Exercise related syncope, when it?s not the heart

Krediet, C. T. Paul; Wilde, Arthur A.M.; Wieling, Wouter; Halliwill, John R.

doi:10.1007/s10286-004-1005-1

Cited by 44 publications

(27 citation statements)

References 104 publications

(143 reference statements)

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“…Postexercise hypotension (PEH) occurs regardless of body posture and results from a persistent decrease in systemic vascular resistance that is not completely offset by increases in cardiac output, although endurance-trained men and older hypertensive patients are exceptions (Hagberg et al, 1987;Raine et al, 2001;McCord & Halliwill, 2006). Importantly, in exaggerated forms of PEH, gravitational stress may further aggravate the magnitude of drop in BP, thus predisposing to orthostatic intolerance (Krediet et al, 2004). The mechanisms underlying PEH are not completely understood.…”

Section: Introductionmentioning

confidence: 99%

The influence of water ingestion on postexercise hypotension and standing haemodynamics

Mendonça

Fernhall

2015

Clin Physio Funct Imaging

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In young healthy adults, postexercise hypotension (PEH) occurs after a single bout of dynamic exercise due to peripheral vasodilation. Gravitational stress may further aggravate the magnitude of PEH, thus predisposing to orthostatic intolerance. As water drinking activates sympathetic vasoconstriction, it might offset PEH via enhanced α-adrenergic vascular responsiveness. We hypothesized that water ingestion before exercise would decrease the magnitude of PEH and improve the haemodynamic reaction to active standing postmaximal exercise. In a randomized fashion, 17 healthy adults (nine men; eight women, 21·2 ± 1·6 years) ingested 50 and 500 ml of water before completing resting, cycle ergometer and recovery protocols on two separate days. After exercise, measurements [arterial blood pressure (BP), heart rate and spectral heart rate variability (HRV)] were taken in the seated position followed by 5 min of active standing. Compared to that seen post-50 ml of water, the 500 ml volume elicited an overall increase in BP (P < 0·05). Nevertheless, the magnitude of PEH was not different after either volume of water. There was an overall bradycardic effect of water, and this was accompanied by increased high-frequency power (P < 0·05). Finally, no BP, heart rate or HRV differences were found between conditions in response to active standing. These data suggest that, despite being well preserved after maximal exercise, the water pressor response does not affect the magnitude of PEH. They also indicate that drinking 500 ml of water does not impact the BP, heart rate or HRV response to 5 min of active standing during recovery postmaximal exercise.

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Section: Introductionmentioning

confidence: 99%

The influence of water ingestion on postexercise hypotension and standing haemodynamics

Mendonça

Fernhall

2015

Clin Physio Funct Imaging

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“…While physical maneuvers such as squatting and muscle tensing have been evaluated in individuals with autonomic dysfunction (Krediet, 2002; Krediet et al , 2004, 2005; Groothuis et al , 2007), these have not been systematically assessed in healthy individuals post-exercise (although Eichna et al established the principle in 1947 by having subjects move their legs in place on a tilt table to avert severe post-exercise hypotension) (Eichna et al , 1947). We propose that different models of post-exercise syncope (intense but short anaerobic exercise vs. longer moderate aerobic exercise in the heat) will each be amenable to countermeasures that act specifically on the underlying physiology of each model, seeing post-exercise syncope as a spectrum of challenges that needs a quiver of fixes, rather than a single physiology fixed by a single “one-size fits all” solution.…”

Section: Discussionmentioning

confidence: 99%

“…It is plausible that the common reductions in blood pressure known as post-exercise hypotension can be large enough in magnitude to become symptomatic (Halliwill et al , 2013 a ); however, most reports of post-exercise syncope are likely to be incidents of neurally mediated syncope (formally called vasovagal syncope) (Freeman et al , 2011) that have occurred during recovery from exercise, with the underlying changes associated with post-exercise hypotension contributing to the onset of the event (Kosinski et al , 2000; Krediet et al , 2004; O’Connor et al , 2009). Several case studies of individuals who have reportedly fainted following physical activity have been examined, yet the physiology remains poorly understood (Tsutsumi & Hara, 1979; Tamura et al , 1990; Arad et al , 1993; Ziegelstein, 2004; Krediet et al , 2005, 2006).…”

