenging. We describe a case of noncardiogenic pulmonary edema without refractory hypotension and bradycardia after ingestion of 500 milligram amlodipine with suicidal intent. Mechanical ventilation, dexamethasone, atrovent HFA (ipratropium, pulmicort inhalation, and antibiotic therapy were used for the management. Length of hospital stay was 11 days. The patient was discharged with full recovery.

  5. Pharmacological Hypotension as a Cause of Delirious Mania in a Patient with Bipolar Disorder

    Directory of Open Access Journals (Sweden)

    Manuel Glauco Carbone

    2017-01-01

    Full Text Available Delirious mania is a severe but often underrecognized syndrome characterized by rapid onset of delirium, mania, and psychosis, not associated with a prior toxicity, physical illness, or mental disorder. We discuss the case of a delirious mania potentially triggered and maintained by a systemic hypotension induced by antihypertensive drugs. Symptoms recovered completely after the discontinuation of antihypertensive medications and the normalization of blood pressure levels.

  6. Magnetic resonance findings associated with intracranial hypotension. A report of three cases occurring after lumbar puncture

    International Nuclear Information System (INIS)

    Galan, J.; Vuelta, R. V.; Oleaga, L.; Grande, D.

    1999-01-01

    The magnetic resonance (MR) findings are presented for three patients who developed intracranial hypotension syndrome following lumbar puncture, one of the most common causes of this complication. All three patients presented the MR findings characteristically associated with this event, consisting of diffuse dural enhancement after administration of a paramagnetic contrast medium, as well as extraaxial collection that played either an accompanying or a causative role. (Author) 7 refs

  7. Pathogenesis of transient ischemic attacks within the vertebrobasilar arterial system

    International Nuclear Information System (INIS)

    Naritomi, H.; Sakai, F.; Meyer, J.S.

    1979-01-01

    Regional cerebral blood flow (rCBF) was measured by xenon 133 inhalation in 36 patients with vertebrobasilar arterial insufficiency (VBI), three patients with brain stem infarction, and 15 age-matched normal controls before and after inducing postural hypotension. Probes mounted over the suboccipital area by means of a helmet were used to measure rCBF over the brain stem and cerebellar regions. When lying flat, rCBF values measured over both cerebral hemispheres and the brain stem-cerebellar regions in patients with VBI were not significantly different from normal controls. Unlike carotid transient ischemic attacks, regional flow reduction rarely persisted for three weeks after transient ischemic symptoms in patients with VBI. When postural hypotension was induced, rCBF became significantly reduced in patients with VBI whether or not they were treated with papaverine. Dysautoregulation was restricted to vertebral, basilar, and posterior cerebral arterial distribution in patients with VBI of 1 to 12 months' duration, but was more widespread and involved both cerebral hemispheres in long-standing VBI. Hemodynamic factors and dysautoregulation appear to play a part in the pathogenesis of symptoms of VBI

  8. Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review.

    Directory of Open Access Journals (Sweden)

    Jon Gitz Holler

    Full Text Available Acute patients presenting with hypotension in the prehospital or emergency department (ED setting are in need of focused management and knowledge of the epidemiology characteristics might help the clinician. The aim of this review was to address prevalence, etiology and mortality of nontraumatic hypotension (SBP ≤ 90 mmHg with or without the presence of shock in the prehospital and ED setting.We performed a systematic literature search up to August 2013, using Medline, Embase, Cinahl, Dare and The Cochrane Library. The analysis and eligibility criteria were documented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-guidelines and The Cochrane Collaboration. No restrictions on language, publication date, or status were imposed. We used the Newcastle-Ottawa quality assessment scale (NOS-scale and the Strengthening the Reporting of Observational studies in Epidemiology (STROBE-statement to assess the quality.Six observational studies were considered eligible for analysis based on the evaluation of 11,880 identified papers. Prehospital prevalence of hypotension was 19.5/1000 emergency medicine service (EMS contacts, and the prevalence of hypotensive shock was 9.5-19/1000 EMS contacts with an inhospital mortality of shock between 33 to 52%. ED prevalence of hypotension was 4-13/1000 contacts with a mortality of 12%. Information on mortality, prevalence and etiology of shock in the ED was limited. A meta-analysis was not feasible due to substantial heterogeneity between studies.There is inadequate evidence to establish concise estimates of the characteristics of nontraumatic hypotension and shock in the ED or in the prehospital setting. The available studies suggest that 2% of EMS contacts present with nontraumatic hypotension while 1-2% present with shock. The inhospital mortality of prehospital shock is 33-52%. Prevalence of hypotension in the ED is 1% with an inhospital mortality of 12%. Prevalence

  9. Lactic acidosis and diastolic hypotension after intermittent albuterol nebulization in a pediatric patient

    Directory of Open Access Journals (Sweden)

    Tehila A. Saadia

    2015-01-01

    Full Text Available We describe a case of 13-year-old female with intermittent asthma who developed lactic acidosis and diastolic hypotension after receiving intermittent albuterol nebulizer treatment. She presented to the emergency department (ED with sudden onset of shortness of breath and chest pain. She received two albuterol nebulizer treatments at home without symptomatic relief. She was treated in the ED with intermittent albuterol nebulization for a total of 22.5 mg over the next 5 hours. A decrease in diastolic blood pressure from 60 mmHg to 40 mmHg was noted after the treatment. Blood lactate level was 5.9 mmol/L. She recovered from it and was discharged to home but she had recurrence of shortness of breath and presented to the ED two days later. She was treated with albuterol nebulization for a total of 17.5 mg over the next two and half hours and developed diastolic hypotension again, as low as 30 mm Hg. After discontinuation of albuterol nebulization, her BP normalized. Cardiopulmonary and metabolic side effects of continuous albuterol therapy have been reported in the recent medical literature. Our patient, however, developed these adverse effects on intermittent albuterol nebulizer treatment. It is important for the pediatrician to recognize the adverse effects of β2-agonist therapy to avoid carrying out extensive workup for hypotension and hyperlactatemia prolonging hospital stay.

  10. Role of prophylactic ondansetron for prevention of spinal anaesthesia induced hypotension in lower segment caesarean section

    International Nuclear Information System (INIS)

    Abbas, N.

    2016-01-01

    Objective: To determine the efficacy of prophylactic administration of intravenous Ondansetron for prevention of spinal anaesthesia induced hypotension in lower segment caesarean section. Study Design: Double blinded randomized controlled trial. Place and Duration of Study: It was conducted in Anesthesiology department, CMH Rawalakot; from 3 Mar to 4 Jun 2014. Material and Methods: One hundred patients were selected for this study, and randomly divided in two groups of 50 each, using random numbers table. Both groups were preloaded with Ringer's lactate at dose of 10ml/kg. Group A received 04 mg of IV ondansetron 5 min prior to spinal anaesthesia, whereas Group B received normal saline 05 minutes before administration of Spinal Anaesthesia. Results: Average age of Group A was 28.62 +- 4.64 years, whereas that of Group B was 27.88 +- 3.98 (p-value= 0.394). Average weight of Group A was 70.30 +- 6.25 kg, whereas that of Group B was 70.74 +- 6.17 kg (p-value= 0.724). Hypotension was noted in 21 patients in group A (42 percent), whereas it was observed in 34 Patients in Group B (68 percent) (p-value= 0.009). Bradycardia was noted in 9 patients in Group A (18 percent) and 19 patients in Group B (p=0.026). Conclusion: Intravenous administration of 04 mg of intravenous ondansetron, 05 minutes prior to subarachnoid block, is effective in decreasing frequency of hypotension. (author)

  11. Hypotensive responses to common daily activities in institutionalized elderly. A potential risk for recurrent falls.

    Science.gov (United States)

    Jonsson, P V; Lipsitz, L A; Kelley, M; Koestner, J

    1990-07-01

    Transient hypotension may be one of many factors contributing to the high prevalence of falls among elderly people. To determine the frequency and magnitude of hypotensive responses to common daily activities, and their potential relationship to falls in the elderly, we examined blood pressure (BP) and heart rate during a standardized series of activities in 38 institutionalized recurrent fallers (age, 87 +/- 6 years), 20 institutionalized nonfallers (age, 85 +/- 5 years), and 10 healthy young control subjects (age, 24 +/- 3 years). The coefficient of variation for systolic BP during all activities was higher in elderly subjects (fallers, 14% +/- 5%; nonfallers, 12% +/- 3%) than in young control subjects (8% +/- 1%). In contrast, the coefficient of variation for heart rate during all activities was higher in young subjects than in the elderly subjects. Elderly subjects had marked BP reduction following meals and nitroglycerin, which was significantly greater in fallers than in nonfallers, independent of the cause of the fall. Thus, institutionalized elderly have marked BP variability and hypotensive responses to meals and nitroglycerin. A decline in BP during common preload-reducing stresses may predispose some elderly people to falls.

  12. Similar hypotensive responses to resistance exercise with and without blood flow restriction

    Directory of Open Access Journals (Sweden)

    Jr R Moriggi

    2015-11-01

    Full Text Available Low intensity resistance exercise (RE with blood flow restriction (BFR has gained attention in the literature due to the beneficial effects on functional and morphological variables, similar to those observed during traditional RE without BFR, while the effects of BFR on post-exercise hypotension remain unclear. The aim of the present study was to compare the blood pressure (BP response of trained normotensive individuals to RE with and without BFR. In this cross-over randomized trial, eight male subjects (23.8 ± 4 years, 74 ± 3 kg, 174 ± 4 cm completed two exercise protocols: traditional RE (3 x 10 repetitions at 70% one-repetition maximum [1-RM] and low intensity RE (3 x 15 repetitions at 20% 1-RM with BFR. Blood pressure measurements were performed after 15 min of seated rest (0, immediately after and 10 min, 20 min, 30 min, 40 min, 50 min and 60 min after the experimental sessions. Similar hypotensive effects for systolic BP (SBP were observed for both protocols (P 0.05 and no statistically significant difference for diastolic BP (P > 0.05. These results suggest that in normotensive trained individuals, both traditional RE and RE with BFR induce hypotension for SBP, which is important to prevent cardiovascular disturbances.

  13. Hepatic falciform artery

    International Nuclear Information System (INIS)

    Jaques, Paul F.; Mauro, Matthew A.; Sandhu, Jeet

    1997-01-01

    The hepatic falciform artery is an occasional terminal branch of the left or middle hepatic artery, and may provide an uncommon but important collateral route when the principal visceral arteries are occluded

  14. Prehospital management and fluid resuscitation in hypotensive trauma patients admitted to Karolinska University Hospital in Stockholm.

