Optimization of premedication of patients with arterial hypertension and severe ventricular rhythm disturbances with Amiodarone-associated thyrotoxicosis

Introduction: The effectiveness of premedication of patients with arterial hypertension and severe ventricular rhythm disturbances against the background of Amiodarone-associated thyrotoxicosis, high anxiety and cyclothymiae disorders should be based on the pharmacological positions of the need to reduce the risk of dangerous adverse cardiovascular reactions. Materials and methods: During the research, a clinical group of 114 patients with arterial hypertension, severe ventricular arrhythmias and Amiodarone-associated type I thyrotoxicosis was formed: four subgroups were identified. In Subgroup 1 (n=22), no premedication was given. In Subgroup 2 (n=32), premedication was given with Diazepam and magnesium sulfate in a prolonged mode. In Subgroup 3 (n=30), the patients received Diazepam the day before surgery. In Subgroup 4 (n=30), premedication was given with Midazolam. A dynamic assessment of the severity of anxiety, depression, sedation and daily monitoring of blood pressure and ECG were carried out. Results and discussion: After surgery, in Subgroup 1, the level of anxiety and depression increased. In all other Subgroups, regardless of the type of premedication, the use of benzodiazepines was accompanied by a decrease in the level of anxiety after surgery. A decrease in pressure load and an increase in the stability of the parameters of systemic hemodynamics were registered in Subgroup 2 of patients, whereas in Subgroup 4 of patients, the pressure load increased while limiting the differences in blood pressure values during the day. After surgery, in Subgroup 2, cardiac rhythm disturbances were less common; in Subgroup 3, the structure of rhythmogenesis disturbances in the heart almost did not change, and in Subgroup 4, there was an unfavorable trend of an increase in the frequency of supraventricular, single and group ventricular extrasystoles. Conclusion: The prolonged premedication with long-acting benzodiazepines and magnesium preparations in patients with arterial hypertension, ventricular rhythm disturbances against the background of Amiodarone-associated thyrotoxicosis reduces the level of anxiety, as well as the risk of developing cardiovascular complications and instability of systemic hemodynamics.

Еffects of percutaneous electrical stimulation of the spinal cord in combination with mechanotherapy on changes in systemic and regional hemodynamics

Objective: to evaluate changes in systemic and cerebral hemodynamics during percutaneous electrical stimulation of the spinal cord and in combination of electrical stimulation with mechanotherapy. Methodology. The subjects underwent percutaneous electrical stimulation of the spinal cord, the duration of the session was 5 minutes. Mechanotherapy was performed using a treadmill. The subjects performed walking at a power of 25W. for 5 minutes. Hemodynamics was evaluated before and after the electrical stimulation session, as well as before and after the mechanical therapy session on the track in combination with percutaneous electrical stimulation of the spinal cord. To study systemic and regional hemodynamics, a rheograph-polyanalyzer "REAN-POLY" was used. Results. Electrical stimulation of the spinal cord does not lead to significant changes in systemic and cerebral hemodynamics. Percutaneous electrical stimulation of the spinal cord in combination with physical exertion leads to reactive changes in systemic hemodynamics, increased blood filling and venous outflow, against the background of a decrease in peripheral resistance of cerebral vessels. Key words: electrostimulation, percutaneous electrostimulation, mechanotherapy, systemic hemodynamics, regional hemodynamics.

Non-invasive Systemic Hemodynamic Index in Vascular Risk Stratification Tailored for Hypertensives