Section: Introductionmentioning

confidence: 99%

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Postexercise syncope: Wingate syncope test and effective countermeasure

Lacewell

Buck

Romero

et al. 2013

Experimental Physiology

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Altered systemic hemodynamics following exercise can compromise cerebral perfusion and result in syncope. As the Wingate anaerobic test often induces pre-syncope, we hypothesized that a modified Wingate test could form the basis of a novel model for the study of post-exercise syncope and a test-bed for potential countermeasures. Along these lines, breathing through an impedance threshold device has been shown to increase tolerance to hypovolemia, and could prove beneficial in the setting of post-exercise syncope. Therefore, we hypothesized that a modified Wingate test followed by head-up tilt would produce post-exercise syncope, and that breathing through an impedance threshold device (countermeasure) would prevent post-exercise syncope in healthy individuals. Nineteen recreationally active men and women underwent a 60° head-up tilt during recovery from the Wingate test while arterial pressure, heart rate, end-tidal CO2, and cerebral tissue oxygenation were measured on a control and countermeasure day. The duration of tolerable tilt was increased by a median time of 3 min 48 sec with countermeasure compared to control (P < 0.05) and completion of the tilt test increased from 42% to 67% with countermeasure. During the tilt, mean arterial pressure was greater (108.0 ± 4.1 vs.100.4 ± 2.4 mmHg; P < 0.05) with countermeasure compared to control. These data suggest that the Wingate syncope test produces a high incidence of pre-syncope which is sensitive to countermeasures such as inspiratory impedance.

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“…These factors combined can lead to exercise-induced hypotension. 23 Presumably, this is the reason why SBP measured shortly after intense PA in the Tetra group was not greater than SBP rest as was observed in the Control group. In six of the participants, the post-exercise blood pressure was lower and in three participants, it was not measurable likely due to very low, non-detectable values.…”

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confidence: 82%

Cardiovascular response to peak voluntary exercise in males with cervical spinal cord injury

Machač

Radvanský

Kolář

et al. 2015

The Journal of Spinal Cord Medicine

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Context/Objective: Traumatic damage to the cervical spinal cord is usually associated with a disruption of the autonomic nervous system (ANS) and impaired cardiovascular control both during and following exercise. The magnitude of the cardiovascular dysfunction remains unclear. The aim of the current study was to compare cardiovascular responses to peak voluntary exercise in individuals with tetraplegia and able-bodied participants. Design: A case-control study. Subjects: Twenty males with cervical spinal cord injury (SCI) as the Tetra group and 27 able-bodied males as the Control group were included in the study. Outcome Measures: Blood pressure (BP) response one minute after the peak exercise, peak heart rate (HR peak ), and peak oxygen consumption (VO 2peak ) on an arm crank ergometer were measured. In the second part of the study, 17 individuals of the Control group completed the Tetra group's workload protocol with the same parameters recorded. Results: There was no increase in BP in response to the exercise in the Tetra group. Able-bodied individuals exhibited significantly increased post-exercise systolic BP after the maximal graded exercise test (123±16%) and after completion of the Tetra group's workload protocol (114±11%) as compared to pre-exercise. The Tetra group VO 2peak was 59% and the HR peak was 73% of the Control group VO 2peak and HR peak , respectively. Conclusions: BP did not increase following maximal arm crank exercise in males with a cervical SCI unlike the increases observed in the Control group. Some males in the Tetra group appeared to be at risk of severe hypotension following high intensity exercise, which can limit the ability to progressive increase and maintain high intensity exercise.

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Exercise related syncope, when it?s not the heart

Cited by 44 publications

References 104 publications

The influence of water ingestion on postexercise hypotension and standing haemodynamics

The influence of water ingestion on postexercise hypotension and standing haemodynamics

Postexercise syncope: Wingate syncope test and effective countermeasure

Cardiovascular response to peak voluntary exercise in males with cervical spinal cord injury

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