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Dikshit MB. Cardiovascular Responses to Commonly Used Tests in and Outside of the Laboratory Settings. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2022. [DOI: 10.1055/s-0042-1744391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractSeveral tests are available for assessing cardiovascular response to various interventions which may be given in the laboratory, or outside of it in the field. The tests are meant to excite or deactivate cardiovascular and other sensory receptors which signal the central mechanisms. They have been found useful in generating data to study cardiovascular effects on subjects exposed to specialized physical training (e.g., athletes), in the evaluation of people engaged in special occupations such as pilots, astronauts, and other military personnel, and in training undergraduate and postgraduate students. If the response does not fit into the physiological norm, it may reflect a temporary aberration, or a more serious defect in the cardiovascular control mechanism because of disease. Interpretation of data generated may vary between various operators/observers. Here, an attempt has been made to bring out responses of the cardiovascular system to the commonly used tests, and their applicability in clinical situations.
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Affiliation(s)
- Mohan B. Dikshit
- Formerly Department of Physiology and Clinical Physiology, College of Medicine and Sultan Qaboos Hospital, Sultan Qaboos University, Muscat, Oman
- Formerly Department of Physiology, Maharashtra Institute of Medical Education and Research Medical College, Pune, Maharashtra, India
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Rivera AL, Estañol B, Macias-Gallardo JJ, Delgado-Garcia G, Fossion R, Frank A, Torres-Villalobos GM. Cardiovascular dysautonomia in Achalasia Patients: Blood pressure and heart rate variability alterations. PLoS One 2021; 16:e0248106. [PMID: 33720957 PMCID: PMC7959365 DOI: 10.1371/journal.pone.0248106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 02/20/2021] [Indexed: 01/11/2023] Open
Abstract
Achalasia is a disease characterized by the inability to relax the esophageal sphincter due to a degeneration of the parasympathetic ganglion cells located in the wall of the thoracic esophagus. Achalasia has been associated with extraesophageal dysmotility, suggesting alterations of the autonomic nervous system (ANS) that extend beyond the esophagus. The purpose of the present contribution is to investigate whether achalasia may be interpreted as the esophageal manifestation of a more generalized disturbance of the ANS which includes alterations of heart rate and/or blood pressure. Therefore simultaneous non-invasive records of the heart inter-beat intervals (IBI) and beat-to-beat systolic blood pressure (SBP) of 14 patients (9 female, 5 male) with achalasia were compared with the records of 34 rigorously screened healthy control subjects (17 female, 17 male) in three different conditions: supine, standing up, and controlled breathing at 0.1 Hz, using a variety of measures in the time and spectral domains. Significant differences in heart rate variability (HRV) and blood pressure variability (BPV) were observed which seem to be due to cardiovagal damage to the heart, i.e., a failure of the ANS, as expected according to our hypothesis. This non-invasive methodology can be employed as an auxiliary clinical protocol to study etiology and evolution of achalasia, and other pathologies that damage ANS.
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Affiliation(s)
- Ana Leonor Rivera
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Ciudad Universitaria, Coyoacan, Mexico City, Mexico
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad Universitaria, Coyoacan, Mexico City, Mexico
- * E-mail:
| | - Bruno Estañol
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad Universitaria, Coyoacan, Mexico City, Mexico
- Department of Neurology and Psychiatry and Clinical Neurophysiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Julio J. Macias-Gallardo
- Department of Neurology and Psychiatry and Clinical Neurophysiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | | | - Ruben Fossion
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Ciudad Universitaria, Coyoacan, Mexico City, Mexico
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad Universitaria, Coyoacan, Mexico City, Mexico
| | - Alejandro Frank
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Ciudad Universitaria, Coyoacan, Mexico City, Mexico
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad Universitaria, Coyoacan, Mexico City, Mexico
- El Colegio Nacional, Centro Histórico, Mexico City, Mexico
| | - Gonzalo M. Torres-Villalobos
- Department of Experimental Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
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Vranish JR, Young BE, Stephens BY, Kaur J, Padilla J, Fadel PJ. Brief periods of inactivity reduce leg microvascular, but not macrovascular, function in healthy young men. Exp Physiol 2018; 103:1425-1434. [PMID: 30110509 DOI: 10.1113/ep086918] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 06/18/2018] [Indexed: 01/21/2023]
Abstract
