Cardiac and autonomic system reactions to stretch of the atria

Evaluation of Baroreflex Sensitivity by the Sequence Method Using Blood Pressure Oscillations and R–R Interval Changes during Deep Respiration

BACKGROUND

Baroreflex sensitivity assessments have been considered to be important to evaluate cardiac autonomic neuropathy. The phenylephrine method, Valsalva maneuver or sequence method at rest caused several problems. We evaluated the usefulness of the sequence method during deep respiration.

METHOD

Baroreflex sensitivity was evaluated in 20 normal volunteers and 50 patients with Parkinson's disease. R-R intervals and systolic blood pressures were obtained by electrocardiogram and tonometry using a continuous blood pressure monitoring system. The sequence method is an evaluation of baroreflex sensitivity using sequences of 3 or more consecutive beats for 4 min. Baroreflex sensitivity was also assessed by the Valsalva maneuver at 5 beats before the peak systolic blood pressure of phase IV. The slope of the linear interrelationship between systolic blood pressure and the following R-R interval, i.e. baroreflex sensitivity (ms/mm Hg), was calculated with a correlation coefficient greater than 0.8.

RESULT

The mean value of baroreflex sensitivity obtained by the Valsalva maneuver was 7.91 in normal volunteers and 5.35 in patients with Parkinson's disease; the one obtained by the sequence method at rest was 9.10 in normal volunteers and 8.42 in patients with Parkinson's disease, and the one obtained by the sequence method during deep respiration was 10.23 in normal volunteers and 6.73 in patients with Parkinson's disease. In some cases with Parkinson's disease, baroreflex sensitivities could not be found, whereas in all patients with Parkinson's disease, the sequence method during deep respiration could be used for evaluations. Significant correlations were found among the baroreflex sensitivities obtained by the Valsalva maneuver, and the sequence method at rest or during deep respiration in normal volunteers and patients with Parkinson's disease.

CONCLUSIONS

The baroreflex sensitivity obtained by the sequence method during deep respiration could be investigated noninvasively in all cases with PD, being thus a useful method for clinical evaluation of baroreflex sensitivity.

Abnormal heart rate regulation in GIRK4 knockout mice

Acetylcholine (ACh) released from the stimulated vagus nerve decreases heart rate via modulation of several types of ion channels expressed in cardiac pacemaker cells. Although the muscarinic-gated potassium channel I(KACh) has been implicated in vagally mediated heart rate regulation, questions concerning the extent of its contribution have remained unanswered. To assess the role of I(KACh) in heart rate regulation in vivo, we generated a mouse line deficient in I(KACh) by targeted disruption of the gene coding for GIRK4, one of the channel subunits. We analyzed heart rate and heart rate variability at rest and after pharmacological manipulation in unrestrained conscious mice using electrocardiogram (ECG) telemetry. We found that I(KACh) mediated approximately half of the negative chronotropic effects of vagal stimulation and adenosine on heart rate. In addition, this study indicates that I(KACh) is necessary for the fast fluctuations in heart rate responsible for beat-to-beat control of heart activity, both at rest and after vagal stimulation. Interestingly, noncholinergic systems also appear to modulate heart activity through I(KACh). Thus, I(KACh) is critical for effective heart rate regulation in mice.

Heart rate variability: origins, methods, and interpretive caveats

Components of heart rate variability have attracted considerable attention in psychology and medicine and have become important dependent measures in psychophysiology and behavioral medicine. Quantification and interpretation of heart rate variability, however, remain complex issues and are fraught with pitfalls. The present report (a) examines the physiological origins and mechanisms of heart rate variability, (b) considers quantitative approaches to measurement, and (c) highlights important caveats in the interpretation of heart rate variability. Summary guidelines for research in this area are outlined, and suggestions and prospects for future developments are considered.