    Science.gov (United States)

    Talving, Peep; Pålstedt, Joakim; Riddez, Louis

    2005-01-01

    Few previous studies have been conducted on the prehospital management of hypotensive trauma patients in Stockholm County. The aim of this study was to describe the prehospital management of hypotensive trauma patients admitted to the largest trauma center in Sweden, and to assess whether prehospital trauma life support (PHTLS) guidelines have been implemented regarding prehospital time intervals and fluid therapy. In addition, the effects of the age, type of injury, injury severity, prehospital time interval, blood pressure, and fluid therapy on outcome were investigated. This is a retrospective, descriptive study on consecutive, hypotensive trauma patients (systolic blood pressure Karolinska University Hospital in Stockholm, Sweden, during 2001-2003. The reported values are medians with interquartile ranges. Basic demographics, prehospital time intervals and interventions, injury severity scores (ISS), type and volumes of prehospital fluid resuscitation, and 30-day mortality were abstracted. The effects of the patient's age, gender, prehospital time interval, type of injury, injury severity, on-scene and emergency department blood pressure, and resuscitation fluid volumes on mortality were analyzed using the exact logistic regression model. In 102 (71 male) adult patients (age > or = 15 years) recruited, the median age was 35.5 years (range: 27-55 years) and 77 patients (75%) had suffered blunt injury. The predominant trauma mechanisms were falls between levels (24%) and motor vehicle crashes (22%) with an ISS of 28.5 (range: 16-50). The on-scene time interval was 19 minutes (range: 12-24 minutes). Fluid therapy was initiated at the scene of injury in the majority of patients (73%) regardless of the type of injury (77 blunt [75%] / 25 penetrating [25%]) or injury severity (ISS: 0-20; 21-40; 41-75). Age (odds ratio (OR) = 1.04), male gender (OR = 3.2), ISS 21-40 (OR = 13.6), and ISS >40 (OR = 43.6) were the significant factors affecting outcome in the exact

  15. Double profunda brachii artery

    OpenAIRE

    Gavishiddappa A Hadimani; Jyoti V Hadimani; Ishwar B Bagoji; Shardha Bai Rathod; Balappa M Bannur

    2016-01-01

    Brachial artery (BA) is a continuation of the axillary artery at the lower border of teres major. In the cubital fossa, BA divides into radial artery and ulnar artery as terminal branches. Large branch given from the BA in the upper part is profunda brachii artery. In the present case, we noticed double profunda brachii that arises from the BA. They are profunda brachii artery 1 and profunda brachii artery 2. Profunda brachii artery 1 arises in the proximal part of the BA and profunda brachii...

  16. In-flight Assessment of Lower Body Negative Pressure as a Countermeasure for Post-flight Orthostatic Intolerance

    Science.gov (United States)

    Charles, J. B.; Stenger, M. B.; Phillips, T. R.; Arzeno, N. M.; Lee, S. M. C.

    2009-01-01

    Introduction. We investigated the efficacy of combining fluid loading with sustained lower body negative pressure (LBNP) to reverse orthostatic intolerance associated with weightlessness during and immediately after Space Shuttle missions. Methods. Shuttle astronauts (n=13) underwent 4 hours of LBNP at -30 mm(Hg) and ingested water and salt ( soak treatment) during flight in two complementary studies. In the first study (n=8), pre-flight heart rate (HR) and blood pressure (BP) responses to an LBNP ramp (5-min stages of -10 mm(Hg) steps to -50 mm(Hg) were compared to responses in-flight one and two days after LBNP soak treatment. In the second study (n=5), the soak was performed 24 hr before landing, and post-flight stand test results of soak subjects were compared with those of an untreated cohort (n=7). In both studies, the soak was scheduled late in the mission and was preceded by LBNP ramp tests at approximately 3-day intervals to document the in-flight loss of orthostatic tolerance. Results. Increased HR and decreased BP responses to LBNP were evident early in-flight. In-flight, one day after LBNP soak, HR and BP responses to LBNP were not different from pre-flight, but the effect was absent the second day after treatment. Post-flight there were no between-group differences in HR and BP responses to standing, but all 5 treatment subjects completed the 5-minute stand test whereas 2 of 7 untreated cohort subjects did not. Discussion. Exaggerated HR and BP responses to LBNP were evident within the first few days of space flight, extending results from Skylab. The combined LBNP and fluid ingestion countermeasure restored in-flight LBNP HR and BP responses to pre-flight levels and provided protection of post-landing orthostatic function. Unfortunately, any benefits of the combined countermeasure were offset by the complexity of its implementation, making it inappropriate for routine application during Shuttle flights.

  17. Medical infrared imaging and orthostatic analysis to determine lameness in the pelvic limbs of dogs

    Directory of Open Access Journals (Sweden)

    Erika Fernanda V. Garcia

    2017-12-01

    Full Text Available Subtle lameness makes it difficult to ascertain which is the affected limb. A study was conducted to investigate a change in the thermal pattern and temperature of the thermal image of the paw print in a lame pelvic limb compared to a non-lame pelvic limb of dogs confirmed by orthostatic analysis. Fourteen client owned dogs with a unilateral pelvic limb lameness and 14 healthy employee dogs were examined and the pelvic limbs radiographed. Thermal images of the paw print were taken after each dog was kept in a static position on a foam mat for 30 seconds. Average temperatures and thermographic patterns were analyzed. Analysis was performed in a static position. The asymmetry index for each stance variable and optimal cutoff point for the peak vertical force and thermal image temperatures were calculated. Image pattern analysis revealed 88% success in differentiating the lame group, and 100% in identifying the same thermal pattern in the healthy group. The mean of the peak vertical force revealed a 10.0% difference between the left and right pelvic limb in healthy dogs and a 72.4% between the lame and non-lame limb in the lame dog group. Asymmetry index analysis revealed 5% in the healthy group and 36.2% in the lame group. The optimal cutoff point for the peak vertical force to determine lameness was 41.77% (AUC = 0.93 and for MII 0.943% (AUC = 0.72. The results of this study highlight the change in the thermal pattern of the paw print in the lame pelvic limb compared to a non-lame pelvic limb in the lame group and the healthy group. Medical infrared imaging of the paw prints can be utilized to screen for the lame limb in dogs.

  18. Vasorelaxant and Hypotensive Effects of an Ethanolic Extract of Eulophia macrobulbon and Its Main Compound 1-(4′-Hydroxybenzyl-4,8-Dimethoxyphenanthrene-2,7-Diol

    Directory of Open Access Journals (Sweden)

    Sutthinee Wisutthathum

    2018-05-01

    Full Text Available Background: Ethnopharmacological studies demonstrated the potential for Eulophia species to treat inflammation, cancer, and cardio-metabolic diseases. The aim of the study was to investigate the vasorelaxant effect of ethanolic Eulophia macrobulbon (EM extract and its main phenanthrene on rat isolated mesenteric artery and to investigate the hypotensive effect of EM.Methods: The vasorelaxant effects of EM extract or phenanthrene and the underlying mechanisms were evaluated on second-order mesenteric arteries from Sprague Dawley rats. In addition, the acute hypotensive effect was evaluated in anesthetized rats infused with cumulative concentrations of the EM extract.Results: Both EM extract (10-4–1 mg/ml and phenanthrene (10-7–10-4 M relaxed endothelium-intact arteries, an effect that was partly reduced by endothelium removal (p < 0.001. A significant decrease in the relaxant effect of the extract and the phenanthrene was observed with L-NAME and apamin/charybdotoxin in endothelium-intact vessels, and with iberiotoxin in denuded vessels. SNP (sodium nitroprusside-induced relaxation was significantly enhanced by EM extract and phenanthrene. By contrast, ODQ (1H-[1,2,4]oxadiazolo[4,3-a]quinoxaline-1-one, 4-aminopyridine and glibenclamide (endothelium-denuded vessels and indomethacin (endothelium-intact vessels had no effect. In calcium-free solution, both the EM extract and phenanthrene inhibited extracellular Ca2+-induced contraction in high KCl and phenylephrine (PE pre-contracted rings. They also inhibited the intracellular Ca2+ release sensitive to PE. The acute infusion of EM extract (20 and 70 mg/kg induced an immediate and transient dose-dependent hypotensive effect.Conclusion: The ethanolic extract of EM tubers and its main active compound, 1-(4′-hydroxybenzyl-4,8-dimethoxyphenanthrene-2,7-diol (phenanthrene induced vasorelaxant effects on rat resistance vessels, through pleiotropic effects including endothelium-dependent effects (NOS

  19. Anesthesia information management system-based near real-time decision support to manage intraoperative hypotension and hypertension.

    Science.gov (United States)

    Nair, Bala G; Horibe, Mayumi; Newman, Shu-Fang; Wu, Wei-Ying; Peterson, Gene N; Schwid, Howard A

    2014-01-01

    Intraoperative hypotension and hypertension are associated with adverse clinical outcomes and morbidity. Clinical decision support mediated through an anesthesia information management system (AIMS) has been shown to improve quality of care. We hypothesized that an AIMS-based clinical decision support system could be used to improve management of intraoperative hypotension and hypertension. A near real-time AIMS-based decision support module, Smart Anesthesia Manager (SAM), was used to detect selected scenarios contributing to hypotension and hypertension. Specifically, hypotension (systolic blood pressure 1.25 minimum alveolar concentration [MAC]) of inhaled drug and hypertension (systolic blood pressure >160 mm Hg) with concurrent phenylephrine infusion were detected, and anesthesia providers were notified via "pop-up" computer screen messages. AIMS data were retrospectively analyzed to evaluate the effect of SAM notification messages on hypotensive and hypertensive episodes. For anesthetic cases 12 months before (N = 16913) and after (N = 17132) institution of SAM messages, the median duration of hypotensive episodes with concurrent high MAC decreased with notifications (Mann Whitney rank sum test, P = 0.031). However, the reduction in the median duration of hypertensive episodes with concurrent phenylephrine infusion was not significant (P = 0.47). The frequency of prolonged episodes that lasted >6 minutes (sampling period of SAM), represented in terms of the number of cases with episodes per 100 surgical cases (or percentage occurrence), declined with notifications for both hypotension with >1.25 MAC inhaled drug episodes (δ = -0.26% [confidence interval, -0.38% to -0.11%], P 1.25 MAC inhaled drug episodes. However, since phenylephrine infusion is manually documented in an AIMS, the impact of notification messages was less pronounced in reducing episodes of hypertension with concurrent phenylephrine infusion. Automated data capture and a higher frequency of

