Droxidopa improves orthostatic intolerance symptoms in low and normal supine blood pressure phenotypes of vasovagal syncope

2015 ◽  
Vol 192 ◽  
pp. 100 ◽  
Author(s):  
S.J. Corcoran ◽  
C.I. Sari ◽  
E. Lambert ◽  
N.E. Straznicky ◽  
G. Hamilton ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Orthostatic Intolerance ◽  
Vasovagal Syncope ◽  
Supine Blood Pressure

Different haemodynamic patterns in head-up tilt test on 400 paediatric cases with unexplained syncope

2014 ◽  
Vol 25 (5) ◽  
pp. 911-917 ◽  
Author(s):  
Yilmaz Yozgat ◽  
Cem Karadeniz ◽  
Rahmi Ozdemir ◽  
Onder Doksoz ◽  
Mehmet Kucuk ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Orthostatic Intolerance ◽  
Vasovagal Syncope ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Response Patterns ◽  
Baseline Blood Pressure ◽  
Test Protocol ◽  
Tilt Testing ◽  
Head Up Tilt ◽  
Unexplained Syncope

AbstractObjective: To assess haemodynamic patterns in head-up tilt testing on 400 paediatric cases with unexplained syncope. Methods: Medical records of 520 children who underwent head-up tilt testing in the preceding year were retrospectively evaluated, and 400 children, 264 (66%) girls and 136 (34%) boys, aged 12.6±2.6 years (median 13; range 5–18), with unexplained syncope were enrolled in the study. Age, sex, baseline heart rate, baseline blood pressure, frequency of symptoms, and/or fainting attacks were recorded. The test protocol consisted of 25 minutes of supine resting followed by 20 minutes of 70° upright positioning. Subjects were divided into nine groups according to their differing haemodynamic patterns. Results: There were no statistically significant differences between the groups with regard to age, gender, baseline blood pressure, and frequency of syncope (p>0.05). The response was compatible with orthostatic intolerance in 28 cases (7.0%), postural orthostatic tachycardia syndrome in 24 cases (6.0%), asymptomatic postural orthostatic tachycardia syndrome in 26 cases (6.5%), orthostatic hypotension in seven cases (1.7%), vasovagal syncope in 38 cases (9.5%), and negative in 274 cases (69.2%). Vasovagal syncope response patterns were of type 3 in nine cases (2.2%), type 2A in 10 cases (2.5%), type 2B in two cases (0.5%), and type 1 (mixed) in 17 cases (4.25%). Conclusions: In the 400 paediatric cases with unexplained syncope, nine different haemodynamic response patterns to head-up tilt testing were discerned. Children with orthostatic intolerance syndromes are increasingly referred to hospitals because of difficulty in daily activities. Therefore, there is need for further clinical trials in these patient groups.

scholarly journals The diagnostic value of supine blood pressure in hypertension

2016 ◽  
Vol 2 ◽  
pp. 310-318 ◽  
Author(s):  
Paweł Krzesiński ◽  
Adam Stańczyk ◽  
Grzegorz Gielerak ◽  
Katarzyna Piotrowicz ◽  
Małgorzata Banak ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diagnostic Value ◽  
Supine Blood Pressure

scholarly journals Autonomic dysfunction in post-COVID patients with and witfhout neurological symptoms: a prospective multidomain observational study

2021 ◽  
Author(s):  
Alex Buoite Stella ◽  
Giovanni Furlanis ◽  
Nicolò Arjuna Frezza ◽  
Romina Valentinotti ◽  
Milos Ajcevic ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Orthostatic Intolerance ◽  
Neurological Symptoms ◽  
Postural Tachycardia Syndrome ◽  
Symptom Scale ◽  
Autonomic Symptom ◽  
Postural Tachycardia ◽  
Ambulatory Services

AbstractThe autonomic nervous system (ANS) can be affected by COVID-19, and dysautonomia may be a possible complication in post-COVID individuals. Orthostatic hypotension (OH) and postural tachycardia syndrome (POTS) have been suggested to be common after SARS-CoV-2 infection, but other components of ANS function may be also impaired. The Composite Autonomic Symptom Scale 31 (COMPASS-31) questionnaire is a simple and validated tool to assess dysautonomic symptoms. The aim of the present study was to administer the COMPASS-31 questionnaire to a sample of post-COVID patients with and without neurological complaints. Participants were recruited among the post-COVID ambulatory services for follow-up evaluation between 4 weeks and 9 months from COVID-19 symptoms onset. Participants were asked to complete the COMPASS-31 questionnaire referring to the period after COVID-19 disease. Heart rate and blood pressure were manually taken during an active stand test for OH and POTS diagnosis. One-hundred and eighty participants were included in the analysis (70.6% females, 51 ± 13 years), and OH was found in 13.8% of the subjects. Median COMPASS-31 score was 17.6 (6.9–31.4), with the most affected domains being orthostatic intolerance, sudomotor, gastrointestinal and pupillomotor dysfunction. A higher COMPASS-31 score was found in those with neurological symptoms (p < 0.01), due to more severe orthostatic intolerance symptoms (p < 0.01), although gastrointestinal (p < 0.01), urinary (p < 0.01), and pupillomotor (p < 0.01) domains were more represented in the non-neurological symptoms group. This study confirms the importance of monitoring ANS symptoms as a possible complication of COVID-19 disease that may persist in the post-acute period.

