Discrimination between cardiac para- and sympathetic damage in diabetics

Oikawa, Noboru; Umetsu, Masanori; Sakurada, Mikio; Sato, Hideyuki; Toyota, Takayoshi; Gotō, Yoshio

doi:10.1016/s0168-8227(85)80013-9

Cited by 6 publications

(6 citation statements)

References 16 publications

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“…This notion was also supported by a close relation between relative reductions in LBNP tolerance in the HT (49%) and LT (39%) groups and tachycardic responses (59% and 31%, respectively) induced by 13 blockade. Although increases in baseline arterial pressure lead to predominantly vagally mediated reflex bradycardia [24,27], our findings are consistent with previous evidence that orthostatic tachycardia is mediated predominantly through sympathetic adrenergic control [19,[27][28][29]. Our findings are not without precedent.…”

Section: Role Of Sympathetically Mediated Cardiac Mechanismssupporting

confidence: 92%

Effects of cholinergic and β-adrenergic blockade on orthostatic tolerance in healthy subjects

Convertino

Sather

2000

Clinical Autonomic Research

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Cardiovascular responses during a graded lower body negative pressure (LBNP) protocol were compared before and after atropine and propranolol administration to test the hypothesis that both sympathetic and parasympathetic control of cardio-acceleration are associated with syncopal predisposition to orthostatic stress in healthy subjects. Eleven men were categorized into two groups having high (HT, N = 6) or low (LT, N = 5) tolerance based on their total time before the onset of presyncopal symptoms. HT and LT groups were similar in physical characteristics, fitness, and baseline cardiovascular measurements. Atropine treatment had no effect on LBNP tolerance or mean arterial pressure at presyncope, despite an atropine-induced increase in heart rate. Propranolol treatment reduced (p<0.05) LBNP tolerance in both groups. Diminished LBNP tolerance after propranolol administration was associated with reductions in cardiac output, whereas increase in systemic peripheral resistance from baseline to presyncope was unaffected by propranolol. Reduction in cardiac output and LBNP tolerance after beta blockade reflected a chronotropic effect because lower LBNP tolerance for the HT (-50%) and LT (-39%) groups was associated with dramatic reductions (p <0.05) in the magnitude of LBNP-induced tachycardia without significant effects on stroke volume at presyncope. Absence of an atropine-induced difference in cardiac output and systemic peripheral resistance between HT and LT groups failed to support the notion that cardiac vagal withdrawal represents a predominant mechanism that could account for differences in orthostatic tolerance. Because a reduction in LBNP tolerance in both HT and LT groups after propranolol treatment was most closely associated with reduced tachycardia, the data suggest that a primary autonomically mediated mechanism for maintenance of mean arterial pressure and orthostatic tolerance in healthy subjects is beta adrenergic-induced tachycardia.

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Section: Role Of Sympathetically Mediated Cardiac Mechanismssupporting

confidence: 92%

Effects of cholinergic and β-adrenergic blockade on orthostatic tolerance in healthy subjects

Convertino

Sather

2000

Clinical Autonomic Research

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“…Therefore, it is most important to have an accurate, sensitive method for evaluating autonomic dysfunctions in patients during the progression of FAP. Frequency analysis of the cardiographic K-K intervap 12,13 showed that one asymptomatic carrier of FAP, and all the patients in the early stage, had lower coefficients of variation, especially in LFC (Table 2), then those of control subjects. ':' This is indicative of dysfunction of the cardiac parasympathetic nerve, which increases with FAP progression.…”

Section: Discussionmentioning

confidence: 98%

Role of autonomic nerve functions in patients with familial amyloidotic polyneuropathy as analyzed by laser doppler flowmetry, capsule hydrograph, and cardiographic R–R interval