Vascular dysfunction is a key hallmark of hypertension and related cardiovascular outcomes. As a well-known hemodynamic disease, hypertension is characterized by abnormal ventricular-vascular interactions. Complementing non-invasive systemic hemodynamics in hypertensive vascular risk assessment is of promising significance. We aimed to investigate the effects of abnormal hemodynamic states other than elevated blood pressure on vascular damage and establish a united index of systemic hemodynamics for generalized vascular risk evaluation. Non-invasive systemic hemodynamics, assessed by impedance cardiography, was compared among blood pressure stages. Vascular function was evaluated by flow-mediated dilation (FMD) and brachial-ankle pulse wave velocity (baPWV). Systemic hemodynamics was obtained from a total of 88 enrollees with a mean (±SD) systolic blood pressure 140 (±17) mm Hg, and aged 17 to 91 years. Both stroke systemic vascular resistance index and left stroke work index exhibited a significant alteration among blood pressure stages (p < 0.001; p = 0.01, respectively), whereas heterogeneous hemodynamic and vascular function subsets existed within similar blood pressure. In addition, blood pressure categories failed to recognize between-group differences in endothelial dysfunction (p = 0.88) and arterial stiffness (p = 0.26). An increase in myocardial contractility and a parallel decrease in afterload was associated with the decline of vascular dysfunction. Systemic Hemodynamic Index (SHI), as a surrogate marker, demonstrated a significantly negative correlation with vascular damage index (VDI, r = −0.49, p < 0.001). These findings illustrate that systemic hemodynamics underlying hypertensives provides more vascular information. The SHI/VDI score may be a feasible tool for cardiovascular function assessment.

Exercise Heat Acclimation With Dehydration Does Not Affect Vascular and Cardiac Volumes or Systemic Hemodynamics During Endurance Exercise

Permissive dehydration during exercise heat acclimation (HA) may enhance hematological and cardiovascular adaptations and thus acute responses to prolonged exercise. However, the independent role of permissive dehydration on vascular and cardiac volumes, ventricular-arterial (VA) coupling and systemic hemodynamics has not been systematically investigated. Seven males completed two 10-day exercise HA interventions with controlled heart rate (HR) where euhydration was maintained or permissive dehydration (-2.9 ± 0.5% body mass) occurred. Two experimental trials were conducted before and after each HA intervention where euhydration was maintained (-0.5 ± 0.4%) or dehydration was induced (-3.6 ± 0.6%) via prescribed fluid intakes. Rectal (Tre) and skin temperatures, HR, blood (BV) and left ventricular (LV) volumes, and systemic hemodynamics were measured at rest and during bouts of semi-recumbent cycling (55% V̇O2peak) in 33°C at 20, 100, and 180 min. Throughout HA sweat rate (12 ± 9%) and power output (18 ± 7 W) increased (P < 0.05), whereas Tre was 38.4 ± 0.2°C during the 75 min of HR controlled exercise (P = 1.00). Neither HA intervention altered resting and euhydrated exercising Tre, BV, LV diastolic and systolic volumes, systemic hemodynamics, and VA coupling (P > 0.05). Furthermore, the thermal and cardiovascular strain during exercise with acute dehydration post-HA was not influenced by HA hydration strategy. Instead, elevations in Tre and HR and reductions in BV and cardiac output matched pre-HA levels (P > 0.05). These findings indicate that permissive dehydration during exercise HA with controlled HR and maintained thermal stimulus does not affect hematological or cardiovascular responses during acute endurance exercise under moderate heat stress with maintained euhydration or moderate dehydration.

Effect of ingesting a meal and orthostasis on the regulation of splanchnic and systemic hemodynamics and the responsiveness of cardiovascular α1-adrenoceptors

Background: Postprandial orthostasis activates mechanisms of cardiovascular homeostasis in order to maintain normal blood pressure (BP) and adequate blood flow to vital organs. The underlying mechanisms of cardiovascular homeostasis in postprandial orthostasis still require elucidation. Methods: Fourteen healthy volunteers were recruited to investigate the effect of an orthostatic challenge (600-head-up-tilt for 20 minutes) on splanchnic and systemic hemodynamics before and after ingesting an 800-kilocalorie composite meal. The splanchnic circulation was assessed by ultrasonography of the superior mesenteric and hepatic arteries and portal vein. Systemic hemodynamics were assessed non-invasively by continuous monitoring of BP, heart rate (HR), cardiac output (CO), and the pressor response to an intravenous infusion on increasing doses of phenylephrine, an α1-adrenoceptor agonist. Neurohumoral regulation was assessed by spectral analysis of HR and BP, plasma catecholamine and aldosterone levels and plasma renin activity. Results: Postprandial mesenteric hyperemia was associated with an increase in CO, a decrease in SVR and cardiac vagal tone, and reduction in baroreflex sensitivity with no change in sympathetic tone. Arterial α1-adrenoceptor responsiveness was preserved and reduced in hepatic sinusoids. Postprandial orthostasis was associated with a shift of 500 ml of blood from mesenteric to systemic circulation with preserved sympathetic-mediated vasoconstriction Conclusions: Meal ingestion provokes cardiovascular hyperdynamism, cardiac vagolysis, and resetting of the baroreflex without activation of the sympathetic nervous system. Meal ingestion also alters α1-adrenoceptor responsiveness in the hepatic sinusoids and participates in the redistribution of blood volume from the mesenteric to the systemic circulation in order to maintain a normal BP during orthostasis.

