CO2-related vasoconstriction superimposed on ischemic medullary brain autonomic nuclei may contribute to sudden death

Jaster, J. Howard; Zámečnı́k, Josef; Giannì, Aldo Bruno; Ottaviani, Giulia

doi:10.1016/j.carpath.2018.10.009

Cited by 10 publications

(9 citation statements)

References 25 publications

(67 reference statements)

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“…These two additional factors are vasoconstriction in the brain related to carbon dioxide (CO 2 ) levels [ 6 ] and gravity in the brain [ 7 , 8 ]. These possibly have several clinical effects, but the one applicable here is sudden unexpected death related to both cardiac arrhythmias and neurogenic pulmonary edema [ 7 , 8 ], and are possibly responsible for significant mortality in patients discharged from the hospital following acute heart failure.…”

Section: Discussionmentioning

confidence: 99%

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Acute Heart Failure, 90-Day Mortality, and Gravitational Ischemia in the Brain

Jaster

Ottaviani

2022

Diagnostics

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During the 90 days following hospitalization for acute heart failure, the ejection fraction and type of discharge medications have been shown in clinical trials to have little effect on mortality. We examined the recent literature addressing brain-related etiologies of sudden death following heart failure. Two mechanisms of sudden unexpected death have been suggested to possibly result from four significant influences on pathophysiology in the brain. The two causes of sudden death are (1) severe cardiac arrhythmia and (2) neurogenic pulmonary edema. They are both mediated through the brainstem autonomic nuclei generally and executed specifically through the dorsal motor nucleus of the vagus nerve. The four significant influences on pathophysiology, all contributing to ischemia in the brainstem autonomic nuclei, are: (1) Hyper-stimulation of neurons in the solitary tract nucleus, increasing their metabolic requirements; (2) Inadequate blood flow at a vascular watershed terminus, perfusing the autonomic nuclei; (3) Additionally decreased blood flow, globally throughout the brain, following vasoconstriction related to relative hyperventilation and decreased pCO2 levels; (4) Gravitational ischemia in the brainstem caused by the weight of the cerebral hemispheres sitting above the brainstem. Changes in head tilt release gravitational ischemia in the brain. There is no specific head position relative to gravity that is considered favorable or unfavorable for an extended period of time, longer than 24 h. Even a small degree of head elevation, used in managing pulmonary congestion, may increase gravitational ischemia in the posterior fossa and brainstem. In this paper, we suggest a new and important research avenue for intervening in cardiac arrhythmias and preventing their occurrence through the non-invasive use of head-tilting and other head repositioning maneuvers. This could potentially help many geriatric patients with heart failure, who have decreased mobility in bed, and who tend to stay in one position longer, thereby increasing gravitational ischemia in the brain.

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Section: Discussionmentioning

confidence: 99%

“…CO 2 is a potent vasodilator in the brain, and reduced CO 2 levels typically cause vasoconstriction, thereby contributing to ischemia in brainstem autonomic nuclei [ 6 ]. CO 2 levels become decreased most frequently as a result of mechanical ventilation or respiratory therapy.…”

Section: Discussionmentioning

confidence: 99%

Acute Heart Failure, 90-Day Mortality, and Gravitational Ischemia in the Brain

Jaster

Ottaviani

2022

Diagnostics

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“…Restoration of blood flow by reopening of capillary vascular beds follows repositioning (unloading of ischemic regions) of the brain relative to gravity-by head tilting, which is significant through the 24-h sleep/wake cycle. Other factors such as intracranial carbon dioxide levels and metabolic rate in the autonomic nuclei may play a role in ischemia, there as well (4)(5)(6)(7)(8)(9)(10)(11).…”

Section: To the Editormentioning

confidence: 99%

Gravity in the brain: how compressive ischemic changes in the weight-bearing brainstem autonomic nuclei may contribute to vascular endothelial dysfunction elsewhere in the body following sleep deprivation

Jaster

2021

American Journal of Physiology-Heart and Circulatory Physiology

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“…Does the brain roll itself from side to side? Maybe so-by sleeping 8 h/day, which encourages a horizontal positioning of head and body-and by maintaining wakefulness for 16 h/day, which encourages a vertical positioning of head and body (Jaster, 2021(Jaster, , 2018(Jaster, , 2020(Jaster, , 2015Jaster et al, 2019).…”

Section: Gravity In the Brain-how It May Regulate Skeletal Muscle Metabolism By Balancing Compressive Ischemic Changes In The Weight-bearmentioning

confidence: 99%

Gravity in the brain—how it may regulate skeletal muscle metabolism by balancing compressive ischemic changes in the weight‐bearing pituitary and hypothalamus

CO2-related vasoconstriction superimposed on ischemic medullary brain autonomic nuclei may contribute to sudden death

Abstract: Ottaviani , CO2-related vasoconstriction superimposed on ischemic medullary brain autonomic nuclei may contribute to sudden death. Cvp (2018),

Cited by 10 publications

References 25 publications

Acute Heart Failure, 90-Day Mortality, and Gravitational Ischemia in the Brain

Acute Heart Failure, 90-Day Mortality, and Gravitational Ischemia in the Brain

Gravity in the brain: how compressive ischemic changes in the weight-bearing brainstem autonomic nuclei may contribute to vascular endothelial dysfunction elsewhere in the body following sleep deprivation

Gravity in the brain—how it may regulate skeletal muscle metabolism by balancing compressive ischemic changes in the weight‐bearing pituitary and hypothalamus

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