Beat-to-beat variation of heart rate in diabetic patients with autonomic neuropathy and in completely cardiac denervated patients following orthotopic heart transplantation

Dysfunction of the vagal nerve, an early symptom in the development of autonomic neuropathy, can be assessed reliably by the beat-to-beat variation in heart rate. Patients after a cardiac transplantation are a unique model to investigate the beat-to-beat variation of a completely denervated heart. Heart rate and the beat-to-beat variation during normal and deep respiration were investigated in diabetic subjects with an autonomic neuropathy (n = 10), age and sex matched healthy controls (n = 10) and cardiac transplanted patients (n = 10). Further studies during pharmacological blockade of the parasympathetic nervous system with atropine were performed. In the denervated heart the coefficient of variation of the beat-to-beat interval was 0.38 +/- 0.02% during normal respiration, compared to 1.32 +/- 0.13% (P less than 0.0001) and 2.56 +/- 0.13% (P less than 0.0001) in the diabetic and control subjects, respectively. Administration of atropine (2 mg intravenously) decreased the coefficient of variation of the RR-interval to 0.73 +/- 0.09% in the diabetic patients (P less than 0.0005) and to 0.67 +/- 0.07% in the controls (P less than 0.0001), whereas the coefficient of variation remained unaffected in the cardiac denervated patients (0.39 +/- 0.02%). In the three groups an almost parallel increase of the RR-variation was observed during deep respiration at a rate of 6 breaths/min (from 0.38 +/- 0.02% to 1.99 +/- 0.38% in cardiac transplanted patients, P less than 0.0025; from 1.32 +/- 0.13% to 3.10 +/- 0.43% in diabetic patients, P less than 0.0025; from 2.56 +/- 0.13% to 5.42 +/- 0.94% in healthy controls, P less than 0.005). We conclude that a beat-to-beat variation of heart rate is present in the completely denervated heart. This RR-variation can not be influenced by a pharmacological blockade of the parasympathetic nervous system with atropine. The beat-to-beat variation increases during deep respiration not only in healthy controls but also in diabetic patients with autonomic neuropathy (partially denervated hearts) and cardiac transplanted patients (completely denervated hearts). This indicates an intracardiac mechanism in the modulation of heart rate.

Effect of acute intravenous volume loading on haemodynamics and aortic baroreceptor activity in dogs

This study evaluates the effect of acute intravenous volume loading on haemodynamics and aortic baroreceptor activity in order to determine the mechanistic factors responsible for divergent heart rate responses to volume loading. Eleven beagles were anaesthetized and instrumented for the recording of aortic pressure, diameter, flow and aortic baroreceptor activity. Isotonic saline, equal to 20% of the estimated blood volume, was infused intravenously within 60-90 s. The animals were divided into tachycardiac and bradycardic groups according to their heart rate response to volume loading. In the group developing the tachycardic response, aortic baroreceptor activity increased. Total peripheral resistance was reduced by 31% and variables representing aortic stretch, mean aortic pressure, diameter and tension remained unchanged. In contrast, in the group developing the bradycardiac response, aortic baroreceptor activity increased markedly. Also in this group peripheral resistance decreased, but only by 15%, which was significantly less than in the tachycardiac group. Factors determining aortic stretch, mean aortic pressure, diameter and tension also increased significantly. Earlier studies show that regardless of the resulting heart rate response, atrial receptor activity increases during volume loading. Thus, we conclude that during cardiac acceleration, marked peripheral vasodilation eliminates the stimulation of baroreceptors and therefore the tachycardic response caused by atrial receptors develops. In the case of cardiac slowing, vasodilation also takes place, but is not sufficient to prevent activation of baroreceptors. In consequence, increased baroreceptor activity overrides the tachycardic drive coming from the atrial receptors and a typical baroreceptor reflex becomes manifested.

Reflex tracheal contraction during pulmonary venous congestion in the dog

1. The effect of pulmonary venous congestion on tracheal tone was studied in dogs anaesthetized with alpha-chloralose. Pulmonary venous congestion was produced by partial obstruction of the mitral valve to increase left atrial pressure by 10 mmHg. Tracheal tone was measured in vivo by an isometric force displacement method. 2. Tracheal tone increased by 6.3 +/- 0.3 g from a control level of 91.6 +/- 2.8 g when left atrial pressure was increased by 10.5 +/- 0.3 mmHg. This response was abolished by cooling the cervical vagi to 8 degrees C at a point caudal to the origin of the superior laryngeal nerves. Also, sectioning the superior laryngeal nerves abolished this increase in tracheal tone. 3. Afferent activity recorded from rapidly adapting receptors of the airways increased significantly during pulmonary venous congestion. This increase in activity was abolished by cooling the vagi caudal to the recording site to 8-9 degrees C. 4. Administration of propranolol (0.5 mg/kg) failed to abolish this increase in tracheal tone while atropine (3 mg/kg) did so. 5. Stimulation of left atrial receptors without an increase in left atrial pressure and stimulation of right atrial receptors with and without increases in right atrial pressure did not cause any change in tracheal tone. 6. It is suggested that pulmonary venous congestion is associated with a reflex increase in tracheal tone, the afferent limb of which is formed by pulmonary receptors discharging into myelinated fibres in the cervical vagi and the efferent limb by parasympathetic cholinergic fibres in the superior laryngeal nerves. The afferent receptors are likely to be the rapidly adapting receptors. This reflex may be of importance in the development of the respiratory symptoms associated with left ventricular failure.

