Sympathetic outflow to the hand in patients with Raynaud's phenomenon

Fagius, Jan; Blumberg, H.

doi:10.1093/cvr/19.5.249

Cited by 58 publications

(24 citation statements)

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“…Limb immersion in ice water triggers sympathetic vasoconstrictor discharge in the extremities, which reduces cutaneous blood flow (Fagius and Blumberg, 1985) and increases blood pressure in proportion to muscle sympathetic nerve activity (Fagius et al, 1989). The combination of a vasoconstrictive response in the limbs and an increase in facial blood flow is reminiscent of the pattern of vascular response during emotions such as anger and embarrassment (Drummond, 1997;Drummond, 1999), and also resembles the response evoked by microinjections of the synaptic excitant D,L homocysteic acid into the pretentorial part of the lateral periaqueductal gray of decerebrate cats (Carrive and Bandler, 1991).…”

Section: Discussionmentioning

confidence: 99%

Immersion of the hand in ice water releases adrenergic vasoconstrictor tone in the ipsilateral temple

Drummond

2006

Autonomic Neuroscience

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Immersion of the hand in painfully-cold water induces cutaneous vasodilatation in the temples, more so ipsilaterally than contralaterally. To investigate the mechanism of this response, guanethidine or saline was administered by transcutaneous iontophoresis to a recording site in the temple of ten participants before they immersed one of their hands in ice water. Guanethidine displaces noradrenaline from sympathetic nerve terminals and inhibits sympathetic noradrenergic neurotransmission. Therefore, it was hypothesized that guanethidine pretreatment would block vasodilatation mediated by release of sympathetic vasoconstrictor tone in cutaneous vessels in the temple. During hand immersion, increases in the amplitude of the pulse waveform detected by laser Doppler flowmetry were greater in the ipsilateral than contralateral temple (86% versus 34% above baseline, p<0.05), and pretreatment with guanethidine prevented this asymmetric response (ipsilateral response 21% above baseline and contralateral response 32%, difference not significant). Guanethidine also inhibited ipsilateral increases in cutaneous blood flow during hand immersion in responsive participants. These findings suggest that limb pain inhibited ipsilateral adrenergic vasoconstrictor outflow in the temple. Thus, the findings challenge the concept of the sympathetic nervous system as a "mass action" system that discharges in unison to meet environmental demands. Instead, they suggest that the sympathetic nervous system is highly differentiated, with separate control of discrete reflex pathways on each side of the body.

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Section: Discussionmentioning

confidence: 99%

Immersion of the hand in ice water releases adrenergic vasoconstrictor tone in the ipsilateral temple

Drummond

2006

Autonomic Neuroscience

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“…In contrast to our study in which muscle sympathetic activity increased only after the first 30 seconds of the CPT, skin sympathetic activity in the median nerve increased immediately upon immersion of the contralateral hand in ice water. 35 This finding is not surprising since skin sympathetic activity is extremely responsive to noxious or arousal stimuli. 23 In contrast, MSNA does not increase and sometimes tends to decrease in response to arousal stimuli.…”

Section: Comparison Of Effects Of Cold Pressor Test On Sympathetic Nementioning

confidence: 92%

“…The discrepancy between their results and our findings of increased MSNA during the CPT mostly likely relate to differences in the duration of the cold stimulus (i.e., a few seconds vs 2 minutes). More recently, Fagius and Blumberg 35 reported that the CPT produced abrupt increases in skin sympathetic activity. In contrast to our study in which muscle sympathetic activity increased only after the first 30 seconds of the CPT, skin sympathetic activity in the median nerve increased immediately upon immersion of the contralateral hand in ice water.…”

Section: Comparison Of Effects Of Cold Pressor Test On Sympathetic Nementioning

confidence: 99%

Effects of the cold pressor test on muscle sympathetic nerve activity in humans.