scholarly journals Refined Multiscale Fuzzy Entropy to Analyse Post-Exercise Cardiovascular Response in Older Adults With Orthostatic Intolerance

Entropy ◽  
2018 ◽  
Vol 20 (11) ◽  
pp. 860 ◽  
Author(s):  
Marcos Hortelano ◽  
Richard Reilly ◽  
Francisco Castells ◽  
Raquel Cervigón
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Orthostatic Intolerance ◽  
Cardiovascular Response ◽  
Recovery Period ◽  
The Elderly ◽  
Fuzzy Entropy ◽  
Post Exercise ◽  
And Gender ◽  
Risk Factors For Falls

Orthostatic intolerance syndrome occurs when the autonomic nervous system is incapacitated and fails to respond to the demands associated with the upright position. Assessing this syndrome among the elderly population is important in order to prevent falls. However, this problem is still challenging. The goal of this work was to determine the relationship between orthostatic intolerance (OI) and the cardiovascular response to exercise from the analysis of heart rate and blood pressure. More specifically, the behavior of these cardiovascular variables was evaluated in terms of refined composite multiscale fuzzy entropy (RCMFE), measured at different scales. The dataset was composed by 65 older subjects, 44.6% (n = 29) were OI symptomatic and 55.4% (n = 36) were not. Insignificant differences were found in age and gender between symptomatic and asymptomatic OI participants. When heart rate was evaluated, higher differences between groups were observed during the recovery period immediately after exercise. With respect to the blood pressure and other hemodynamic parameters, most significant results were obtained in the post-exercise stage. In any case, the symptomatic OI group exhibited higher irregularity in the measured parameters, as higher RCMFE levels in all time scales were obtained. This information could be very helpful for a better understanding of cardiovascular instability, as well as to recognize risk factors for falls and impairment of functional status.

scholarly journals Disruption of phase synchronization between blood pressure and muscle sympathetic nerve activity in postural vasovagal syncope

2013 ◽  
Vol 305 (8) ◽  
pp. H1238-H1245 ◽  
Author(s):  
Christopher E. Schwartz ◽  
Elisabeth Lambert ◽  
Marvin S. Medow ◽  
Julian M. Stewart
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Sympathetic Nerve ◽  
Sympathetic Nerve Activity ◽  
Phase Synchronization ◽  
Vasovagal Syncope ◽  
Muscle Sympathetic Nerve Activity ◽  
Nerve Activity ◽  
Control Subjects ◽  
Late Stages

Withdrawal of muscle sympathetic nerve activity (MSNA) may not be necessary for the precipitous fall of peripheral arterial resistance and arterial pressure (AP) during vasovagal syncope (VVS). We tested the hypothesis that the MSNA-AP baroreflex entrainment is disrupted before VVS regardless of MSNA withdrawal using the phase synchronization between blood pressure and MSNA during head-up tilt (HUT) to measure reflex coupling. We studied eight VVS subjects and eight healthy control subjects. Heart rate, AP, and MSNA were measured during supine baseline and at early, mid, late, and syncope stages of HUT. Phase synchronization indexes, measuring time-dependent differences between MSNA and AP phases, were computed. Directionality indexes, indicating the influence of AP on MSNA (neural arc) and MSNA on AP (peripheral arc), were computed. Heart rate was greater in VVS compared with control subjects during early, mid, and late stages of HUT and significantly declined at syncope ( P = 0.04). AP significantly decreased during mid, late, and syncope stages of tilt in VVS subjects only ( P = 0.001). MSNA was not significantly different between groups during HUT ( P = 0.700). However, the phase synchronization index significantly decreased during mid and late stages in VVS subjects but not in control subjects ( P < .001). In addition, the neural arc was significantly affected more than the peripheral arc before syncope. In conclusion, VVS is accompanied by a loss of the synchronous AP-MSNA relationship with or without a loss in MSNA at faint. This provides insight into the mechanisms behind the loss of vasoconstriction and drop in AP independent of MSNA at the time of vasovagal faint.

