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Reduced compensatory responses to maintain central blood volume during hypovolemic stress in women with vasovagal syncope
Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.ORCID iD: 0000-0002-9095-403X
Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
2017 (English)In: American Journal of Physiology. Regulatory Integrative and Comparative Physiology, ISSN 0363-6119, E-ISSN 1522-1490, Vol. 312, no 1, R55-R61 p.Article in journal (Refereed) Published
Abstract [en]

Although vasovagal syncope (VVS) is a common clinical condition, the underlying pathophysiology is not fully understood. A decrease in cardiac output has recently been suggested as a factor in orthostatic VVS. The aim was to investigate compensatory mechanisms to maintain central blood volume and venous return during hypovolemic stress in women with VVS. Fourteen VVS women (25.7 +/- 5.0 yr) and 15 matched controls (22.8 +/- 3.2 yr) were investigated. Single-step and graded lower body negative pressure (LBNP) to presyncope were used to create hypovolemic stress. Peripheral mobilization of venous blood from the arm (capacitance response and net capillary fluid absorption) and lower limb blood pooling (calf capacitance response) were evaluated using a volumetric technique. Cardiovascular responses and plasma norepinephrine (P-NE) were measured. Resting P-NE was elevated in VVS women (P amp;lt; 0.01). Despite a similar hypovolemic stimulus, the increase in P-NE was blunted (P amp;lt; 0.01) and the maximal percent increase in total peripheral resistance was reduced (P amp;lt; 0.05) during graded LBNP in VVS women. The arm capacitance response was slower (P amp;lt; 0.05) and reduced in VVS women at higher levels of LBNP (P amp;lt; 0.05). Capillary fluid absorption from extra-to intravascular space was reduced by similar to 40% in VVS women (P amp;lt; 0.05). Accordingly, the reduction in cardiac output was more pronounced (P amp;lt; 0.05). In conclusion, in VVS women, mobilization of peripheral venous blood and net fluid absorption from tissue to blood during hypovolemic stress were decreased partly as a result of an attenuated vasoconstrictor response. This may seriously impede maintenance of cardiac output during hypovolemic stress and could contribute to the pathogenesis of VVS.

Place, publisher, year, edition, pages
AMER PHYSIOLOGICAL SOC , 2017. Vol. 312, no 1, R55-R61 p.
Keyword [en]
vasovagal syncope; veins; hemodynamics; baroreflex; blood pooling
National Category
Physiology
Identifiers
URN: urn:nbn:se:liu:diva-136181DOI: 10.1152/ajpregu.00166.2016ISI: 000395715600008PubMedID: 27654398OAI: oai:DiVA.org:liu-136181DiVA: diva2:1086648
Note

Funding Agencies|Futurum-The Academy of Health Care [156871]; Jonkoping County Council; Medical Research Council of Southeast Sweden [160691]; County Council of Ostergotland [LIO-391351, LIO-441081]; Heart and Lung Foundation [20130650]

Available from: 2017-04-03 Created: 2017-04-03 Last updated: 2017-04-03

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Skoog, JohanZachrisson, HeleneLänne, TosteLindenberger, Marcus
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Department of Medical and Health SciencesFaculty of Medicine and Health SciencesDivision of Cardiovascular MedicineDepartment of Clinical Physiology in LinköpingDepartment of Thoracic and Vascular Surgery
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American Journal of Physiology. Regulatory Integrative and Comparative Physiology
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CiteExportLink to record
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