Cardiac sympathetic afferent input onto neurons in nucleus ventralis posterolateralis in cat thalamus

Neurons receiving cardiac sympathetic afferent input were studied in the nucleus ventralis posterolateralis (VPL) of the cat thalamus. Animals were anesthetized with urethan-chloralose. Units in the VPL were classified into 3 classes; low-threshold mechanoreceptive (LTM), nociceptive specific (NS) and wide dynamic range (WDR) units. Units driven by electrical stimulation of the left inferior cardiac nerve (ICN) were not included in the population of LTM units, but 43.5% of NS units and 68.8% of WDR units were excited by this stimulation. Units exclusively responsive to cardiac sympathetic afferents were not found. Both NS and WDR units were located in the shell region of the caudal VPL. NS units responsive to cardiac sympathetic afferents had a circumscribed cutaneous receptive field in the area corresponding to tactile dermatomes C5-T13. WDR units receiving cardiac sympathetic afferent input had at least a part of their receptive fields in the same area. These results suggest that the shell region of the caudal VPL constitutes a thalamic link in a cardiac pain pathway, and that cardiac and cutaneous pain systems share a common projection locus in the VPL.

Tracing of afferent and efferent pathways in the left inferior cardiac nerve of the cat using retrograde and transganglionic transport of horseradish peroxidase

Retrograde and transganglionic transport of horseradish peroxidase (HRP) was used to trace afferent and efferent pathways in the left inferior cardiac nerve of the cat. Cardiac efferent and afferent neurons were located, respectively, in the stellate ganglion (average cell count per experiment:2679) and in the ipsilateral dorsal root ganglia (DRG) from C8 to T9 (average cell count per experiment:213). Labeled cardiac afferent projections to the spinal cord were most dense in segments T2-T6 where they were located in Lissauer's tract and in lamina 1 on the lateral border of the dorsal horn. Labeled afferent axons extended ventrally through lamina 1 into lamina 5 and the dorsolateral region of lamina 7 in proximity to the intermediolateral nucleus. A weak projection was noted on the medial side of the dorsal horn. These sites of termination are similar to projections by other sympathetic afferent pathways (i.e. renal, hypogastric and splanchnic nerves) to the lower thoracic and lumbar spinal cord, indicating that visceral afferents may have a uniform pattern of termination at various segmental levels. This pattern of termination in regions of the gray matter containing spinothalamic tract neurons and neurons involved in autonomic mechanisms is consistent with the known functions of sympathetic afferent pathways in nociception and in the initiation of autonomic reflexes.

Properties of mechanoreceptor afferent fibres in left inferior cardiac nerve

Single afferent fibres with receptive field in the heart chambers and great vessels were dissected from the thoracic sympathetic chain. The fibres were identified by the electrical stimulation of the left inferior cardiac nerve, which was left in continuity with the heart. Fifty-six percent of the afferent fibres from the left inferior cardiac nerve were spontaneously active, the rest was silent. The spontaneously active fibres with receptive field in the aorta or left ventricle fired in close relation to the cardiac cycle as revealed by constructing post-R-wave time histogram of their activity. Fibres with cardiac rhythmicity were all myelinated. The second group of the spontaneously active fibres had their receptive field in the left atrium. The activity of these fibres was slightly or not at all correlated with cardiac cycle. They were both myelinated fibres.

Patterns of reflex action, their autonomic components, and their behavioral significance

This is a discussion of the evidence that autonomic system reflexes are invariably triggered by stimuli that evoke both simple and complex somatic reflexes. Stimuli not only initiate reverberatory activity but sequences of reinforcements from higher centers. Reflexes come in chains, one reaction triggering another. Reflex actions are patterned, and these patterns are appropriate to the behavioral requirement indicated by stimuli. Reciprocal action produces a powerful braking or stimulatory action. Coactivation or synergic action of autonomic "antagonists" also occurs and can effect a greater cardiac output in certain vascular reflexes that can sympathetic action alone. Coactivation of vagus and sympathetic fibers occurring in reflex action or resulting from stimulation of specific areas in the hypothalamus has a physiologic importance to attainment of maximal cardiac function. Finally, two additional suggestions are made: (1) that the rhythmic reflex feedback discharge of the vagus from the baroreceptors aids in maintaining the regularity of cardiac rhythm as by interaction of oscillators and (2) that the autonomic system, due to its early and often conditioned response, can be determinative as well as modulatory and supportive of behavior.