The study of systemic hemodynamics by the method of volumetric compression oscillometry in young people

Aim. To investigate the state of systemic hemodynamics (SHD) in young people to assess the potential impact of its disorders in the formation of arterial hypertension (AH) and to carry out preventive measures.Methods. A random sample of 91 young people from 17 to 25 years old was examined; 27 of them were men (average age 23.7±1.6 years) and 64 women (average age 20.4±1.1 years). The study involved clinical residents and students who, according to preliminary and periodic medical examinations, excluded the presence of cardiovascular diseases. The indicators of SHD were investigated by the method of volumetric compression oscillometry using a portable automated software and hardware complex for non-invasive research of central hemodynamics (Device “CAP TsG osm-“Globus”).Results. AH was detected in 4.4%; “white coat” AH in 8.79%; arterial hypotension – in 5.49%. In individuals with normal blood pressure (BP) (75 people), an increase in specific peripheral vascular resistance was most often revealed in 30.6%. An unchanged hemodynamic profile in the group with a normal BP level was recorded only in 28.0% of the examinees.Conclusion. The obtained results indicate that even among “healthy” young people aged 18- 25 years with a normal BP level, the proportion of people with impaired SHD values is 72%. People with hypertension and with altered SHD indicators should be included in the regular medical check-up observation group.

Exertional Desaturation in Idiopathic Pulmonary Fibrosis: The Role of Oxygen Supplementation in Modifying Cerebral-Skeletal Muscle Oxygenation and Systemic Hemodynamics

<b><i>Background:</i></b> In patients with idiopathic pulmonary fibrosis (IPF) with isolated exertional desaturation, there are limited data regarding the effectiveness of oxygen supplementation during exercise training; the underlying mechanisms that contribute to these responses are unknown. <b><i>Objectives:</i></b> To examine in these IPF patients the effects of oxygen supplementation during submaximal exercise (vs. medical air) on cerebral/skeletal muscle oxygenation and systemic hemodynamics. <b><i>Methods:</i></b> In this randomized, cross-over, placebo-controlled trial, IPF patients (<i>n</i> = 13; 63.4 ± 9.6 years) without resting hypoxemia but a significant desaturation during maximal cardiopulmonary exercise testing underwent 2 steady-state exercise trials (65% peak-work-load), breathing either oxygen-enriched or medical air. Cerebral/skeletal muscle oxygenation (near-infrared spectroscopy) and beat-by-beat hemodynamics (photoplethysmography) were monitored. <b><i>Results:</i></b> In the air protocol, from the initial minutes of submaximal exercise, patients exhibited a marked decline in cerebral oxygenated hemoglobin (O₂Hb) and an abrupt rise in deoxygenated hemoglobin (HHb). Oxygen supplementation alleviated desaturation, lessened dyspnea, and prolonged exercise duration (<i>p</i> &#x3c; 0.01). Oxygen supplementation during exercise (i) attenuated cerebral deoxygenation (cerebral-HHb: 0.7 ± 1.9 vs. 2.5 ± 1.5 μmol/L, O₂ and air protocol; <i>p</i> = 0.009) and prevented cerebral-Hb_difference decline (2.1 ± 2.7 vs. −1.7 ± 2.0 μmol/L; <i>p</i> = 0.001), (ii) lessened the decline in muscle O₂-saturation index, and (iii) at isotime exercise, it resulted in lower muscle-HHb (<i>p</i> = 0.05) and less leg fatigue (<i>p</i> &#x3c; 0.05). No differences between protocols were observed in exercise cardiac output and vascular resistance. <b><i>Conclusions:</i></b> IPF patients with isolated exertional hypoxemia exhibit an inability to increase/maintain cerebral oxygenation during submaximal exercise. Correcting desaturation with O₂ supplementation prevented the decline in brain oxygenation, improved muscle oxygenation, and lessened dyspnea, suggesting an efficacy of acute oxygen supplementation during exercise training in protecting brain hypoxia in these IPF patients.