et al. 1992

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Laser Doppler flowmetry (LDF) was conducted on familial amyloidotic polyneuropathy (FAP) patients and asymptomatic carriers of FAP. Vasoconstrictive responses in the 11 FAP patients tested, induced by deep inspiration, were markedly depressed compared with those of the healthy controls. The responses decreased with the progression of FAP, with no responses being elicited from the 7 patients in stages 2 (moderate) to 4 (terminal). Interestingly, vasoconstrictive responses following deep inspiration also were depressed in 3 of 4 asymptomatic carriers of FAP who showed no clinical sign of FAP, and who had normal sensory nerve conduction velocity. Patients who had such diseases as Shy-Drager's disease, spinocelebellar degeneration, and pandysautonomia showed no decrease in blood flow for various stimulations. In contrast, patients with primary amyloidosis, who had no autonomic dysfunction, showed a normal pattern. Detection of the autonomic functions in FAP patients and asymptomatic carriers by capsule polyhydrography and computer analysis of the cardiographic R-R interval revealed that the asymptomatic carriers of FAP, as well as the FAP patients, had disordered peripheral autonomic functions. Our results suggest that the autonomic nervous system is first affected during the very early stage of FAP.

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“…Stand ing up from the lying position results in a rise in heart rate. With the dysfunction of the parasympathetic sys tem, this rise is slight, and with additional sympathetic damage it may be abolished [3,15]. The orthostatic fall in systolic blood pressure increases with the dysfunction of the sympathetic nervous system, and the rise in dia stolic blood pressure during sustained handgrip de creases [3], Our results confirm those mentioned above, as the initial, functional disturbances of the autonomic nervous system (which indicate first of all the dysfunc tion of the parasympathetic system) may appear rela tively early, in the early stage of the disease in the case of childhood diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…Each child was examined -in the lying position -for the mean resting heart rate for a period of 1 min, for hyperventilatory arrhythmia during five maximal inspirations and expirations, for increase in heart rate and fall in systolic blood pressure during 1 min standing after the lying position, and for rise in diastolic blood pressure after a 1-min sustained maximal handgrip. Heart rates were determined with a routine ECG device by R-R intervals in standard leads, for blood pressure measurements, KorotkofFs method was used [3,[13][14][15].…”

Section: Methodsmentioning

confidence: 99%

Investigation of Subclinical Signs of Autonomic Neuropathy in the Early Stage of Childhood Diabetes

1990

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It has been suggested that subclinical signs of neuropathy appear earlier than microvascular complications of diabetes. To evaluate the occurrence of autonomic nervous system dysfunction in the early stage of childhood diabetes, subclinical signs of autonomic neuropathy (resting heart rate, hyperventilatory arrhythmia, standing/lying heart rate ratio, orthostatic decrease in blood pressure, and increase in blood pressure during sustained handgrip) were investigated in 54 children with type 1 diabetes divided into three groups: 14 recent-onset diabetics (3 weeks after the diagnosis), 20 diabetics in the remission phase, and 20 patients after the remission phase. 30 healthy age-matched children were used as control group. The mean resting heart rates of the diabetic groups in the remission phase and after the remission phase were significantly higher than those in the healthy control group (81.7 ± 5/min and 88.5 ± 6/min vs. 72.2 ± 8/min; p < 0.01). The hyperventilatory arrhythmia in the group of diabetic children after the remission phase in comparison with the control group was significantly decreased (29.1 ± 4/min vs. 22.7 ± 3/min; p < 0.01). In a few cases of the recent-onset diabetic group, the increase in resting heart rate, the decrease in hyperventilatory arrhythmia, and the standing/lying heart rate ratio proved to be significant. In the remission phase, the same parameters showed abnormal values in one third to one fifth of the children. In the diabetic group after the remission phase, these parameters were established as pathologic in one half to one fifth of the children, and in some cases, the orthostatic decrease in blood pressure and the increase in blood pressure during sustained handgrip were pathognomic as well. These results indicate that the initial, functional disturbances of the autonomic nervous system may appear early during the course of childhood diabetes and they emphasize the necessity to search for subclinical neuropathy in diabetic children.

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Discrimination between cardiac para- and sympathetic damage in diabetics

Cited by 6 publications

References 16 publications

Effects of cholinergic and β-adrenergic blockade on orthostatic tolerance in healthy subjects

Effects of cholinergic and β-adrenergic blockade on orthostatic tolerance in healthy subjects

Role of autonomic nerve functions in patients with familial amyloidotic polyneuropathy as analyzed by laser doppler flowmetry, capsule hydrograph, and cardiographic R–R interval

Investigation of Subclinical Signs of Autonomic Neuropathy in the Early Stage of Childhood Diabetes

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