Zur Patho-Physiologie und Klinik der orthostatischen Kreislaufstörungen

[Rhythmic regulation of pulse and respiration while standing in subjects with stable and labile orthostatic blood pressure]

The pulse and respiration rate of normal people in a recumbant position has a fairly high degree of coordination. This increases in a upright position. In patients with orthostatic hypotension the degree of coordination is fairly low when lying and mostly decreases when standing. - The rhythmic regulation of the bradycard subgroup of the patients with orthostatic hypotension is still relatively strong, but the hypotension is extreme; that of the tachycard subgroup is extremely unstable, but the hypotension is not so marked. As collapse occurs with the same frequency in both subgroups, blood pressure and rhythmic regulation must be able to compensate each other to a certain degree. - Normal values can be detected by observing regulative optima. The marked optimum in an upright position is found by a pulse rate of 80-85 min-1, a respiration rate of 16-18 min-1 and a QP/R of 5. A minor, second optimum exists near a pulse rate of 100-105 min-1, a respiration rate of 14-15 min-1 and a QP/R of 7. - In patients with orthostatic hypotension these optima also can occur but sometimes less markedly. It can thus be accepted that the normal regulative process is latent more or less in ill people. This becomes particularly meaningful for all methods of therapies which strengthen this regulative process. - As in pathological cases a minor, second optimum is found in the regulative process, illness cannot mean a total loss of order but merely a reorganisation.

[The relation between blood pressure and pulse and respiration rate in the borderline between orthostatic hypotension and normal regulation (author's transl)]

On the border between orthostatic normal regulation and hypotension, the size of the blood pressure amplitude in upright position is dependent upon the pulse frequency and the pulse respiration quotient. The relationship between the blood pressure amplitude and the pulse frequency is linear and lends itself to the setting up of an orthostasis quotient. As into this quotient enter only data of upright position, we speak of a "standing reaction", the result of which satisfactorily corresponds with certain criteria of the "standing-up reaction" noticed by us so far. The orthostasis quotient coincides better with the clinical picture than the results of the standing-up reaction and separates the orthostatically stable person more precisely than the orthostasis index.

[The pulse-respiratory quotient of persons with stable and instable postural circulation while standing (author's transl)]

The pulse-respiratory quotient of patients with postural circulatory instability is the same in a prone position as that of patients with stable postural circulation, however, it is higher in an upright postiion. This is not only caused by the higher pulse frequency of postural circulatory instable patients while standing, but also by the lower respiratory rate. The difference of the pulse-respiratory quotient between standing and lying indicates with more accuracy the diagnosis of postural circulatory instability. The severity of the symptoms is related not only to the pulse and respiratory rate, but also to the pulse-respiratory quotient. Tachycardiac patients with a high pulse-respiratory quotient show clinically symptoms more severe than tachycardiac patients with lower pulse-respiratory quotients. Due to the results shown here, the terms of rhythmical concordance and discordance are proposed.