Profound Sympathoinhibition Complicating Hypovolemia in Humans

Abstract

Brief Reports1 September 1989Profound Sympathoinhibition Complicating Hypovolemia in HumansJeffrey S. Sanders, MD, David W. Ferguson, MDJeffrey S. Sanders, MD, David W. Ferguson, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-111-5-439 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTachycardia, increased sympathetic activity, and peripheral vasoconstriction have been described as the principal reflex adjustments to hypovolemic shock. However, experiments in animals suggest that bradycardia and sympathoinhibition can occur during severe hemorrhagic hypotension (1-5). In addition, recent observations indicate that a paradoxical bradycardia can occur during hypotensive hemorrhage in humans (6-8). The mechanisms of this response are not appreciated by most practicing physicians because hypovolemic shock is often promptly treated with volume expansion and because the acute manifestations of rapid, severe hypovolemia are rarely observed. Our observations in a normal, human subject help to delineate the autonomic responses to acute...References1. ObergWhite BS. The role of vagal cardiac nerves and arterial baroreceptors in the circulatory adjustments to hemorrhage in the cat. Acta Physiol Scand. 1970;80:395-403. CrossrefMedlineGoogle Scholar2. MoritaVatner HS. Effects of hemorrhage on renal nerve activity in conscious dogs. Circ Res. 1985;57:788-93. CrossrefMedlineGoogle Scholar3. Sjostrand T. Circulatory control via vagal afferents. VI. The bleeding bradycardia in the rat, its elicitation and relation to the release of vasopressin. Acta Physiol Scand. 1973;89:39-50. CrossrefMedlineGoogle Scholar4. ObergThoren BP. Increased activity in left ventricular receptors during hemorrhage or occlusion of caval veins in the cat. A possible cause of the vaso-vagal reaction. Acta Physiol Scand. 1972;85:164-73. CrossrefMedlineGoogle Scholar5. VictorThorenMorganMark RPDA. Differential control of adrenal and renal sympathetic nerve activity during hemorrhagic hypotension in rats. Circ Res. 1989;64:686-94. CrossrefMedlineGoogle Scholar6. SecherSander JensenWernerWarbergBie NKCJP. Bradycardia during severe but reversible hypovolemia shock in man. Circ Shock. 1984;14:267-74. MedlineGoogle Scholar7. RorsgaardSecher SN. Slowing of the heart during hypotension in major abdominal surgery. Acta Anaesthesiol Scand. 1986;30:507-10. CrossrefMedlineGoogle Scholar8. Sander-JensenSecherBieWarbergSchwartz KNPJT. Vagal slowing of the heart during hemorrhage: observations from 20 consecutive hypotensive patients. Br Med J [Clin Res]. 1986;292:364-6. CrossrefMedlineGoogle Scholar9. SandersFerguson JD. Cardiopulmonary baroreflexes fail to modulate sympathetic responses during isometric exercise in humans: direct evidence from microneurographic studies. J Am Coll Cardiol. 1988;12:1241-51. CrossrefMedlineGoogle Scholar10. WallinSundlof BG. Sympathetic outflow to muscles during vasovagal syncope. J Auton Nerv Syst. 1982;6:287-91. CrossrefMedlineGoogle Scholar11. MoritaNishidaMotochigawaUemuraHosomiVatner HYHNHS. Opiate receptor-mediated decrease in renal nerve activity during hypotensive hemorrhage in conscious rabbits. Circ Res. 1988;63:165-72. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: From the University of Iowa College of Medicine and Hospitals. For current author addresses, see end of text. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byLower Body Negative Pressure: Physiological Effects, Applications, and ImplementationTime course of compensatory physiological responses to central hypovolemia in high- and low-tolerant human subjectsHow to build a lower-body differential pressure chamber integrated on a tilt-table: A pedagogy tool to demonstrate the cardiovagal baroreflexImpact of central hypovolemia on photoplethysmographic waveform parameters in healthy volunteers part 2: frequency domain analysisMuscle sympathetic nerve activity during intense lower body negative pressure to presyncope in humansThe origin of vasovagal syncope: to protect the heart or to escape predation?Sympathetic nervous system and spaceflightHeart Rate Variability and Its Association with Mortality in Prehospital Trauma PatientsStroke volume and sympathetic responses to lower-body negative pressure reveal new insight into circulatory shock in humansLower body negative pressure as a model to study progression to acute hemorrhagic shock in humansArrhythmias during spinal anesthesiaNear-infrared oximetry of the brainSinus bradycardia and asystole during spinal and epidural anesthesia: a report of 13 casesAutonomic control of vasovagal syncopeVagal and Sympathetic Mechanisms in Patients With Orthostatic Vasovagal SyncopeCold Stress Provokes Sympathoinhibitory Presyncope in Healthy Subjects and Hemodialysis Patients With Low Cardiac OutputPATHOPHYSIOLOGIC BASIS FOR VASODEPRESSOR SYNCOPEMechanisms of Heart Rate and Arterial Blood Pressure Control: Implications for the Pathophysiology of Neurocardiogenic SyncopeAutonomic control of asystolic vasovagal syncope.Interrogatoire et examen clinique des patients admis pour « malaiseSubcutaneous oxygen and carbon dioxide tensions during head-up tilt-induced central hypovolaemia in humansBrain and muscle oxygen saturation during head-up-tilt-induced central hypovolemia in humansIncidence and hemodynamic characteristics of near-fainting in healthy 6- to 16-year old subjectsArterial diameter during central volume depletion in humansMechanisms of Vasovagal Syncope: Relevance to Postflight Orthostatic IntoleranceCirculatory and catecholamine changes during head-up tilt testing in neurocardiogenic (vasovagal) syncopeNeural Control Mechanisms and Vasovagal SyncopeMiddle cerebral artery velocity during head-up tilt induced hypovolemic shock in humansCentral venous oxygen saturation during hypovolaemic shock in humansPeripheral venous oxygen saturation during head-up tilt induced hypovolaemic shock in humansPlasma endothelin-1 during central hypovolaemia in manHaemoperfusion, Indications and Side-EffectsNitroprusside in preeclampsia. Circulatory distress and paradoxical bradycardia.Dialysis hypotension: A hemodynamic analysisBlood Pressure Control in Chronic Hemodialysis Patients 1 September 1989Volume 111, Issue 5Page: 439-441KeywordsBradycardiaCardiology and cardiovascular diseasesHeartHospital medicineHypotensionLungsReflexesShockTachycardiaVasoconstriction Issue Published: 1 September 1989 PDF downloadLoading ...