Distension of pulmonary vein--left atrial junction: heart rate responses in conscious and anesthetized dogs

The cardiac chronotropic effects of distension of pulmonary vein-left atrial junction were investigated in conscious dogs and in dogs anesthetized with intravenous alpha-chloralose (100 mg/kg) or pentobarbital (30 mg/kg). All the experiments were made on trained, chronically instrumented, closed chest animals held in horizontal position. Inflation of a single small balloon in the junction elicited a tachycardic response both in conscious and chloralose-anesthetized dogs, while in pentobarbital anesthesia no change in heart rate was found. Contrary to reports of other investigators, no transient bradycardia was found, nor any correlation between predistension heart rate and the increase in heart rate due to the distension. It is suggested that the choice of anesthetic can be done only after its modifying effect on the parameter studied is known. Only the use of trained, chronically instrumented and conscious dogs will reveal this effect.

Influence of intravenous infusion on heart rate, sympathetic and vagal efferentation and left atrial and aortic baroreceptor activity in dogs

The influence of 42 i.v. infusions of saline on heart rate, sympathetic and vagal cardiac efferent activity and on the aortic baroreceptor and left atrial B-type nerve impulse activity was studied in 32 morphine-chloralose anesthetized dogs. The responses in heart rate were tachycardic in 31 infusions and bradycardic in 11 infusions. In tachycardia, sympathetic activity increased in a majority of the cases but also decreases and nonsignificant changes were observed. Vagal efferentation decreased in most of the cases but also nonsignificant changes or increases in activity occurred. Sympathetic efferentation mainly decreased in bradycardic responses while vagal efferentation diverged in different directions in its nerve activity rate. The ratio of sympathetic to vagal impulses significantly correlated to the heart rate in most of the cases in tachycardia but not in bradycardia. It is concluded that sympathetic and vagal cardiac efferentation plays a significant role in heart rate regulation in volume load-induced tachycardia but in bradycardia only the changes in sympathetic cardiac efferentation are important in respect to heart rate changes. The aortic baroreceptor and left atrial B-type receptor activity rate increased both in tachycardia and bradycardia. Changes in the activities of these receptors do not explain the different heart rate responses. It is supposed that bradycardic responses result from changes in cardiac contraction associated with some reflex mechanism suppressing the excitatory influence of the activity of atrial receptors on sympathetic cardiac efferentation.

Influence of atrial stretch receptors on hypothalamic neurosecretory neurones

1. The effects of stimulation of atrial receptors on hypothalamic neurosecretory cells were investigated in anaesthetized dogs and cats. Atrial receptors were activated by stretching the left and the right atria while action potentials of individual neurosecretory neurones in the supraoptic (s.o.n.) and paraventricular (p.v.m.) nuclei of the hypothalamus were recorded. 2. Stretching the left atrium markedly decreased firing frequencies of 'antidromically identified' s.o.n. and p.v.n. neurones in dogs and cats; 98% of neurones in dogs and 70% in cats were thus inhibited. Heart rate accelerated following a transient reflexly induced deceleration. The blood pressure was not affected. The magnitude and duration of inhibitory effects produced by atrial stretch on s.o.n. and p.v.n. neurones paralleled changes observed in heart rate. Approximately one third of 'unidentified' cells in s.o.n. and p.v.n. (those which could not be activated antidromically) were inhibited by left atrium stretch. 3. Bilateral vagotomy abolished the effects on neurosecretory neurones as well as on heart rate produced by left atrial stretch, indicating that the vagus nerves carry afferent impulses responsible for the observed changes. 4. Stretching the right atrium did not produce changes in firing frequencies of s.o.n. and p.v.n. neurones in dogs and cats, although cardiac rate was increased considerably by such stretch. Stimulation of the left and right atria was tested in the same animal in succession to permit comparison of the diverse results. 5. Interaction of responses originating from atrial receptors, baro- and chemoreceptors were studied. During carotid occlusion or stimulation of chemoreceptors activity of the neurosecretory cells was greatly augmented. Left atrial stretch when then applied evoked slight or no reduction in activity in s.o.n. and p.v.n. neurones. These results were interpreted to mean that the influence of baro- or chemoreceptors on neurosecretory neurones probably is stronger than that originating from atrial receptors. 6. Unlike the observations made in rats, no rhythmically bursting neurones (phasic cells) were found in dogs and cats. However, atrial stretch sometimes evoked a rhythmic bursting pattern which appeared only during stretch. 7. It is concluded that activation of left atrial receptors, through afferent impulses carried mainly by vagus nerves, inhibits neurosecretory neurones in s.o.n. and p.v.n. The implications of this finding in relation to the role of ADH in the maintenance of blood volume control were discussed.

