Orthostatic tachycardia and orthostatic hypotension: Defects in the return of venous blood to the heart

MacLean, Alexander R.; Allen, Edgar V.; Magath, Thomas B.

doi:10.1016/s0002-8703(44)90720-9

Cited by 71 publications

(50 citation statements)

References 4 publications

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“…3), suggest allocation of the expanded body fluid volume to the perivascular space rather than to the intravascular space. This mechanism is supported by the observation that head-up tilt sleeping becomes effective coincidentally with the appearance of slight edema of the lower legs and that the beneficial effects of head-up tilt sleeping are also observed in patients without renin release [42,47,48]. This perivascular "water jacket" in the legs limits the vascular volume available for orthostatic venous pooling and explains the reduction of the orthostatic decrease in CO.…”

Section: Mechanisms Underlying the Rise In Svmentioning

confidence: 91%

Fludrocortisone and sleeping in the head-up position limit the postural decrease in cardiac output in autonomic failure

Lieshout

Harkel

Wieling

2000

Clinical Autonomic Research

132

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Treatment with head-up tilt sleeping and low-dose fludrocortisone effectively minimizes orthostatic symptoms and increases orthostatic blood pressure in patients with neurogenic orthostatic hypotension. The aim of the present study was to examine whether the improvement in orthostatic blood pressure during combined treatment with low-dose fludrocortisone and nocturnal head-up tilt in patients with neurogenic orthostatic hypotension can be attributed to expansion of plasma volume or to increased total peripheral resistance. The effects of a 3-week treatment with fludrocortisone and nocturnal head-up tilting on the postural changes in arterial pressure, heart rate, and cardiac output (pulse contour) were evaluated in eight consecutive patients with orthostatic hypotension. The period during which the patients were able to remain in the standing position without orthostatic complaints increased minimally from 3 to 10 minutes. The decrease in arterial pressure after 1 minute of standing--(means with standard deviations in parentheses) systolic, 49 (20) mm Hg; diastolic, 18 (11) mm Hg--before treatment was produced by a greater than normal decrease in cardiac output: 37% (10%) in patients with neurogenic orthostatic hypotension versus -14% (8%) in control subjects. Treatment increased upright arterial pressure from 83 (19) mm Hg systolic and 55 (13) mm Hg diastolic to 114 (22) mm Hg systolic and 60 (16) mm Hg diastolic by limiting the decrease in cardiac output. Body weight increased but hematocrit did not change. Leg pressure-volume relationship decreased in the two patients studied. The responses of plasma renin activity and aldosterone to orthostatic stress prior to treatment were subnormal and became even lower after treatment. The improvement in upright blood pressure in orthostatic hypotension during treatment with fludrocortisone and nocturnal head-up sleeping is the result of a reduction in the orthostatic decrease in cardiac output. Preliminary data suggest that the expanded body fluid volume is allocated to the perivascular space rather than to the intravascular space.

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Section: Mechanisms Underlying the Rise In Svmentioning

confidence: 91%

Fludrocortisone and sleeping in the head-up position limit the postural decrease in cardiac output in autonomic failure

Lieshout

Harkel

Wieling

2000

Clinical Autonomic Research

132

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“…Discussion of the physiologic response to intrathoracic pressure change The effects of transient increase of intrathoracic pressure, produced by voluntary straining, upon cardiovascular dynamics have been studied intensively by many methods (10,11,13,(21)(22)(23)(24)(25)(26)(27)(28)(29). The differential pressures in the various heart chambers and great vessels, stroke volume, the distribution of blood mass, and the pulse rate have been shown to be influenced.…”

Section: Analysis Of Resultsmentioning

confidence: 99%

The Validity of the Electrokymographic Method for Measurement of Diameter Change of the Aorta and Pulmonary Artery During Circulatory Disturbance1

Kay

Woods²,

Zinsser³

et al. 1949

J. Clin. Invest.

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“…These clinical investigators observed that orthostatic hypotension in patients with pure autonomic failure appeared to improve symptomatically and objectively during daytime and that this improvement had disappeared in the morning after sleeping in bed at night. The observation of diurnal changes in orthostatic tolerance led MacLean and Allen to the suggestion that patients with orthostatic hypotension should not sleep in a flat bed but should lie in a semi inclined or head-up position [11,12]. Definite symptomatic and objective reversible changes were documented.…”

Section: Sleep With Head-up Tilt: Past and Presentmentioning

confidence: 99%

Are small observational studies sufficient evidence for a recommendation of head-up sleeping in all patients with debilitating orthostatic hypotension? MacLean and Allen revisited after 70 years

2009

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Orthostatic tachycardia and orthostatic hypotension: Defects in the return of venous blood to the heart

Cited by 71 publications

References 4 publications

Fludrocortisone and sleeping in the head-up position limit the postural decrease in cardiac output in autonomic failure

Fludrocortisone and sleeping in the head-up position limit the postural decrease in cardiac output in autonomic failure

The Validity of the Electrokymographic Method for Measurement of Diameter Change of the Aorta and Pulmonary Artery During Circulatory Disturbance1

Are small observational studies sufficient evidence for a recommendation of head-up sleeping in all patients with debilitating orthostatic hypotension? MacLean and Allen revisited after 70 years

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