  20. Balloon Blocking Technique (BBT) for Superselective Catheterization of Inaccessible Arteries with Conventional and Modified Techniques

    Energy Technology Data Exchange (ETDEWEB)

    Morishita, Hiroyuki, E-mail: hmorif@koto.kpu-m.ac.jp, E-mail: mori-h33@xa2.so-net.ne.jp [Japan Red Cross Kyoto Daiichi Hospital, Department of Diagnostic Radiology (Japan); Takeuchi, Yoshito, E-mail: yotake62@qg8.so-net.ne.jp [Kyoto Prefectural University of Medicine, Department of Radiology, North Medical Center (Japan); Ito, Takaaki, E-mail: takaaki@koto.kpu-m.ac.jp [Japan Red Cross Kyoto Daiichi Hospital, Department of Diagnostic Radiology (Japan); Hayashi, Natsuko, E-mail: hayashin@koto.kpu-m.ac.jp [Kyoto Prefectural University of Medicine, Department of Radiology, Graduate School of Medical Science (Japan); Sato, Osamu, E-mail: osamu-sato@kyoto1-jrc.org [Japan Red Cross Kyoto Daiichi Hospital, Department of Diagnostic Radiology (Japan)

    2016-06-15

    PurposeThe purpose of the study was to retrospectively evaluate the efficacy and safety of the balloon blocking technique (BBT).Materials and MethodsThe BBT was performed in six patients (all males, mean 73.5 years) in whom superselective catheterization for transcatheter arterial embolization by the conventional microcatheter techniques had failed due to anatomical difficulty, including targeted arteries originating steeply or hooked from parent arteries. All BBT procedures were performed using Seldinger’s transfemoral method. Occlusive balloons were deployed and inflated at the distal side of the target artery branching site in the parent artery via transfemoral access. A microcatheter was delivered from a 5-F catheter via another femoral access and was advanced over the microguidewire into the target artery, under balloon blockage of advancement of the microguidewire into non-target branches. After the balloon catheter was deflated and withdrawn, optimal interventions were performed through the microcatheter.ResultsAfter success of accessing the targeted artery by BBT, optimal interventions were accomplished in all patients with no complications other than vasovagal hypotension, which responded to nominal therapy.ConclusionThe BBT may be useful in superselective catheterization of inaccessible arteries due to anatomical difficulties.

  1. Period-dependent Associations between Hypotension during and for Four Days after Noncardiac Surgery and a Composite of Myocardial Infarction and Death

    DEFF Research Database (Denmark)

    Sessler, Daniel I; Meyhoff, Christian S; Zimmerman, Nicole M

    2018-01-01

    BACKGROUND: The relative contributions of intraoperative and postoperative hypotension to perioperative morbidity remain unclear. We determined the association between hypotension and a composite of 30-day myocardial infarction and death over three periods: (1) intraoperative, (2) remaining day.......83 (98.3% CI, 1.26, 6.35; P = 0.002) in patients with hypotension during the subsequent four days of hospitalization. CONCLUSIONS: Clinically important hypotension-a potentially modifiable exposure-was significantly associated with a composite of myocardial infarction and death during each of three...

  2. Modulation of cardiac autonomic tone in non-hypotensive hypovolemia during blood donation.

    Science.gov (United States)

    Yadav, Kavita; Singh, Akanksha; Jaryal, Ashok Kumar; Coshic, Poonam; Chatterjee, Kabita; Deepak, K K

    2017-08-01

    Non-hypotensive hypovolemia, observed during mild haemorrhage or blood donation leads to reflex readjustment of the cardiac autonomic tone. In the present study, the cardiac autonomic tone was quantified using heart rate and blood pressure variability during and after non-hypotensive hypovolemia of blood donation. 86 voluntary healthy male blood donors were recruited for the study (age 35 ± 9 years; weight 78 ± 12 kg; height 174 ± 6 cms). Continuous lead II ECG and beat-to-beat blood pressure was recorded before, during and after blood donation followed by offline time and frequency domain analysis of HRV and BPV. The overall heart rate variability (SDNN and total power) did not change during or after blood donation. However, there was a decrease in indices that represent the parasympathetic component (pNN50 %, SDSD and HF) while an increase was observed in sympathetic component (LF) along with an increase in sympathovagal balance (LF:HF ratio) during blood donation. These changes were sustained for the period immediately following blood donation. No fall of blood pressure was observed during the period of study. The blood pressure variability showed an increase in the SDNN, CoV and RMSSD time domain measures in the post donation period. These results suggest that mild hypovolemia produced by blood donation is non-hypotensive but is associated with significant changes in the autonomic tone. The increased blood pressure variability and heart rate changes that are seen only in the later part of donation period could be because of the progressive hypovolemia associated parasympathetic withdrawal and sympathetic activation that manifest during the course of blood donation.

  3. Chronic Renin-Angiotensin System (RAS) Blockade May Not Induce Hypotension During Anaesthesia for Bariatric Surgery.

    Science.gov (United States)

    Salvetti, Guido; Di Salvo, Claudio; Ceccarini, Giovanni; Abramo, Antonio; Fierabracci, Paola; Magno, Silvia; Piaggi, Paolo; Vitti, Paolo; Santini, Ferruccio

    2016-06-01

    The use of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) for the treatment of hypertensive obese patients is steadily increasing. Some studies have reported that the use of these drugs was associated with an increased risk of hypotensive episodes, during general anaesthesia. The number of bariatric procedures is also increasing worldwide, but there is a lack of studies investigating the hypotensive effect of renin-angiotensin system (RAS) blockers in severely obese patients during general anaesthesia for bariatric surgery. The aim of this pilot study was to evaluate hemodynamic changes induced by general anaesthesia in obese patients chronically treated with ACE-I or ARB compared to a control group not treated with antihypertensive therapy. Fourteen obese subjects (mean body mass index (BMI) 47.5 kg/m(2)) treated with ACE-I or ARB and twelve obese (mean BMI 45.7 kg/m2) controls not treated with antihypertensive therapy underwent general anaesthesia to perform laparoscopic bariatric surgery. Systolic blood pressure, diastolic blood pressure, and heart rate were monitored continuously and registered at different time points: T0 before induction, then at 2, 5, 7, 10, 15, 20, 30, 60, 90, 120, and 150 min after induction, and the last time point taken following recovery from anaesthesia. A progressive reduction of both systolic and diastolic blood pressure values was observed without significant differences between the two groups. A similar trend of heart rate values was observed. In conclusion, our pilot study suggests that RAS blockers may be continued during the perioperative period in patients undergoing bariatric surgery, without increasing the risk of hypotensive episodes.

  4. Pre-hospital emergency anaesthesia in awake hypotensive trauma patients: beneficial or detrimental?

    Science.gov (United States)

    Crewdson, K; Rehn, M; Brohi, K; Lockey, D J

    2018-04-01

    The benefits of pre-hospital emergency anaesthesia (PHEA) are controversial. Patients who are hypovolaemic prior to induction of anaesthesia are at risk of severe cardiovascular instability post-induction. This study compared mortality for hypovolaemic trauma patients (without major neurological injury) undergoing PHEA with a patient cohort with similar physiology transported to hospital without PHEA. A retrospective database review was performed to identify patients who were hypotensive on scene [systolic blood pressure (SBP) < 90 mmHg], and GCS 13-15. Patient records were reviewed independently by two pre-hospital clinicians to identify the likelihood of hypovolaemia. Primary outcome measure was mortality defined as death before hospital discharge. Two hundred and thirty-six patients were included; 101 patients underwent PHEA. Fifteen PHEA patients died (14.9%) compared with six non-PHEA patients (4.4%), P = 0.01; unadjusted OR for death was 3.73 (1.30-12.21; P = 0.01). This association remained after adjustment for age, injury mechanism, heart rate and hypovolaemia (adjusted odds ratio 3.07 (1.03-9.14) P = 0.04). Fifty-eight PHEA patients (57.4%) were hypovolaemic prior to induction of anaesthesia, 14 died (24%). Of 43 PHEA patients (42.6%) not meeting hypovolaemia criteria, one died (2%); unadjusted OR for mortality was 13.12 (1.84-578.21). After adjustment for age, injury mechanism and initial heart rate, the odds ratio for mortality remained significant at 9.99 (1.69-58.98); P = 0.01. Our results suggest an association between PHEA and in-hospital mortality in awake hypotensive trauma patients, which is strengthened when hypotension is due to hypovolaemia. If patients are hypovolaemic and awake on scene it might, where possible, be appropriate to delay induction of anaesthesia until hospital arrival. © 2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  5. Ambulatory monitoring of left ventricular function in patients with Parkinson`s disease and postural hypotension

    Energy Technology Data Exchange (ETDEWEB)

    Nappi, A. [Dept. of Nuclear Medicine, Univ. ``Federico II``, Naples (Italy); Cuocolo, A. [Dept. of Nuclear Medicine, Univ. ``Federico II``, Naples (Italy); Iazzetta, N. [Inst. of Internal Medicine and Metabolic Diseases, Univ. ``Federico II``, Naples (Italy); Ferrara, L.A. [Inst. of Internal Medicine and Metabolic Diseases, Univ. ``Federico II``, Naples (Italy); Marotta, T. [Inst. of Internal Medicine and Metabolic Diseases, Univ. ``Federico II``, Naples (Italy); Pace, L. [Dept. of Nuclear Medicine, Univ. ``Federico II``, Naples (Italy); Nicolai, E. [Dept. of Nuclear Medicine, Univ. ``Federico II``, Naples (Italy); De Michele, G. [Inst. of Neurological Sciences, Univ. ``Federico II``, Naples (Italy); Campanella, G. [Inst. of Neurological Sciences, Univ. ``Federico II``, Naples (Italy); Salvatore, M. [National Cancer Inst., Naples (Italy); Postiglione, A. [Inst. of Internal Medicine and Metabolic Diseases, Univ. ``Federico II``, Naples (Italy)

    1994-12-01

    Left ventricular (LV) function was continuously monitored using a radionuclide detector (VEST) after intravenous injection of 25 mCi technetium-99m labelled red blood cells in nine patients with Parkinson`s disease and postural hypotension (group 1) and ten patients with Parkinson`s disease but without postural hypotension (group 2). LV function and blood pressure were monitored in the supine position for 15 min (period A), upon changing posture from the supine to the upright position for 10 min (period B), and upon returning to the supine position for 10 min (period C). In group 1, the passage from period A to period B induced a significant decrease in end-diastolic volume, end-systolic volume and ejection fraction (all P<0.01). In group 2, ejection fraction increased (P<0.05) upon changing posture from the supine to the upright position. Ejection fraction (F=33, P<0.01), end-diastolic volume (F=9, P<0.05) and end-systolic volume (F=10, P<0.05) were significantly different between the two groups. In group 1, stroke volume, cardiac output and vascular peripheral resistance decreased from period A to period B (all P<0.001). In group 2, no changes in stroke volume, cardiac output and vascular peripheral resistance were observed from period A to period B. All parameters were similar in the two groups during the periods A and C. Upon changing posture from the supine to the upright position, patients with Parkinson`s disease and postural hypotension showed marked changes in parameters of LV function induced by vascular abnormalities. The results of this study may help to clarify the potential risk of sudden postural changes in such patients, which may cause fainting, syncope and increased risk of ischaemic coronary and cerebrovascular attacks and of lower limb fractures. (orig.)