NEW FINDINGS What is the central question of this study? We aimed to examine leg vascular responses to brief periods of inactivity. What is the main finding and its importance? We demonstrate that a mere 10 min of sitting is sufficient to impair leg microvascular function (reactive hyperaemia). However, conduit artery vasodilatation (flow-mediated dilatation) was unaffected, indicating maintained macrovascular function. Interestingly, immobile supine rest also resulted in a reduction in microvascular function alone that was prevented when calf muscle contractions were performed. Collectively, these data highlight the susceptibility of the microcirculation to short periods of inactivity and the beneficial role of skeletal muscle contraction for vascular health. ABSTRACT Prolonged sitting for 1-6 h has been shown to impair leg macrovascular [i.e. reduced flow-mediated dilatation (FMD)] and microvascular (i.e. reduced reactive hyperaemia) function. These impairments appear to be mediated through reductions in shear stress. Interestingly, a reduction in shear rate has been observed as early as 10 min into sitting. However, it is unknown whether this acute reduction in shear stress is sufficient to affect vascular function. Accordingly, we studied 18 young men and assessed popliteal artery FMD and reactive hyperaemia before (Baseline) and after (PostSit) a 10 min sitting period. Popliteal artery shear rate was significantly reduced during sitting (Baseline, 62 ± 35 s-1 ; 10 min sitting, 27 ± 13 s-1 ; P < 0.001). Macrovascular function was unaffected by 10 min of sitting (Baseline, 4.4 ± 2.1%; PostSit, 4.3 ± 2.3%; P = 0.97), but microvascular function was reduced (Baseline, 4852 ± 2261 a.u.; PostSit, 3522 ± 1872 a.u.; P = 0.02). In a subset of individuals, we extended the recovery period after sitting and demonstrated that resting shear rate and reactive hyperaemia responses remained low up to 1 h post-sitting (P < 0.001), whereas FMD was unchanged throughout (P = 0.99). Additionally, time control experiments were performed with participants in an immobile supine position, which demonstrated no change in macrovascular function (P = 0.94) but, unexpectedly, a reduction in microvascular function (P = 0.008). Importantly, when calf muscle contractions were performed during supine rest, reactive hyperaemia responses were maintained (P = 0.76), along with FMD (P = 0.88). These findings suggest that the leg microcirculation might be more vulnerable to short periods of inactivity, whereas conduit artery vasodilatation appears well maintained. Moreover, intermittent skeletal muscle contractions are beneficial for microvascular function.
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Affiliation(s)
- Jennifer R Vranish
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA
| | - Benjamin E Young
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA
| | - Brandi Y Stephens
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA
| | - Jasdeep Kaur
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA
| | - Jaume Padilla
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, USA.,Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, USA.,Department of Child Health, University of Missouri, Columbia, MO, USA
| | - Paul J Fadel
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA
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Estañol B, Rivera AL, Martínez Memije R, Fossion R, Gómez F, Bernal K, Murúa Beltrán S, Delgado-García G, Frank A. From supine to standing: in vivo segregation of myogenic and baroreceptor vasoconstriction in humans. Physiol Rep 2017; 4:4/24/e13053. [PMID: 28039403 PMCID: PMC5210387 DOI: 10.14814/phy2.13053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 10/30/2016] [Indexed: 11/24/2022] Open
Abstract
Myogenic vascular response is a form of systemic and regional vasoconstriction produced increasing the intra‐arterial pressure by gravity. Here, the vasoconstriction due to the myogenic response, induced by the gravitational action in a dependent limb, is separated from that caused by the baroreceptor reflex. Regional changes of skin blood flow (SBF), total blood volume of the finger (TBVF), pulse pressure (PP), heart rate (HR), systolic, and diastolic blood pressure (BP) were analyzed in 10 healthy young subjects in supine and upright positions. By lowering the arm in supine position, SBF decreased compared to its basal measurement, PR increased, and PP contracted, indicating arterial vasoconstriction that rise BP. TBVF increased, demonstrating an increment in venous volume. HR did not change, reflecting no action of the baroreceptor reflex. In upright position with lowered arm, there was an additional increase in BP variables, demonstrating vasoconstriction. Moreover, BP and HR showed oscillations at 0.1 Hz reflecting the entrance of the baroreceptor reflex. The action of gravity in a dependent limb in supine position induces a regional vasoconstriction and an increase of BP due to activation of the myogenic response, while the baroreceptor reflex or other neural factors do not appear to operate. In the upright position with the arm dependent, there is a further increase in regional vasoconstriction and BP with reciprocal changes in HR, indicating the entrance of the baroreceptor superimposed to the myogenic response. This study demonstrates that the myogenic and baroreceptor vasoconstriction can be separated in vivo.
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Affiliation(s)
- Bruno Estañol
- Laboratorio de Neurofisiología Clínica, Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México.,Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, México City, México
| | - Ana Leonor Rivera
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, México City, México .,Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, México City, México
| | - Raúl Martínez Memije
- Departamento de Instrumentación Electromecánica, Instituto Nacional de Cardiología, México City, México
| | - Ruben Fossion
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, México City, México.,Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, México City, México
| | - Fermín Gómez
- Laboratorio de Neurofisiología Clínica, Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Katherine Bernal
- Laboratorio de Neurofisiología Clínica, Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Sofía Murúa Beltrán
- Laboratorio de Neurofisiología Clínica, Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Guillermo Delgado-García
- Laboratorio de Neurofisiología Clínica, Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México .,Departamento de Medicina Interna, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Alejandro Frank
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, México City, México.,Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, México City, México.,Colegio Nacional, México City, México
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