Why do patients with congestive heart failure stop exercising?
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Blood Circulation↗
Biomedical subjects
L I Sinoway
Publications and source records attributed to L I Sinoway.
Sympathetic tone affects human limb vascular resistance during a maximal metabolic stimulus.
To evaluate the relationship between heightened sympathetic tone and maximal metabolic vasodilation, peak forearm blood flow (ml.min-1.100 ml-1) was measured plethysmographically in 18 volunteers after the release of 10 min of arterial occlusion (the peak reactive hyperemic blood flow response, RHBF) both before and after a stimulus to induce heightened sympathetic tone. The stimulus was the application of ice to the forehead for 90 s just before and during RHBF measurements. Mean arterial cuff blood pressure (MAP; mmHg) was calculated, and corresponding resistance (R; mmHg.ml-1.min.100 ml) was derived from blood pressure divided by RHBF. During ice application, blood pressure rose (pre 92 vs. post 115 ml/mmHg; P less than 0.05), peak RHBF was unchanged (pre 38.8 vs. post 36.4 ml.min-1.100 ml-1; not significant), but R during the maximal metabolic stimulus rose (pre 2.5 vs. post 3.2 mmHg.ml-1.min.100 ml; P less than 0.05). To examine the effects of heightened sympathetic tone on conduit vessels, simultaneous measurements of maximal metabolic blood flow (RHBF) and brachial artery Doppler velocity (V, cm/s) were conducted (n = 5) with and without ice applied to the forehead. Velocity rose by 70% as flow remained constant. Thus brachial artery area (area = flow/velocity) and diameter decreased substantially (20% decrease in diameter). The increase in R noted with ice was due to an alpha-mediated response, since the increase in R was blocked by oral prazosin (n = 6) and was unaffected by maneuvers to alter myogenic tone (n = 5). We conclude that maximal metabolic vasodilation can be counteracted to some extent by the effects of heightened sympathetic tone. Moreover, some of the interaction between these two opposing influences takes place at the arterial level.
Adult↗
Acute cardiogenic pulmonary edema: clinical and noninvasive evaluation.
Left ventricular echocardiograms performed within ninety-six hours of admission were prospectively correlated with the clinical course in 87 consecutive patients admitted with acute pulmonary edema. Patients were stratified into four groups based on their two-dimensional echocardiogram: hyperdynamic, normal, mildly reduced, and severely reduced. Echocardiographic estimates of left ventricular function were compared with their ejection fraction measured by the gated radioisotope technique. The authors found that 48% of the patients were either normal or hyperdynamic (38% and 10% respectively). Patients in these two groups had a greater incidence of left ventricular hypertrophy (wall thickness greater than 13 mm) (66% vs 39%, p less than .05), hypertension on admission (BP greater than 160/100) (66% vs 41%, p = .05), and smaller end-diastolic dimension (p less than .05) than those with decreased left ventricular function. The authors conclude that echocardiography is a good screening test of left ventricular function in patients presenting with pulmonary edema. Patients with normal or increased left ventricular systolic function should be evaluated for correctable or treatable causes of acute pulmonary edema.
Acute Disease↗
A 30-day forearm work protocol increases maximal forearm blood flow.
To evaluate the local circulatory changes that accompany chronic localized work, we studied the effects of a 4-wk handgrip work protocol on maximal forearm work-related blood flow (ml X min-1 X 100 ml-1) in the nondominant forearms of six normal subjects. The reactive hyperemic blood flow response (RHBF) was also evaluated pre- and posttraining in both forearms of each subject to determine whether maximal vasodilatory capacity would be enhanced. In addition, maximal O2 consumption (VO2max) was measured. We found that chronic handgrip work led to an increase in work-related blood flow (before, 22.4; after, 32.1; P less than 0.05); a drop in work-related minimal resistance (R) (before, 6.4; after, 4.1; P less than 0.05). RHBF rose in the chronically exercised extremity by 30% (before, 33.5; after, 43.7; P less than 0.05) as minimal R fell (before, 3.2; after, 2.2; P less than 0.05). RHBF and R in the unstimulated dominant forearm remained unchanged (blood flow: before, 33.5; after, 31.0; NS; R before, 3.2; after, 3.2; NS). VO2max (ml X kg-1 X min-1) did not change (before, 35.7; after, 34.0). These findings show that localized skeletal muscle forearm work is associated with a localized increase in vasodilation (RHBF). Thus the vascular system appears to be an independent integral partner in the training process.
Adult↗
Effect of training/detraining on submaximal exercise responses in humans.