  6. Effects of Orthostatism and Hemodialysis on Mean Heart Period and Fractal Heart Rate Properties of Chronic Renal Failure Patients.

    Science.gov (United States)

    Echeverría, Juan C; Infante, Oscar; Pérez-Grovas, Héctor; González, Hortensia; José, Marco V; Lerma, Claudia

    2017-11-01

    The aim of this work was to evaluate the short-term fractal index (α 1 ) of heart rate variability (HRV) in chronic renal failure (CRF) patients by identifying the effects of orthostatism and hemodialysis (HD), and by evaluating the correlation between α 1 and the mean RR interval from sinus beats (meanNN). HRV time series were derived from ECG data of 19 CRF patients and 20 age-matched healthy subjects obtained at supine and orthostatic positions (lasting 5 min each). Data from CRF patients were collected before and after HD. α 1 was calculated from each time series and compared by analysis of variance. Pearson's correlations between meanNN and α 1 were calculated using the data from both positions by considering three groups: healthy subjects, CRF before HD and CRF after HD. At supine position, α 1 of CRF patients after HD (1.17 ± 0.30) was larger (P renal disease condition in itself. In conclusion, as in healthy subjects, α 1 of CRF patients correlates with meanNN after HD (indicating a more irregular-like HRV behavior at slower heart rates). This suggests that CRF patients with stable blood pressure preserve a regulatory adaptability despite a shifted setting point of the heart period (i.e., higher heart rate) in comparison with healthy subjects. © 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  7. Hypotension following patent ductus arteriosus ligation: The role of adrenal hormones

    OpenAIRE

    Clyman, RI; Wickremasinghe, A; Merritt, TA; Solomon, T; McNamara, P; Jain, A; Singh, J; Chu, A; Noori, S; Sekar, K; Lavoie, PM; Attridge, JT; Swanson, JR; Gillam-Krakauer, M; Reese, J

    2014-01-01

    Objective To test the hypothesis that an impaired adrenal response to stress might play a role in the hypotension that follows patent ductus arteriosus (PDA) ligation. Study design We performed a multicenter study of infants born at < 32 weeks' gestation who were about to undergo PDA ligation. Serum adrenal steroids were measured 3 times: before and after a cosyntropin (1.0 μg/kg) stimulation test (performed before the ligation), and at 10-12 hours after the ligation. A standardized approach...

  8. [New directions in the hypotensive therapy of open-angle glaucoma (experimental and clinical research)].

    Science.gov (United States)

    Bunin, A Ia; Ermakov, V N; Filina, A A

    1993-01-01

    Clinical use of eye drops of a hybrid beta-alpha-adrenoblocker OF-4680 to reduce intraocular pressure has shown a high efficacy of the drug, not inferior to thymolol, for local hypotensive therapy of open-angle glaucoma. A combination of thymolol with taurin helped reduce the inhibiting effect of the beta-blocker on chamber humor secretion and simultaneously enhanced its discharge. The results evidence the desirability of correcting glutathion deficiency, detected in the patients with narrow-angle glaucoma, by lipoic acid.

  9. Spontaneous Intracranial Hypotension: A Review and Introduction of an Algorithm For Management.

    Science.gov (United States)

    Davidson, Benjamin; Nassiri, Farshad; Mansouri, Alireza; Badhiwala, Jetan H; Witiw, Christopher D; Shamji, Mohammed F; Peng, Philip W; Farb, Richard I; Bernstein, Mark

    2017-05-01

    Spontaneous intracranial hypotension (SIH) is a condition of low cerebrospinal fluid volume and pressure caused by a leak of cerebrospinal fluid through a dural defect. Diagnosis and management can be difficult, often requiring coordination between multiple disciplines for myelography, blood patching, and possible surgical repair. Patients should be monitored closely, because they can deteriorate into a coma or even death. There are no widely accepted guidelines for the management of SIH. We review the existing SIH literature, illustrate management challenges via a case review, and propose an algorithm developed by neurosurgeons, radiologists, and anesthesiologists intended to simplify and streamline the management of SIH. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Acute hypotension induced by aortic clamp vs. PTH provokes distinct proximal tubule Na+ transporter redistribution patterns

    DEFF Research Database (Denmark)

    Leong, Patrick K K; Yang, Li E; Lin, Harrison W

    2004-01-01

    . This study aimed to determine the effects of acute hypotension, induced by aortic clamp or by high-dose PTH (100 microg PTH/kg), on renal hemodynamics and proximal tubule Na/H exchanger isoform 3 (NHE3) and type IIa Na-P(i) cotransporter protein (NaPi2) distribution. Subcellular distribution was analyzed...... clearance. There was, however, no significant change in glomerular filtration rate (GFR) or subcellular distribution of NHE3 and NaPi2. In contrast, high-dose PTH rapidly (

  11. Is it possible to predict hypotension during onset of spinal anesthesia in elderly patients?

    DEFF Research Database (Denmark)

    Meyhoff, Christian S; Haarmark, Christian; Kanters, Jørgen K

    2009-01-01

    STUDY OBJECTIVE: To evaluate the sensitivity and specificity of various predictors of hypotension during onset of spinal anesthesia in elderly patients. DESIGN: Prospective study. SETTING: 32 ASA physical status I, II, and III patients, aged >or=60 years, scheduled for elective lower limb surgery...... with spinal anesthesia. INTERVENTIONS: Patients received spinal anesthesia with 10-17.5 mg of bupivacaine. No prophylactic ephedrine or fluid preloading was used. MEASUREMENTS: A 5-minute baseline was recorded and during onset of spinal anesthesia, hemodynamic changes were measured every 10 seconds from...

  12. Pulse Rate and Transit Time Analysis to Predict Hypotension Events After Spinal Anesthesia During Programmed Cesarean Labor.

    Science.gov (United States)

    Bolea, Juan; Lázaro, Jesús; Gil, Eduardo; Rovira, Eva; Remartínez, José M; Laguna, Pablo; Pueyo, Esther; Navarro, Augusto; Bailón, Raquel

    2017-09-01

    Prophylactic treatment has been proved to reduce hypotension incidence after spinal anesthesia during cesarean labor. However, the use of pharmacological prophylaxis could carry out undesirable side-effects on mother and fetus. Thus, the prediction of hypotension becomes an important challenge. Hypotension events are hypothesized to be related to a malfunctioning of autonomic nervous system (ANS) regulation of blood pressure. In this work, ANS responses to positional changes of 51 pregnant women programmed for a cesarean labor were explored for hypotension prediction. Lateral and supine decubitus, and sitting position were considered while electrocardiographic and pulse photoplethysmographic signals were recorded. Features based on heart rate variability, pulse rate variability (PRV) and pulse transit time (PTT) analysis were used in a logistic regression classifier. The results showed that PRV irregularity changes, assessed by approximate entropy, from supine to lateral decubitus, and standard deviation of PTT in supine decubitus were found as the combination of features that achieved the best classification results sensitivity of 76%, specificity of 70% and accuracy of 72%, being normotensive the positive class. Peripheral regulation and blood pressure changes, measured by PRV and PTT analysis, could help to predict hypotension events reducing prophylactic side-effects in the low-risk population.

  13. Predicting the Occurrence of Hypotension in Stable Patients With Nonvariceal Upper Gastrointestinal Bleeding: Point-of-Care Lactate Testing.

    Science.gov (United States)

    Ko, Byuk Sung; Kim, Won Young; Ryoo, Seung Mok; Ahn, Shin; Sohn, Chang Hwan; Seo, Dong Woo; Lee, Yoon-Seon; Lim, Kyoung Soo; Jung, Hwoon-Yong

    2015-11-01

    It is difficult to assess risk in normotensive patients with upper gastrointestinal bleeding. The aim of this study was to evaluate whether the initial lactate value can predict the in-hospital occurrence of hypotension in stable patients with acute nonvariceal upper gastrointestinal bleeding. Retrospective, observational, single-center study. Emergency department of a tertiary-care, university-affiliated hospital during a 5-year period. Medical records of 3,489 patients with acute upper gastrointestinal bleeding who were normotensive at presentation to the emergency department. We analyzed the ability of point-of-care testing of lactate at emergency department admission to predict hypotension development (defined as systolic blood pressure upper gastrointestinal bleeding, 157 patients experienced hypotension within 24 hours. Lactate was independently associated with hypotension development (odds ratio, 1.6; 95% CI, 1.4-1.7), and the risk of hypotension significantly increased as the lactate increased from 2.5-4.9 mmol/L (odds ratio, 2.2) to 5.0-7.4 mmol/L (odds ratio, 4.0) and to greater than or equal to 7.5 mmol/L (odds ratio, 39.2) (pupper gastrointestinal bleeding. However, subsequently, prospective validate research will be required to clarify this.

  14. Postprandial Hypotension

    Science.gov (United States)

    ... Generic and Brand Natural Products, Search Drug Interactions Pill Identifier Commonly searched drugs Aspirin Metformin Warfarin Tramadol Lactulose Ranitidine News & Commentary Recent News Strict Gun Laws Spare Young Lives: Study 'Smart Dresser' Might Help Alzheimer's Patients Clothe Themselves AHA: ...