Pet CO2 inversely affects MSNA response to orthostatic stress

2001 ◽  
Vol 281 (3) ◽  
pp. H1040-H1046 ◽  
Author(s):  
J. Kevin Shoemaker ◽  
Debbie D. O'Leary ◽  
Richard L. Hughson
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Output ◽  
Orthostatic Intolerance ◽  
Muscle Sympathetic Nerve Activity ◽  
Peripheral Resistance ◽  
Burst Frequency ◽  
Head Up Tilt ◽  
End Tidal ◽  
Combined Data

Arterial hypocapnia has been associated with orthostatic intolerance. Therefore, we tested the hypothesis that hypocapnia may be detrimental to increases in muscle sympathetic nerve activity (MSNA) and total peripheral resistance (TPR) during head-up tilt (HUT). Ventilation was increased ∼1.5 times above baseline for each of three conditions, whereas end-tidal Pco 2 (Pet CO2 ) was clamped at normocapnic (Normo), hypercapnic (Hyper; +5 mmHg relative to Normo), and hypocapnic (Hypo; −5 mmHg relative to Normo) conditions. MSNA (microneurography), heart rate, blood pressure (BP, Finapres), and cardiac output (Q, Doppler) were measured continuously during supine rest and 45° HUT. The increase in heart rate when changing from supine to HUT ( P < 0.001) was not different across Pet CO2 conditions. MSNA burst frequency increased similarly with HUT in all conditions ( P < 0.05). However, total MSNA and the increase in total amplitude relative to baseline (%ΔMSNA) increased more when changing to HUT during Hypo compared with Hyper ( P < 0.05). Both BP and Q were higher during Hyper than both Normo and Hypo (main effect; P < 0.05). Therefore, the MSNA response to HUT varied inversely with levels of Pet CO2 . The combined data suggest that augmented cardiac output with hypercapnia sustained blood pressure during HUT leading to a diminished sympathetic response.

Is neurocardiovascular instability a risk factor for cognitive decline and/or dementia? The science to date

2007 ◽  
Vol 17 (3) ◽  
pp. 153-160 ◽  
Author(s):  
Orla Collins ◽  
Rose Anne Kenny
Keyword(s):  
Blood Pressure ◽  
Older People ◽  
Carotid Sinus ◽  
Vasovagal Syncope ◽  
Hypersensitivity Syndrome ◽  
Age Related ◽  
Co Morbidity ◽  
Criteria For Diagnosis ◽  
Rate Behaviour ◽  
Humoral Control

Neurocardiovascular instability (NCVI) is defined as ‘age-related changes in blood pressure and heart-rate behaviour, predominantly resulting in hypotension and bradyarrhythmia’ The four most common presentations of NCVI are orthostatic hypotension (OH), carotid sinus hypersensitivity/syndrome (CSH/CSS), vasovagal syncope (VVS) and post-prandial hypotension (PPH), although there is considerable overlap between these conditions. The criteria for diagnosis of these syndromes are given in Table 1. Clinically, these conditions manifest as dizziness, falls, pre-syncope and syncope. Older people are more susceptible to NCVI because of age-related physiological changes in the cardiovascular system, the autonomic nervous system, and humoral control of blood pressure. These neurocardiovascular changes are further complicated by co-morbidity and polypharmacy in older people.

scholarly journals Time-Frequency Analysis of Cardiovascular and Cardiorespiratory Interactions During Orthostatic Stress by Extended Partial Directed Coherence

Entropy ◽  
2019 ◽  
Vol 21 (5) ◽  
pp. 468 ◽  
Author(s):  
Sonia Charleston-Villalobos ◽  
Sina Reulecke ◽  
Andreas Voss ◽  
Mahmood R. Azimi-Sadjadi ◽  
Ramón González-Camarena ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Information Flow ◽  
Orthostatic Intolerance ◽  
Linear Method ◽  
Orthostatic Stress ◽  
Partial Directed Coherence ◽  
Sinus Arrhythmia ◽  
Time Frequency

In this study, the linear method of extended partial directed coherence (ePDC) was applied to establish the temporal dynamic behavior of cardiovascular and cardiorespiratory interactions during orthostatic stress at a 70° head-up tilt (HUT) test on young age-matched healthy subjects and patients with orthostatic intolerance (OI), both male and female. Twenty 5-min windows were used to analyze the minute-wise progression of interactions from 5 min in a supine position (baseline, BL) until 18 min of the orthostatic phase (OP) without including pre-syncopal phases. Gender differences in controls were present in cardiorespiratory interactions during OP without compromised autonomic regulation. However in patients, analysis by ePDC revealed considerable dynamic alterations within cardiovascular and cardiorespiratory interactions over the temporal course during the HUT test. Considering the young female patients with OI, the information flow from heart rate to systolic blood pressure (mechanical modulation) was already increased before the tilt-up, the information flow from systolic blood pressure to heart rate (neural baroreflex) increased during OP, while the information flow from respiration to heart rate (respiratory sinus arrhythmia) decreased during the complete HUT test. Findings revealed impaired cardiovascular interactions in patients with orthostatic intolerance and confirmed the usefulness of ePDC for causality analysis.

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