Study of cardiac sympathetic and vagal efferent activity during reflex responses produced by stretch of the atria

(1) In chloralose anesthetized dogs, effects of the left and the right atrial stretch were studied in the same animal. Stretch of the sino-atrial region of the right atrium produced acceleration of the heart rate during, and reversal of response at the termination of, the stretch. Stretch of the left pulmonary vein-atrial junctional region evoked an initial decrease followed by an increase in heart rate. The responses were similar in all animals, despite initial heart rates ranging from 120 to 200 beats per minute. (2) Activity in vagal and sympathetic nerve branches innervating the heart was recorded simultaneously. Care was taken to identify the vagal fibers innervating the heart, and record their activity without contamination of sympathetic impulses. The right atrial stretch evoked an augmentation of sympathetic activity which reached its peak at 20 sec after the beginning of stimulus. The stimulus slightly increased the vagal activity; this change occurred slowly and reached its peak in about 40-60 sec after stretch. At the release of stretch, sympathetic activity generally showed a reversal of response, i.e. activity was inhibited for 30 sec. (3) Stretch of the left atrium produced biphasic changes in cardiac sympathetic nerves; their activity was strongly inhibited for the first 15 sec, then augmented throughout the remainder of the stretch. This effect lasted 30 sec after the cessation of stimulus. Effects on vagal cardiac nerve fibers were smaller; mild augmentation in activity was produced. The onset of this effect was faster than that seen in case of the right atrium stretch. (4) Reciprocal action between vagal and sympathetic cardiac nerves was obvious only in the early phase of left atrium stretch. Effects on the heart were determined by balances in activity of these antagonistic nerves. In contrast with what occurred in cardiac reflexes, carotid sinus distension even in the same animal produced a large increase in vagal activity, and near complete inhibition of sympathetic nerve activity. Thus, good reciprocal action between the two sets of nerves was demonstrated. A difference in the two types of reflexes was thus revealed. (5) Stretch of the right atrium evoked during carotid sinus distension caused an increase in heart rate from the new low level which was produced by baroreceptor activation. Vagal activity which was greatly augmented by sinus distension was decreased by atrial stretch, while previously inhibited sympathetic activity due to sinus distension was augmented by stretch of the atrium. The effect of stretch on vagal activity seems to depend to a degree on the prestimulus level. It is of interest that the powerful baroreceptor reflexes do not mask the cardiac reflexes studied. (6) The relative importance of sympathetic and vagal efferents to atrial stretch reflexes was discussed.

Reduction in baroreflex cardiovascular responses due to venous infusion in the rabbit

We studied reflex bradycardia and depression of mean arterial blood pressure (MAP) during left aortic nerve (LAN) stimulation before and after volume infusion in the anesthetized rabbit. Step increases in mean right atrial pressure (MRAP) to 10 mm Hg did not result in a significant change in heart rate or MAP. After volume loading, responses to LAN stimulation were not as great and the degree of attenuation was propoetional to the level of increased MRAP. A change in responsiveness was observed after elevation of MRAP by only 1 mm Hg, corresponding to less than a 10% increase in average calculated blood volume. after an increase in MRAP of 10 mm Hg, peak responses were attenuated by 44% (heart rate) and 52% (MAP), and the initial slopes (rate of change) were reduced by 46% (heart rate) and 66% (MAP). Comparison of the responses after infusion with blood and dextran solutions indicated that hemodilution was an unlikely explanation for the attenuation of the reflex responses. Total arterial baroreceptor denervation (ABD) abolished the volume-related attenuation was still present following bilateral aortic nerve section or vagotomy. It thus appears that the carotid sinus responds to changes inblood volume and influences the reflex cardiovascular responses to afferent stimulation of the LAN. On the other hand, cardiopulmonary receptors subserved by vagal afferents do not appear to be involved.