  15. Human papillomavirus vaccines, complex regional pain syndrome, postural orthostatic tachycardia syndrome, and autonomic dysfunction - a review of the regulatory evidence from the European Medicines Agency

    DEFF Research Database (Denmark)

    Jefferson, Tom; Jørgensen, Lars

    2017-01-01

    Recent concerns about a possible association between exposure of young women to human papillomavirus (HPV) vaccines and two "dysautonomic syndromes" (a collection of signs and symptoms thought to be caused by autoimmunity) - complex regional pain syndrome (CRPS) and postural orthostatic tachycardia...

  16. A double-blind comparison of terazosin and tamsulosin on their differential effects on ambulatory blood pressure and nocturnal orthostatic stress testing

    NARCIS (Netherlands)

    de Mey, C.; Michel, M. C.; McEwen, J.; Moreland, T.

    1998-01-01

    OBJECTIVES: This single-centre, double-blind, randomized parallel-group study compared ambulatory blood pressure (AMBP) and heart rate (HR) profiles and responses to orthostatic testing (OT) for recommended regimens of tamsulosin (TAM, modified release formulation) and terazosin (TER), two

  17. Long-term course of orthostatic tremor in serial posturographic measurement.

    Science.gov (United States)

    Feil, K; Böttcher, N; Guri, F; Krafczyk, S; Schöberl, F; Zwergal, A; Strupp, M

    2015-08-01

    Primary orthostatic tremor (OT) is a rare neurological disease of unknown pathophysiology characterized by a high-frequency tremor mainly of the legs when standing. The aim of this study was to examine its long-term course by subjective estimation and objective recording by serial posturography and to obtain further standardized epidemiological and clinical data on patients with OT. A clinical cohort of 37 patients with the diagnosis of primary OT was screened for this longitudinal follow-up study. Eighteen patients consented to participate. During study visit all patients underwent a standardized neurological examination and completed subjective scales and scores. Posturographic recordings at follow-up were compared to prior clinical posturographic measurements in 15 cases. In our cohort the mean duration of symptoms was 14.1 ± 6.8 years. Subjectively, 78% of patients reported progression of the disease. Posturographic data (5.4 ± 4.0 years) revealed a significant increase of the total sway path (standing on firm ground with eyes open) from 2.4 ± 1.3 to 3.4 ± 1.4 m/min (p = 0.022) and of the total root mean square values from 9.8 ± 4.3 to 12.4 ± 4.8 mm (p = 0.028). None of these observations are explained by aging of the patients. Mean frequency of the tremor did not change over time (14.7 ± 1.9 Hz vs. 14.9 ± 2.0 Hz at follow-up). Clinically, most patients had signs of cerebellar dysfunction and a substantial portion also showed proprioceptive deficits in the long-term course. This long-term follow-up study indicates, that primary OT is a progressive disorder. Furthermore, the clinical observation of cerebellar dysfunction in most OT patients in the long-term course might indicate an important role of the cerebellum in its pathophysiology. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Postural orthostatic tachycardia is not a useful diagnostic marker for chronic fatigue syndrome.

    Science.gov (United States)

    Roerink, M E; Lenders, J W M; Schmits, I C; Pistorius, A M A; Smit, J W; Knoop, H; van der Meer, J W M

    2017-02-01

    Postural orthostatic tachycardia syndrome (POTS) is considered a diagnostic marker for chronic fatigue syndrome (CFS). The aims of this study were to (i) compare POTS prevalence in a CFS cohort with fatigued patients not meeting CFS criteria, and (ii) assess activity, impairment and response to cognitive behavioural therapy (CBT) in CFS patients with POTS (POTS-CFS) and without POTS (non-POTS-CFS). Prospective cohort study at the Radboud University Medical Centre in the Netherlands. Between June 2013 and December 2014, 863 consecutive patients with persistent fatigue were screened. Patients underwent an active standing test, filled out questionnaires and wore an activity-sensing device for a period of 12 days. A total of 419 patients with CFS and 341 non-CFS fatigued patients were included in the study. POTS prevalence in adult patients with CFS was 5.7% vs. 6.9% in non-CFS adults (P = 0.54). In adolescents, prevalence rates were 18.2% and 17.4%, respectively (P = 0.93). Adult patients with POTS-CFS were younger (30 ± 12 vs. 40 ± 13 years, P = 0.001) and had a higher supine heart rate (71 ± 11 vs. 65 ± 9 beats per min, P = 0.009) compared with non-POTS-CFS patients. Severity and activity patterns did not differ between groups. In patients with CFS, criteria for Systemic Exertion Intolerance Disease (SEID) were met in 76% of adults and 67% of adolescents. In these patients with CFS fulfilling the SEID criteria, the prevalence of POTS was not different from that in the overall CFS population. POTS-CFS adolescents had less clinically significant improvement after CBT than non-POTS-CFS adolescents (58% vs. 88%, P = 0.017). In adults with CFS, the prevalence of POTS was low, was not different from the rate in non-CFS fatigued patients and was not related to disease severity or treatment outcome. In POTS-CFS adolescents, CBT was less successful than in non-POTS-CFS patients. The evaluation of POTS appears to be of limited value for the diagnosis of CFS. © 2016 The

  19. Comparison of Two Methods for Noninvasive Determination of Stroke Volume During Orthostatic Challenge

    Science.gov (United States)

    Doerr, Donald F.; Ratliff, Duane A.; Sithole, Joseph; Convertino, Victor A.

    2005-01-01

    Background: The real time, beat-by-beat, non-invasive determination of stroke volume (SV) is an important parameter in many aerospace related physiologic protocols. In this study, we compared simultaneous estimates of SV calculated from peripheral pulse waveforms with a more conventional non-invasive technique. Methods: Using a prospective, randomized blinded protocol, ten males and nine females completed 12-mm tilt table protocols. The relative change (%(Delta)) in beat-to-beat SV was estimated non-invasively from changes in pulse waveforms measured by application of infrared finger photoplethysmography (IFP) with a Portapres(Registered TradeMark) blood pressure monitoring device and by thoracic impedance cardiography (TIC). The %(Delta) SV values were calculated from continuous SV measurements in the supine posture and over the first 10 s (T1), second 10 s (T2), and 3.5 minutes (T3) of 80deg head-up tilt (HUT). Results: The average %(Delta) SV measured by IFP at T1 (-11.7 +/- 3.7 %) was statistically less (P measured by TIC at T1 (-21.7 +/- 3.1 %), while the average %(Delta) SV measured by 1FF at T2 (-16.2 +/- 3.9 %) and T3 (-19.1 +/- 3.8 %) were not statistically distinguishable (P > or = 0.322) than the average %(Delta) SV measured by TIC at T2 (-21.8 +/- 2.5 %), and T3 (-22.6 +/- 2.9 %). Correlation coefficients (r(sup 2)) between IFP and TIC were 0.117 (T1), 0.387 (T2), and 0.7 18 (T3). Conclusion: IFP provides beat-to-beat (real time) assessment of %(Delta) SV after 20 sec of transition to an orthostatic challenge that is comparable to the commonly accepted TIC. Our data support the notion that IFP technology which has flown during space missions can be used to accurately assess physiological status and countermeasure effectiveness for orth static problems that may arise in astronauts after space flight. While the peripherally measured IFP response is slightly delayed, the ease of implementing this monitor in the field is advantageous.

  20. Cerebral blood flow and metabolism during isoflurane-induced hypotension in patients subjected to surgery for cerebral aneurysms

    DEFF Research Database (Denmark)

    Madsen, J B; Cold, G E; Hansen, E S

    1987-01-01

    Cerebral blood flow and cerebral metabolic rate for oxygen were measured during isoflurane-induced hypotension in 10 patients subjected to craniotomy for clipping of a cerebral aneurysm. Flow and metabolism were measured 5-13 days after the subarachnoid haemorrhage by a modification of the classi......Cerebral blood flow and cerebral metabolic rate for oxygen were measured during isoflurane-induced hypotension in 10 patients subjected to craniotomy for clipping of a cerebral aneurysm. Flow and metabolism were measured 5-13 days after the subarachnoid haemorrhage by a modification......). Controlled hypotension to an average MAP of 50-55 mm Hg was induced by increasing the dose of isoflurane, and maintained at an inspired concentration of 2.2 +/- 0.2%. This resulted in a significant decrease in CMRO2 (to 1.73 +/- 0.16 ml/100 g min-1), while CBF was unchanged. After the clipping...

  1. Acute gluteal compartment syndrome: superior gluteal artery rupture following a low energy injury.

    Science.gov (United States)

    Smith, Aubrey; Chitre, Vivek; Deo, Hersh

    2012-12-17

    Acute compartment syndrome affecting the gluteal region is rare when compared to the same condition in the forearm or calf. When it does occur, it is usually due to prolonged immobilisation in those with altered consciousness. Gluteal compartment syndrome resulting from injury to the superior gluteal artery is extremely rare and to our knowledge has been described only twice--both after high-energy road traffic accidents (RTA). Other cases have described profound hypotension with superior gluteal artery injury after an RTA and falling off a horse, without acute gluteal compartment syndrome. We present a case of gluteal compartment syndrome due to rupture of the superior gluteal artery following a relatively minor fall. The patient required an emergency fasciotomy, which was performed within 4 h of the injury. This case highlights the importance of early diagnosis and treatment of this rare condition.

  2. MRI in the liquor hypotension syndrome: a case report and review of literature

    International Nuclear Information System (INIS)

    Costa Machado Junior, Marcos Alberto da; Barbosa, Veronica Aline Oliveira; Taglietti, Isabella; D'Almeida Filho, Fernando.