STATE OF SYSTEMIC HEMODYNAMICS FOR CHILDREN WITH CONGENITAL SURGICAL PATHOLOGY IN DIFFERENT COMBINED ANESTHESIA TYPES

General anesthesia for a surgical correction of congenital malformations in children is accompanied, in particular, by the disorders of systemic hemodynamics. In order to assess the impact of different types of combined anesthesia on the state of systemic hemodynamics in surgical correction of congenital malformations, a retrospective study of the treatment of 150 newborns and infants was conducted. These were children with various congenital malformations, but the most common were intestinal obstruction and abdominal tumors. Three groups of patients were formed depending on the type of combined anesthesia during surgical correction of abnormalities: I − inhalation (sevorane) + regional anesthesia; II − inhalation (sevorane) + intravenous anesthesia (fentanyl); III − total intravenous anesthesia with two drugs: analgesic (fentanyl) and drug sleep on the background of intravenous injection of hypnotics (20 % sodium oxybutyrate). There were preformed the surgeries: thoracic, urological, abdominal. The study was retrospectively evaluated in five stages. The analysis of systemic hemodynamics showed a tendency to reduce diastolic blood pressure in children treated with anesthesia with two intravenous drugs (hypnotic and fentanyl), during all observation stages and a significant decrease in this index at the most painful and traumatic period. At the time of induction of anesthesia in children there was a decrease in heart rate. According to the research results, it is concluded that when using the pre−hypnotics as part of combined anesthesia in children with congenital malformations during surgery there is a risk of complications from central hemodynamics in the form of vasodilation, which leads to a drop in blood pressure and increases compensatively the heart contractions. Key words: infants, congenital malformations, anesthesia, hemodynamics.

The Non-Steroidal FXR Agonist Cilofexor Improves Portal Hypertension and Reduces Hepatic Fibrosis in a Rat NASH Model

Background: The farnesoid X receptor (FXR) influences hepatic metabolism, inflammation and liver fibrosis as key components of non-alcoholic steatohepatitis (NASH). We studied the effects of the non-steroidal FXR agonist cilofexor (formerly GS-9674) on portal pressure and fibrosis in experimental NASH. Methods: NASH was induced in Wistar rats using a choline-deficient high-fat diet plus intraperitoneal sodium nitrite injections. First, a dose-finding study was performed with 10 mg/kg and 30 mg/kg of cilofexor, focusing on histological readouts. Liver fibrosis was assessed by Picro-Sirius-Red, desmin staining and hepatic hydroxyproline content. Gene expression was determined by RT-PCR. In a subsequent hemodynamic study, rats received 30 mg/kg cilofexor with or without propranolol (25 mg/kg). Portal pressure, systemic hemodynamics and splanchnic blood flow were measured. Results: Cilofexor dose-dependently induced FXR target genes shp, cyp7a1 and fgf15 in hepatic and ileal tissues, paralleled by a dose-dependent reduction in liver fibrosis area (Picro-Sirius-Red) of −41% (10 mg/kg) and −69% (30 mg/kg), respectively. The 30 mg/kg cilofexor dose significantly reduced hepatic hydroxyproline content (−41%), expression of col1a1 (−37%) and pdgfr-β (−36%), as well as desmin area (−42%) in NASH rats. Importantly, cilofexor decreased portal pressure (11.9 ± 2.1 vs. 8.9 ± 2.2 mmHg; p = 0.020) without affecting splanchnic blood-flow or systemic hemodynamics. The addition of propranolol to cilofexor additionally reduced splanchnic inflow (−28%) but also mean arterial pressure (−25%) and heart rate (−37%). Conclusion: The non-steroidal FXR agonist cilofexor decreased portal hypertension and reduced liver fibrosis in NASH rats. While cilofexor seems to primarily decrease sinusoidal resistance in cirrhotic portal hypertension, the combination with propranolol additionally reduced mesenteric hyperperfusion.