Human subjects participated in a training/detraining paradigm which consisted of 7 wk of intense endurance training followed by 3 wk of inactivity. In previously sedentary subjects, training produced a 23.9 +/- 7.2% increase in maximal aerobic power (V02max) (group S). Detraining did not affect group S V02max. In previously trained subjects (group T), the training/detraining paradigm did not affect V02max. In group S, training produced an increase in vastus lateralis muscle citrate synthase (CS) activities (nmol.mg protein-1. min-1) from 67.1 +/- 14.5 to 106.9 +/- 22.0. Detraining produced a decrease in CS activity to 80 +/- 14.6. In group T, pretraining CS activity (139.5 +/- 14.9) did not change in response to training. Detraining, however, produced a decrease in CS activity (121.5 +/- 7.8 to 66.8 +/- 5.9). Group S respiratory exchange ratios obtained during submaximal exercise at 60% V02max (R60) decreased in response to training (1.00 +/- 0.02 to 0.87 +/- 0.02) and increased (0.96 +/- 0.02) after detraining. Group T R60 (0.91 +/- 0.01) was not affected by training but increased (0.89 +/- 0.02 to 0.95 +/- 0.02) after detraining. R60 was correlated to changes in CS activity but was unrelated to changes in V02max. These data support the hypothesis that the mitochondrial content of working skeletal muscle is an important determinant of substrate utilization during submaximal exercise.
Adult↗
Norepinephrine kinetics during orthostatic stress in congestive heart failure.
To evaluate the determinants of the plasma norepinephrine (NE) response to orthostatic stress, NE kinetics were measured during steady-state infusion of [3H]NE of high-specific activity for two consecutive 90-minute periods; the first was supine, and the second was during 60 degrees head-up tilt. In 6 normal subjects, plasma NE increased from 242 to 570 pg/ml, and NE clearance decreased from 1.43 to 1.00 l/min X M2. In 6 patients with congestive heart failure, there was no significant change in plasma NE during orthostatic stress. This has been interpreted previously to indicate that there was little activation of the baroreflex arc. In fact, NE clearance decreased from 1.08 to 0.79 l/min X M2; however, there was a decrease in NE spillover from 4.04 to 2.88 nmol/min X M2. A reduction of organ blood flow with tilt could be responsible for the reduced NE clearance by both groups, but the mechanism for the reduction in NE spillover with tilt in congestive heart failure is unclear.
Adult↗
Enhanced maximal metabolic vasodilatation in the dominant forearms of tennis players.
In an effort to evaluate potential peripheral adaptations to training, maximal metabolic vasodilation was studied in the dominant and nondominant forearms of six tennis players and six control subjects. Maximal metabolic vasodilation was defined as the peak forearm blood flow measured after release of arterial occlusion, the reactive hyperemic blood flow (RHBF). Two ischemic stimuli were employed in each subject: 5 min of arterial occlusion (RHBF5) and 5 min of arterial occlusion coupled with 1 min of ischemic exercise (RHBF5ex). RHBF and resting forearm blood flows were measured using venous occlusion strain-gauge plethysmography (ml X min-1 X 100 ml-1). Resting forearm blood flows were similar in both arms of both groups. RHBF5ex was similar in both arms of our control group (dominant, 40.8 +/- 1.2 vs. nondominant, 40.9 +/- 2.1). However, RHBF5ex was 42% higher in the dominant than in the nondominant forearms of our tennis player population (dominant, 48.7 +/- 4.0 vs. nondominant, 34.4 +/- 3.4; P less than 0.05). This intraindividual difference in peak forearm blood flows was not secondary to improved systemic conditioning since the maximal O2 consumptions in the two study groups were similar (controls, 45.4 +/- 3.9 vs. tennis players, 46.1 +/- 1.7). These findings suggest a primary peripheral cardiovascular adaptation to exercise training in the dominant forearms of the tennis players resulting in a greater maximal vasodilatation.
Adult↗
Mean air space diameter, lung surface area and alveolar surface tension.
Results from pressure-volume studies indicate that lung surface area is directly proportional to volume rather than to volume raised to the two thirds power as has been assumed previously. Mean air space diameter was found to decline with an increase in lung volume which is indicative of a significant degree of alveolar recruitment. Calculation of alveolar surface tension during 20-min inflation-deflation cycles reveals a minimum surface tension of 15.9 +/- 2.3 and a maximum surface tension of 42.7 +/- 4.2 dyn/cm (mean +/- SE). Comparison of surface tensions obtained from the surface balance and calculated alveolar surface tension reveals no significant difference between the means and a significant correlation between the two values.
Animals↗
Insight into human baroreceptor function using multiple indices of neural activity.
Baroreflex control of sympathetic nervous system activation and circulatory homeostasis during orthostatic stress maneuvers has become the subject of increasing interest. In this paper, the use and limitation of multiple measurement modalities in the assessment of sympathetic nervous system activation during cardiopulmonary and combined arterial and cardiopulmonary baroreceptor disengagement in humans will be discussed. In addition, the implications of abnormal baroreceptor function in heart failure will be discussed.
Baroreflex↗