    1996-01-01

    The case of a man is presented, who suddenly suffered headaches, with no other neurological disorder or clinical symptom, that partially remitted only in horizontal decubitus. The magnetic resonance imaging (MRI) investigation showed isointense dural thickening or detachment of the convexity in T1, that was hyperintense in T2. After contrast medium i.v. injection, MRI images showed diffuse and marked dural enhancement of the convexity, along the tentorium, at the base, in the upper cervix. Liquor hypotension, accompanied by dural thickening and enhancement visible by MRI have been reported in the literature. In this case, no loss of cerebrospinal fluid was identified as a possible cause for its reduced pressure. Within the frame work of essential liquor hypotension, the authors underline the postural nature of headaches, and hypothesizes the dural alterations are the expression of traction inducing tears in the dural border cell layer with consequent blood extravasation. The correlation of the radiological aspects with these alterations and their changes are discussed. (author). 11 refs., 2 figs

  3. Antioxidant and Vasodilator Activity of Ugni molinae Turcz. (Murtilla and Its Modulatory Mechanism in Hypotensive Response

    Directory of Open Access Journals (Sweden)

    Ignacio Jofré

    2016-01-01

    Full Text Available Hypertension is a systemic condition with high morbidity and mortality rates worldwide, which poses an increased risk for cardiovascular diseases. In this study, we demonstrated the antioxidant and vasodilator activity of Ugni molinae Turcz. (Murtilla fruit, a berry native to Chile and proposed models to explain its modulatory mechanism in hypotensive response. Murtilla fruits were cultivated in a germplasm bank and submitted to chemical and biological analyses. The phenolic compounds gallic acid, Catechin, Quercetin-3-β-D-glucoside, Myricetin, Quercetin, and Kaempferol were identified. Murtilla extract did not generate toxic effects on human endothelial cells and had significant antioxidant activity against ROS production, lipid peroxidation, and superoxide anion production. Furthermore, it showed dose-dependent vasodilator activity in aortic rings in the presence of endothelium, whose hypotensive mechanism is partially mediated by nitric oxide synthase/guanylate cyclase and large-conductance calcium-dependent potassium channels. Murtilla fruits might potentially have beneficial effects on the management of cardiovascular diseases.

  4. Heavily T2-weighted MR myelography vs CT myelography in spontaneous intracranial hypotension.

    Science.gov (United States)

    Wang, Y-F; Lirng, J-F; Fuh, J-L; Hseu, S-S; Wang, S-J

    2009-12-01

    To assess the diagnostic accuracy of heavily T2-weighted magnetic resonance myelography (MRM) in patients with spontaneous intracranial hypotension (SIH). Patients with SIH were recruited prospectively, and first underwent MRM and then computed tomographic myelography (CTM). The results of MRM were validated with the gold standard, CTM, focusing on 1) CSF leaks along the nerve roots, 2) epidural CSF collections, and 3) high-cervical (C1-3) retrospinal CSF collections. Comparisons of these 3 findings between the 2 studies were made by kappa statistics and agreement rates. Targeted epidural blood patches (EBPs) were placed at the levels of CSF leaks if supportive treatment failed. Nineteen patients (6 men and 13 women, mean age 37.9 +/- 8.6 years) with SIH completed the study. MRM did not differ from CTM in the detection rates of CSF leaks along the nerve roots (84% vs 74%, p = 0.23), high-cervical retrospinal CSF collections (32% vs 16%, p = 0.13), and epidural CSF collections (89% vs 79%, p = 0.20). MRM demonstrated more spinal levels of CSF leaks (2.2 +/- 1.7 vs 1.5 +/- 1.5, p = 0.011) and epidural collections (12.2 +/- 5.9 vs 7.1 +/- 5.8, p localizing CSF leaks for patients with spontaneous intracranial hypotension. This noninvasive technique may be an alternative to computed tomographic myelography before targeted epidural blood patches.

  5. Evaluation of Hypotensive and Antihypertensive Effects of Velvet Bean (Mucuna pruriens L.) Hydrolysates.

    Science.gov (United States)

    Chel-Guerrero, Luis; Galicia-Martínez, Saulo; Acevedo-Fernández, Juan José; Santaolalla-Tapia, Jesus; Betancur-Ancona, David

    2017-01-01

    Hypertension could cause significant worldwide health problems that affect 15-20% of all adults; according to National Health and Nutrition Examination Survey, about 29% of the adult population in the United States are hypertensive. Recent research has shown that peptides derived from the hydrolysis of food proteins can decrease blood pressure. This study was carried out to evaluate the hypotensive and antihypertensive potential of Mucuna pruriens protein hydrolysates in in vitro and in vivo models. M. pruriens protein concentrate was prepared by wet fractionation and enzymatically hydrolyzed using Alcalase ® , Flavourzyme ® , and the sequential system Alcalase-Flavourzyme at different times (5-120 min). The biological potential was measured in vitro based on the IC 50 value as well as in vivo effect, measuring the systolic (SBP) and diastolic (DBP) blood pressure in normotensive and antihypertensive Wistar-Kyoto rats by the tail-cuff method. Hydrolysis of M. pruriens protein concentrates with commercial enzymes generated extensive hydrolysates with angiotensin-converting enzyme (ACE-I) inhibitory activity (IC 50 : 0.589-0.993 mg/mL) and hypotensive (SBP: 0.6-47.43%, DBP: 1.94-43.47%) and antihypertensive (SBP: 8.84-27.29% DBP: 16.1-29.37%) effect. These results indicate that Mucuna pruriens protein hydrolysate (MPPH) could be used as a functional ingredient to prevent blood pressure increase.

  6. Reversible coma and Duret hemorrhage after intracranial hypotension from remote lumbar spine surgery: case report.

    Science.gov (United States)

    Bonow, Robert H; Bales, James W; Morton, Ryan P; Levitt, Michael R; Zhang, Fangyi

    2016-03-01

    Intracranial hypotension is a rare condition caused by spontaneous or iatrogenic CSF leaks that alter normal CSF dynamics. Symptoms range from mild headaches to transtentorial herniation, coma, and death. Duret hemorrhages have been reported to occur in some patients with this condition and are traditionally believed to be associated with a poor neurological outcome. A 73-year-old man with a remote history of spinal fusion presented with syncope and was found to have small subdural hematomas on head CT studies. He was managed nonoperatively and discharged with a Glasgow Coma Scale score of 15, only to return 3 days later with obtundation, fixed downward gaze, anisocoria, and absent cranial nerve reflexes. A CT scan showed Duret hemorrhages and subtle enlargement of the subdural hematomas, though the hematomas remained too small to account for his poor clinical condition. Magnetic resonance imaging of the spine revealed a large lumbar pseudomeningocele in the area of prior fusion. His condition dramatically improved when he was placed in the Trendelenburg position and underwent repair of the pseudomeningocele. He was kept flat for 7 days and was ultimately discharged in good condition. On long-term follow-up, his only identifiable deficit was diplopia due to an internuclear ophthalmoplegia. Intracranial hypotension is a rare condition that can cause profound morbidity, including tonsillar herniation and brainstem hemorrhage. With proper identification and treatment of the CSF leak, patients can make functional recoveries.

  7. The effect of pre-donation hypotension on whole blood donor adverse reactions: a systematic review.

    Science.gov (United States)

    Pauwels, Nele S; Cusack, Leila; De Buck, Emmy; Compernolle, Veerle; Vandekerckhove, Philippe

    2014-06-01

    Blood services are reliant upon healthy blood donors to provide a safe and adequate supply of blood products. Inappropriate variables contained within blood donor exclusion criteria can defer potentially appropriate donors. The aim of this systematic review was to examine the effect of low pre-donation blood pressure, as compared with normal blood pressure, on adverse events in allogeneic whole blood donors. A systematic review was performed using highly sensitive search strategies within five databases (Cochrane Central Register of Controlled Trials, CINAHL, Embase, MEDLINE, and Web of Science) from inception date until April 12, 2013. Out of 8305 records, 10 observational studies were identified that addressed the question. Five of these studies (with a combined total of 1,482,020 donations and 2903 donors) included either a statistical analysis or an appropriate study design that controlled for possible confounding factors. Based on the currently available evidence, hypotension has not been shown to be an independent predictive factor for donor complications. However, the overall quality of evidence was rather limited and rated 'low,' using the GRADE approach. In conclusion there is currently no evidence that hypotensive blood donors have a greater risk for donor adverse events compared with their normotensive counterparts. Copyright © 2014 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

  8. Cationic solid lipid nanoparticles enhance ocular hypotensive effect of melatonin in rabbit.

    Science.gov (United States)

    Leonardi, Antonio; Bucolo, Claudio; Drago, Filippo; Salomone, Salvatore; Pignatello, Rosario

    2015-01-15

    The study was aimed at evaluating whether the ocular hypotensive effect of melatonin (MEL) was enhanced by its encapsulation in cationic solid lipid nanoparticles (cSLN), as well as at determining the tolerability of these formulations on the ocular surface. MEL was loaded in cSLN that had already been shown to be suitable for ophthalmic use. The formulations were prepared using Softisan(®) 100 as the main lipid matrix, with the presence of either stearic (SA) or palmitic acid (PA) as lipid modifiers. A fixed positive charge was provided by the addition of a cationic lipid (didecyldimethylammonium bromide). The ocular hypotensive effect was evaluated by measuring the intraocular pressure (IOP) during 24h in albino rabbits. MEL elicited a significant (p<0.01) IOP reduction in rabbit eye. All the formulations tested in vivo demonstrated a good tolerability. The nanocarrier containing SA was the most effective in terms of IOP reduction (maximum IOP reduction: -7 mmHg), and its effect lasted approximately 24h. The experimental data indicate that the new formulations based on cSLN loaded with MEL represent a potent anti-glaucoma treatment with a safe profile, warranting further clinical evaluation of the proposed nanotechnological strategy. Copyright © 2014. Published by Elsevier B.V.