Victor¹,

Leimbach²,

Seals³

et al. 1987

Hypertension

468

350

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SUMMARY The purpose of this study was to determine the effects of the cold pressor test on sympathetic outflow with direct measurements of nerve traffic in conscious humans and to test the strength of correlation between sympathetic nerve discharge and the changes in arterial pressure, heart rate, and plasma norepinephrine. In 25 healthy subjects, arterial pressure, heart rate, and muscle sympathetic nerve activity were measured with microelectrodes inserted percutaneously into a peroneal muscle nerve fascicle in the leg during immersion of the hand in ice water for 2 minutes. Arterial pressure rose steadily during the first and second minutes of the cold pressor test. Muscle sympathetic activity (burst frequency x amplitude) did not increase in the first 30 seconds of the test but increased from 230 ± 27 to 386 ± 52 units (mean ± SE, p< 0.05) by the end of the first minute of the test and to 574 ±73 (p<0.01) during the second minute. In contrast, heart rate increased maximally during the first 30 seconds of the cold pressor test and returned to control during the second minute. The increases in heart rate were abolished by /3-adrenergic blockade. The increases in muscle sympathetic activity during the cold pressor test were correlated with the increases in both mean arterial pressure (r=0.86, p<0.01) and peripheral venous norepinephrine (r=0.72, p<0.05); however, large changes in nerve traffic were associated with small changes in plasma norepinephrine. The major new conclusions from this study are that 1) stimulation of sympathetic neural outflow to skeletal muscle is an important component of the sympathetic response to the cold pressor test, 2) the cold pressor test appears to produce differentia] effects on sympathetic outflow to the heart and to the skeletal muscles, and 3) the arterial pressure response to the cold pressor test provides an approximate index of muscle sympathetic activity in this setting. (Hypertension 9: 429-436, 1987) KEY WORDS • cold pressor test norepinephrine sympathetic nerve activity • heart rate • plasma I N most healthy human subjects, cutaneous application of ice water, the cold pressor test (CPT), increases arterial pressure, heart rate, and vascular resistance.' For many years, the CPT has been Used From the Department of Medicine, the Cardiovascular Center, and the Veterans Administration Medical Center, University of Iowa College of Medicine, Iowa City, Iowa, and the Department of Clinical Neurophysiology, Sahlgrenska Hospital, Goteborg, Sweden.Supported by Clinical Investigator Award (HL01362) to Dr. Victor from the National Heart, Lung, and Blood Institute (NHLBI), by research grants HL24962 and HL14388 from the NHLBI, and by research funds from the Veterans Administration.A preliminary report of this work was presented at the annual meeting of the American College of Cardiology in Anaheim, California, March, 1985 (abstract published in J Am Coll Cardiol 19855:415).Address for reprints: Ronald G. Victor, M.D., Cardiology Division, Rm. H8.116, Department of Internal Medicin...

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“…The control group consisted of proposed by Raynaud (1) of increased activity of the 19 healthy volunteers, matched for age and sex. None of the -, i j--j j// ^ A\ subjects, inclüding controls, had taken any vasoactive drug sympathetic System are almost evenly divided (2,3,4). duriBg the previous ten days Seeking clues to the role of the sympathetic System in Informed consent was obtained from all subjects.…”

Section: Introductionmentioning

confidence: 99%

Cold-Induced Changes in Plasma Norepinephrine, Epinephrine and Dopamine Concentrations in Patients with Raynaud's Phenomenon

Marasini

Biondi

Mollica

et al. 1991

Clinical Chemistry and Laboratory Medicine

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Summary:To investigate the role of the sympathetic System in Raynaud's phenomenon, which has not yet been elucidated, we measured the levels of norepinephrine, epinephrine and dopamine before, immediately and 30 min after the cold pressor test in plasma from 17 patients with primary, 6 with secondary RaynautTs phenomenon and 19 volunteers, matched for age and sex. Patients had significantly low baseline epinephrine (0.13 ± 0.02 vs 0.37 ± 0.04, nmol/1, p < 0.001, mean ± S. E.), but normal norepinephrine and dopamine (norepinephrine: 1.77 ± 0.16 and 2.06 + 0.18; dopamine: 0.10 ± 0.01 and 0.11 + 0.02, patients and controls).Immediately after the cold test norepinephrine significantly increased (p < 0.001) in patients (2.42 + 0.22) and controls (3.24 ± 0.28); epinephrine increased in patients (0.18 ± 0.02, p < 0.02); dopamine did not show any significant change (0.13 ± 0.01 and 0.13 ± 0.02, patients and controls).In the recovery period, while norepinephrine and epinephrine returned to baseline in both groups, dopamine increased in controls (0.21 + 0.04, p < 0.005) but remained unchanged in patients (0.11 ± 0.01).We conclude that there is no sympathetic overactivity in Raynaud's phenomenon and propose a role for circulating dopamine in post-ischaemic vasodilatation äs an explanation for the particular behaviour of dopamine.

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Sympathetic outflow to the hand in patients with Raynaud's phenomenon

Cited by 58 publications

References 0 publications

Immersion of the hand in ice water releases adrenergic vasoconstrictor tone in the ipsilateral temple

Immersion of the hand in ice water releases adrenergic vasoconstrictor tone in the ipsilateral temple

Effects of the cold pressor test on muscle sympathetic nerve activity in humans.

Cold-Induced Changes in Plasma Norepinephrine, Epinephrine and Dopamine Concentrations in Patients with Raynaud's Phenomenon

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