PMID: 9640339Jun 26, 1998Paper

Dynamics of circulatory adjustments to head-up tilt and tilt-back in healthy and sympathetically denervated subjects

Clinical Science
Wouter WielingA D ten Harkel

Abstract

1. The initial circulatory adjustments induced by head-up tilt and tilt-back were investigated in six healthy subject (aged 30-58 years) and six patients with orthostatic hypotension due to pure autonomic failure (aged 33-65 years). 2. Continuous responses of finger arterial pressure and heart rate were recorded by Finapres. A pulse contour algorithm applied to the arterial pressure waveform was used to compute stroke volume responses. 3. In the healthy subjects, head-up tilt induced gradual circulatory adjustments. After 1 min upright stroke volume and cardiac output had decreased by 39 +/- 9% and 26 +/- 10% respectively. Little change in mean blood pressure at heart level (+1 +/- 7 mmHg) indicated that systemic vascular resistance had increased by 39 +/- 24%. The gradual responses to head-up tilt contrasted with the pronounced and rapid circulatory responses upon tiltback. After 2-3 s a rapid increase in stroke volume (from 62 +/- 8% to 106 +/- 10%) and cardiac output (from 81 +/- 11% to 118 +/- 20%) was observed with an overshoot of mean arterial pressure above supine control values of 16 +/- 3 mmHg at 7 s. In the patients a progressive fall in blood pressure on head-up tilt was observed. After 1 min upright mean blood press...Continue Reading

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