  9. Relationship between occupational exposure to lead and local arterial stiffness and left ventricular diastolic function in individuals with arterial hypertension

    International Nuclear Information System (INIS)

    Poreba, Rafal; Gac, Pawel; Poreba, Malgorzata; Antonowicz-Juchniewicz, Jolanta; Andrzejak, Ryszard

    2011-01-01

    Relationship between occupational exposure to lead and frequency of complications in persons with arterial hypertension has been poorly investigated. This study aimed at evaluation of the relationship between occupational exposure to lead and manifestation of an increased local arterial stiffness and left ventricular diastolic dysfunction. The studies included 105 men (mean age: 44.47 ± 9.12 years) with arterial hypertension, treated with hypotensive drugs: group I - men occupationally exposed to lead (n = 53), and group II - men not exposed to lead (n = 52). In echocardiographic examination, the left ventricular diastolic dysfunction was diagnosed significantly more frequently in group I than in group II. In eTracking examination mean values of stiffness parameter (β), augmentation index (AI) and one-point pulse wave velocity (PWV-β) were significantly higher and mean values of arterial compliance (AC) were significantly lower in group I than in group II. The logistic regression showed that in the group of persons with arterial hypertension occupationally exposed to lead a more advanced age, higher blood lead concentration and higher mean values of augmentation index represent independent risk factors of left ventricular diastolic dysfunction. The multifactorial regression showed that amongst persons with arterial hypertension occupationally exposed to lead higher blood zinc protoporphyrin concentration, a more advanced age and higher value of body mass index (BMI) represent independent risk factors of an increased local arterial stiffness. In summary, we should note that in the group of persons with arterial hypertension occupationally exposed to lead the study has demonstrated a significantly more frequent manifestation of left ventricular diastolic dysfunction and an increase in local arterial stiffness. - Highlights: → Amongst persons with AH exposed to Pb higher ZnPP represent independent risk factor of increased local arterial stiffness. → Higher Pb

  10. Rediscovering the wound hematoma as a site of hemostasis during major arterial hemorrhage.

    Science.gov (United States)

    White, N J; Mehic, E; Wang, X; Chien, D; Lim, E; St John, A E; Stern, S A; Mourad, P D; Rieger, M; Fries, D; Martinowitz, U

    2015-12-01

    Treatments for major internal bleeding after injury include permissive hypotension to decrease the rate of blood loss, intravenous infusion of plasma or clotting factors to improve clot formation, and rapid surgical hemostasis or arterial embolization to control bleeding vessels. Yet, little is known regarding major internal arterial hemostasis, or how these commonly used treatments might influence hemostasis. (i) To use a swine model of femoral artery bleeding to understand the perivascular hemostatic response to contained arterial hemorrhage. (ii) To directly confirm the association between hemodynamics and bleeding velocity. (iii) To observe the feasibility of delivering an activated clotting factor directly to internal sites of bleeding using a simplified angiographic approach. Ultrasound was used to measure bleeding velocity and in vivo clot formation by elastography in a swine model of contained femoral artery bleeding with fluid resuscitation. A swine model of internal pelvic and axillary artery hemorrhage was also used to demonstrate the feasibility of local delivery of an activated clotting factor. In this model, clots formed slowly within the peri-wound hematoma, but eventually contained the bleeding. Central hemodynamics correlated positively with bleeding velocity. Infusion of recombinant human activated factor VII into the injured artery near the site of major internal hemorrhage in the pelvis and axillae was feasible. We rediscovered that clot formation within the peri-wound hematoma is an integral component of hemostasis and a feasible target for the treatment of major internal bleeding using activated clotting factors delivered using a simplified angiographic approach. © 2015 International Society on Thrombosis and Haemostasis.

  11. Successful intra-arterial alteplase infusion is a predictor of 12-month limb survival in patients with lower limb arterial occlusion

    International Nuclear Information System (INIS)

    Disini, L.; Wilson, P.; Cockburn, J.F.

    2008-01-01

    Aim: To determine the factors predicting amputation of the affected lower limb 12 months after thrombolysis for acute arterial occlusion. Materials and methods: The clinical endpoints of 39 patients (24 men, 15 women; average age 69 years) 1 year after catheter-directed thrombolysis with alteplase (mean dose 30 mg, mean duration 24 h) for lower limb arterial occlusion (30 native arteries, nine grafts) from January 2001 to June 2005 were assessed. The amputation rate at 12 months was analysed in relation to the thrombolytic outcome, type of vessel occluded, presence or absence of complications, and subsequent requirement for additional surgery on an elective basis using Fischer's exact test. Results: Successful thrombolysis, defined as complete clot dissolution based on angiographic imaging, was achieved in 64.1% of cases (19 native artery, six bypass graft) with a total complication rate of 23% (n = 9). The incidence of major haemorrhage was 7.5% (n = 3, hypotension and haematemesis, groin haematoma and hypotension, haematemesis). No patient had an intracranial bleed. One year after thrombolysis, 28.2% (n = 11) had further surgery (bypass graft, fasciotomy, embolectomy) and the amputation rate was 20.5% (n = 8). Statistical analysis showed that the amputation rate was significantly higher for patients with failed compared with successful thrombolysis (p = 0.02). The amputation rates did not reach statistical significance in relation to native artery or graft occlusion, presence or absence of complications, and whether or not additional surgery was required. Conclusion: Successful thrombolysis was a predictor for limb survival up to 12 months post-thrombolysis regardless of the type of vessel occlusion, presence of complications or additional surgical requirement

  12. Hepatic artery aneurysms (HAAs)

    International Nuclear Information System (INIS)

    Nosratini, H.

    2004-01-01

    The hepatic artery aneurysms are rare, especially in interahepatic branches, The frequency consists of 75-80% extrahepatic and 20-25% intrahepatic. Catheterization is achieved usually from common femoral artery, other methods implemented in the case of unsuccessful catheterization from femoral artery, are translumbar and brachial catheterization. The study consist of 565 patients that were referred to the angiography ward, During seven years of assessment, five cases of hepatic artery aneurysm were found; this is a rare condition reported in the English literature. In the literature as well as in this case report the hepatic artery aneurysms are rare. In reported series the extrahepatic artery aneurysms are found more often than in the intrahepatic artery aneurysm but in this case report intrahepatic artery aneurysms are more than extrahepatic one. (author)

  13. Arterial Pressure Gradients during Upright Posture and 30 deg Head Down Tilt

    Science.gov (United States)

    Sanchez, E. R; William, J. M.; Ueno, T.; Ballard, R. E.; Hargens, A. R.; Holton, Emily M. (Technical Monitor)

    1997-01-01

    Gravity alters local blood pressure within the body so that arterial pressures in the head and foot are lower and higher, respectively, than that at heart level. Furthermore, vascular responses to local alterations of arterial pressure are probably important to maintain orthostatic tolerance upon return to the Earth after space flight. However, it has been difficult to evaluate the body's arterial pressure gradient due to the lack of noninvasive technology. This study was therefore designed to investigate whether finger arterial pressure (FAP), measured noninvasively, follows a normal hydrostatic pressure gradient above and below heart level during upright posture and 30 deg head down tilt (HDT). Seven healthy subjects gave informed consent and were 19 to 52 years old with a height range of 158 to 181 cm. A Finapres device measured arterial pressure at different levels of the body by moving the hand from 36 cm below heart level (BH) to 72 cm above heart level (AH) in upright posture and from 36 cm BH to 48 cm AH during HDT in increments of 12 cm. Mean FAP creased by 85 mmHg transitioning from BH to AH in upright posture, and the pressure gradient calculated from hydrostatic pressure difference (rho(gh)) was 84 mmHg. In HDT, mean FAP decreased by 65 mmHg from BH to AH, and the calculated pressure gradient was also 65 mmHg. There was no significant difference between the measured FAP gradient and the calculated pressure gradient, although a significant (p = 0.023) offset was seen for absolute arterial pressure in upright posture. These results indicate that arterial pressure at various levels can be obtained from the blood pressure at heart level by calculating rho(gh) + an offset. The offset equals the difference between heart level and the site of measurement. In summary, we conclude that local blood pressure gradients can be measured by noninvasive studies of FAP.

  14. Bilateral renal artery variation

    OpenAIRE

    Üçerler, Hülya; Üzüm, Yusuf; İkiz, Z. Aslı Aktan

    2014-01-01

    Each kidney is supplied by a single renal artery, although renal artery variations are common. Variations of the renal arteryhave become important with the increasing number of renal transplantations. Numerous studies describe variations in renalartery anatomy. Especially the left renal artery is among the most critical arterial variations, because it is the referred side forresecting the donor kidney. During routine dissection in a formalin fixed male cadaver, we have found a bilateral renal...

  15. Sonography and hypotension: a change to critical problem solving in undergraduate medical education

    Directory of Open Access Journals (Sweden)

    Amini R

    2016-01-01

    Full Text Available Richard Amini, Lori A Stolz, Nicholas C Hernandez, Kevin Gaskin, Nicola Baker, Arthur Barry Sanders, Srikar AdhikariDepartment of Emergency Medicine, University of Arizona Medical Center, College of Medicine, University of Arizona, Tucson, AZ, USAStudy objectives: Multiple curricula have been designed to teach medical students the basics of ultrasound; however, few focus on critical problem-solving. The objective of this study is to determine whether a theme-based ultrasound teaching session, dedicated to the use of ultrasound in the management of the hypotensive patient, can impact medical students’ ultrasound education and provide critical problem-solving exercises.Methods: This was a cross-sectional study using an innovative approach to train 3rd year medical students during a 1-day ultrasound training session. The students received a 1-hour didactic session on basic ultrasound physics and knobology and were also provided with YouTube hyperlinks, and links to smart phone educational applications, which demonstrated a variety of bedside ultrasound techniques. In small group sessions, students learned how to evaluate patients for pathology associated with hypotension. A knowledge assessment questionnaire was administered at the end of the session and again 3 months later. Student knowledge was also assessed using different clinical scenarios with multiple-choice questions.Results: One hundred and three 3rd year medical students participated in this study. Appropriate type of ultrasound was selected and accurate diagnosis was made in different hypotension clinical scenarios: pulmonary embolism, 81% (95% CI, 73%–89%; abdominal aortic aneurysm, 100%; and pneumothorax, 89% (95% CI, 82%–95%. The average confidence level in performing ultrasound-guided central line placement was 7/10, focused assessment with sonography for trauma was 8/10, inferior vena cava assessment was 8/10, evaluation for abdominal aortic aneurysm was 8/10, assessment for

  16. Sonography and hypotension: a change to critical problem solving in undergraduate medical education.

    Science.gov (United States)

    Amini, Richard; Stolz, Lori A; Hernandez, Nicholas C; Gaskin, Kevin; Baker, Nicola; Sanders, Arthur Barry; Adhikari, Srikar

    2016-01-01

    Multiple curricula have been designed to teach medical students the basics of ultrasound; however, few focus on critical problem-solving. The objective of this study is to determine whether a theme-based ultrasound teaching session, dedicated to the use of ultrasound in the management of the hypotensive patient, can impact medical students' ultrasound education and provide critical problem-solving exercises. This was a cross-sectional study using an innovative approach to train 3rd year medical students during a 1-day ultrasound training session. The students received a 1-hour didactic session on basic ultrasound physics and knobology and were also provided with YouTube hyperlinks, and links to smart phone educational applications, which demonstrated a variety of bedside ultrasound techniques. In small group sessions, students learned how to evaluate patients for pathology associated with hypotension. A knowledge assessment questionnaire was administered at the end of the session and again 3 months later. Student knowledge was also assessed using different clinical scenarios with multiple-choice questions. One hundred and three 3rd year medical students participated in this study. Appropriate type of ultrasound was selected and accurate diagnosis was made in different hypotension clinical scenarios: pulmonary embolism, 81% (95% CI, 73%-89%); abdominal aortic aneurysm, 100%; and pneumothorax, 89% (95% CI, 82%-95%). The average confidence level in performing ultrasound-guided central line placement was 7/10, focused assessment with sonography for trauma was 8/10, inferior vena cava assessment was 8/10, evaluation for abdominal aortic aneurysm was 8/10, assessment for deep vein thrombus was 8/10, and cardiac ultrasound for contractility and overall function was 7/10. Student performance in the knowledge assessment portion of the questionnaire was an average of 74% (SD =11%) at the end of workshop and 74% (SD =12%) 3 months later (P=0.00). At our institution, we

  17. Evaluation of patients with headache due to spontaneous intracranial hypotension by RN cisternography

    International Nuclear Information System (INIS)

    Kim, Su Zy; Park, Chan Hee; Soo, Joo In; Pai, Moon Sun; Yoon, Suk Nam; Kim, Jang Sung

    1997-01-01

    Spontaneous intracranial hypotension (SIH) typically occurs without an obvious cause. However, it can be seen following the lumbar puncture, craniotomy, or spinal surgery. Also listed are contributing factors such as sneezing, coughing, intercourse or minor fall. Spontaneous spinal CSF leaks are not common, but are now increasingly recognized as a cause of postural headache associated with intracranial hypotension. The purpose of our study was to evaluate the role of RN cisternography in the diagnosis of SIH cuased by spinal CSF leakage. Four patients with clinical suspicion of SIH (Group I) and six patients as normal control (Group II) underwent RN cisternography. RN cisternography in Group II was done for various reasons, such as hydrocephalus, syringomyelia and memory loss. Group I consisted of the patients who presented with postural headache, as well as additional symptoms, such as nausea, vomiting, dizziness, tinnitus and eyeball pain. The age range of these patients was 27 - 67 years. Lumbar puncture and CSF examinations were performed in Group I more than once and showed typical findings of low CSF pressure and slightly elevated protein level. Brain MRI (4/4), Cervico-thoracic spine MRI (3/4) were also performed. On gadolinium-enhanced brain MRI, enhancement of the meninges which is the most characteristic radiographic finding in intracranial hypotension was found in all patients of Group I. But, cervico-thoracic spin MRI was nonspecific. None of Group I had contrast myelography because of the patient's refusal. Group I and Group II underwent radionuclide cisternography following lumbar subarachnoid injection of 99mTc-DTPA (1-2mCi). The scans were taken in 2, 5, 24 hours later using single head gamma camera equipped with LEAP. Entire spinal region in posterior view and head in frontal and lateral views were obtained. The cisternography of Group I showed the CSF leakage or diverticulum at the level of cervico-thoracic junction(3/4) and mid-thoracic level (1

  18. Evaluation of patients with headache due to spontaneous intracranial hypotension by RN cisternography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Su Zy; Park, Chan Hee; Soo, Joo In; Pai, Moon Sun; Yoon, Suk Nam; Kim, Jang Sung [College of Medicine, Ajou Univ., Suwon (Korea, Republic of)

    1997-07-01

    Spontaneous intracranial hypotension (SIH) typically occurs without an obvious cause. However, it can be seen following the lumbar puncture, craniotomy, or spinal surgery. Also listed are contributing factors such as sneezing, coughing, intercourse or minor fall. Spontaneous spinal CSF leaks are not common, but are now increasingly recognized as a cause of postural headache associated with intracranial hypotension. The purpose of our study was to evaluate the role of RN cisternography in the diagnosis of SIH cuased by spinal CSF leakage. Four patients with clinical suspicion of SIH (Group I) and six patients as normal control (Group II) underwent RN cisternography. RN cisternography in Group II was done for various reasons, such as hydrocephalus, syringomyelia and memory loss. Group I consisted of the patients who presented with postural headache, as well as additional symptoms, such as nausea, vomiting, dizziness, tinnitus and eyeball pain. The age range of these patients was 27 - 67 years. Lumbar puncture and CSF examinations were performed in Group I more than once and showed typical findings of low CSF pressure and slightly elevated protein level. Brain MRI (4/4), Cervico-thoracic spine MRI (3/4) were also performed. On gadolinium-enhanced brain MRI, enhancement of the meninges which is the most characteristic radiographic finding in intracranial hypotension was found in all patients of Group I. But, cervico-thoracic spin MRI was nonspecific. None of Group I had contrast myelography because of the patient's refusal. Group I and Group II underwent radionuclide cisternography following lumbar subarachnoid injection of 99mTc-DTPA (1-2mCi). The scans were taken in 2, 5, 24 hours later using single head gamma camera equipped with LEAP. Entire spinal region in posterior view and head in frontal and lateral views were obtained. The cisternography of Group I showed the CSF leakage or diverticulum at the level of cervico-thoracic junction(3/4) and mid

  19. Evaluation of patients with headache due to spontaneous intracranial hypotension by RN cisternography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Su Zy; Park, Chan Hee; Soo, Joo In; Pai, Moon Sun; Yoon, Suk Nam; Kim, Jang Sung [College of Medicine, Ajou Univ., Suwon (Korea, Republic of)

    1997-07-01

    Spontaneous intracranial hypotension (SIH) typically occurs without an obvious cause. However, it can be seen following the lumbar puncture, craniotomy, or spinal surgery. Also listed are contributing factors such as sneezing, coughing, intercourse or minor fall. Spontaneous spinal CSF leaks are not common, but are now increasingly recognized as a cause of postural headache associated with intracranial hypotension. The purpose of our study was to evaluate the role of RN cisternography in the diagnosis of SIH cuased by spinal CSF leakage. Four patients with clinical suspicion of SIH (Group I) and six patients as normal control (Group II) underwent RN cisternography. RN cisternography in Group II was done for various reasons, such as hydrocephalus, syringomyelia and memory loss. Group I consisted of the patients who presented with postural headache, as well as additional symptoms, such as nausea, vomiting, dizziness, tinnitus and eyeball pain. The age range of these patients was 27 - 67 years. Lumbar puncture and CSF examinations were performed in Group I more than once and showed typical findings of low CSF pressure and slightly elevated protein level. Brain MRI (4/4), Cervico-thoracic spine MRI (3/4) were also performed. On gadolinium-enhanced brain MRI, enhancement of the meninges which is the most characteristic radiographic finding in intracranial hypotension was found in all patients of Group I. But, cervico-thoracic spin MRI was nonspecific. None of Group I had contrast myelography because of the patient's refusal. Group I and Group II underwent radionuclide cisternography following lumbar subarachnoid injection of 99mTc-DTPA (1-2mCi). The scans were taken in 2, 5, 24 hours later using single head gamma camera equipped with LEAP. Entire spinal region in posterior view and head in frontal and lateral views were obtained. The cisternography of Group I showed the CSF leakage or diverticulum at the level of cervico-thoracic junction(3/4) and mid-thoracic level (1

  20. Multistructure index in revealing complexity of regulatory mechanisms of human cardiovascular system at rest and orthostatic stress in healthy humans

    Science.gov (United States)

    Makowiec, Danuta; Graff, Beata; Struzik, Zbigniew R.

    2017-02-01

    Biological regulation is sufficiently complex to pose an enduring challenge for characterization of both its equilibrium and transient non-equilibrium dynamics. Two univariate but coupled observables, heart rate and systolic blood pressure, are commonly characterized in the benchmark example of the human cardiovascular regulatory system. Asymmetric distributions of accelerations and decelerations of heart rate, as well as rises and falls in systolic blood pressure, recorded in humans during a head-up tilt test provide insights into the dynamics of cardiovascular response to a rapid, controlled deregulation of the system's homeostasis. The baroreflex feedback loop is assumed to be the fundamental physiological mechanism for ensuring homeostatic blood supply to distant organs at rest and during orthostatic stress, captured in a classical beat-to-beat autoregressive model of baroreflex by de Boer et al. (1987). For model corroboration, a multistructure index statistic is proposed, seamlessly evaluating the size spectrum of magnitudes of neural reflexes such as baroreflex, responsible for maintaining the homeostatic dynamics. The multistructure index exposes a distinctly different dynamics of multiscale asymmetry between results obtained from real-life signals recorded from healthy subjects and those simulated using both the classical and perturbed versions of the model. Nonlinear effects observed suggest the pronounced presence of complex mechanisms resulting from baroreflex regulation when a human is at rest, which is aggravated in the system's response to orthostatic stress. Using our methodology of multistructure index, we therefore show a marked difference between model and real-life scenarios, which we attribute to multiscale asymmetry of non-linear origin in real-life signals, which we are not reproducible by the classical model.

  1. A randomized comparative trial of combinational methods for preventing post-spinal hypotension at elective cesarean delivery

    Directory of Open Access Journals (Sweden)

    Mitra Jabalameli

    2011-01-01

    Conclusions: Among the three studied methods, administration of ephedrine plus bandage of the lower extremities was the most effective one in reducing the incidence of post-spinal hypotension. The groups were not clinically different concerning the effect of treatment on newborn health.

  2. Jet pump assisted artery

    Science.gov (United States)

    1975-01-01

    A procedure for priming an arterial heat pump is reported; the procedure also has a means for maintaining the pump in a primed state. This concept utilizes a capillary driven jet pump to create the necessary suction to fill the artery. Basically, the jet pump consists of a venturi or nozzle-diffuser type constriction in the vapor passage. The throat of this venturi is connected to the artery. Thus vapor, gas, liquid, or a combination of the above is pumped continuously out of the artery. As a result, the artery is always filled with liquid and an adequate supply of working fluid is provided to the evaporator of the heat pipe.

  3. Xamoterol, a new selective beta-1-adrenoceptor partial agonist, in the treatment of postural hypotension

    DEFF Research Database (Denmark)

    Mehlsen, J; Trap-Jensen, J

    1986-01-01

    Three patients severely disabled from postural hypotension were treated with xamoterol, a selective beta-1-adrenoceptor antagonist with a high degree of partial agonist activity. Oral treatment (200 mg b.i.d.) was chosen on the basis of the effects of acute intravenous administration of xamoterol...... and pindolol, a non-selective beta-adrenoceptor antagonist with partial agonist activity. In these patients pindolol had a predominantly antagonist effect, whereas xamoterol had a predominantly agonist effect after intravenous administration. Oral treatment was carried out with placebo control in a single......, supine). During the placebo period (2 weeks) heart rate decreased to pretreatment levels and mean blood pressure was reduced by only 14 mmHg. The patients reported substantial improvement in their condition during active medication. Xamoterol seems to be a useful alternative in the treatment of postural...