Use of lower abdominal compression to combat orthostatic hypotension in patients with autonomic dysfunction

Smit, Adrianus A. J.; Wieling, Wouter; Fujimura, Jiro; Denq, Jong Chyou; Opfer‐Gehrking, Tonette L.; Akarriou, Mohammed; Karemaker, John M.; Low, Phillip A.

doi:10.1007/s10286-004-0187-x

Cited by 117 publications

(115 citation statements)

References 44 publications

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“…Not every patient was physically able to perform each countermaneuver without assistance, but most of the patients could adequately perform at least one of the maneuvers. These findings suggest that the overall effectiveness of physical countermaneuvers is rather limited in the FD population compared with other groups of patients [5,16,20,23]. However, in some FD patients a particular countermaneuver may be useful for averting an episode of posturally-related syncope.…”

Section: Discussionmentioning

confidence: 93%

“…In contrast to the usefulness of countermaneuvers in other disorders of orthostatic intolerance [5,16,20,22,23], their efficacy in the FD population is limited because of orthopedic problems, ataxia, and the specific pathophysiology of orthostatic hypotension in FD.…”

Section: Discussionmentioning

confidence: 99%

“…This maneuver mechanically compresses the veins of the legs and thus increases central blood volume [10,20,22]. ■ Abdominal compression A 16 cm broad band, comprising an outer layer of hard polyester cloth and an inner inflatable elastic cuff, was placed around the patients' waist at the level of the umbilicus and inflated to 20 mmHg, thus compressing the abdomen [16,19].…”

Section: ■ Proceduresmentioning

confidence: 99%

“…Furthermore, relative changes in hemodynamic parameters during the countermaneuvers were calculated as percent changes from the preceding standing values [16,22].…”

Section: ■ Data Acquisition and Analysismentioning

confidence: 99%

“…Some of the more common countermaneuvers include leg-crossing, squatting and bending forward accompanied by compressing the abdomen with crossed arms and are rather effective in minimizing postural blood pressure drops [22,23]. Furthermore, abdominal compression, achieved by means of an inflatable binder, has been shown to be particularly effective in the treatment of orthostatic intolerance in children and patients with autonomic failure [16,19]. In the FD population, the effects of various countermaneuvers on standing blood pressure have not yet been studied.…”

Section: Introductionmentioning

confidence: 99%

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Effect of physical countermaneuvers on orthostatic hypotension in familial dysautonomia

et al. 2005

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■ Abstract Familial dysautonomia (FD) patients frequently experience debilitating orthostatic hypotension. Since physical countermaneuvers can increase blood pressure (BP) in other groups of patients with orthostatic hypotension, we evaluated the effectiveness of countermaneuvers in FD patients.In 17 FD patients (26.4 ± 12.4 years, eight female), we monitored heart rate (HR), blood pressure (BP), cardiac output (CO), total peripheral resistance (TPR) and calf volume while supine, during standing and during application of four countermaneuvers: bending forward, squatting, leg crossing, and abdominal compression using an inflatable belt. Countermaneuvers were initiated after standing up, when systolic BP had fallen by 40 mmHg or diastolic BP by 30 mmHg or presyncope had occurred.During active standing, blood pressure and TPR decreased, calf volume increased but CO remained stable. Mean BP increased significantly during bending forward (by 20.0 (17-28.5) mmHg; P = 0.005) (median (25 th -75 th quartile)), squatting (by 50.8 (33.5-56) mmHg; P = 0.002), and abdominal compression (by 5.8 (-1-34.7) mmHg; P = 0.04) -but not during leg-crossing. Squatting and abdominal compression also induced a significant increase in CO (by 18.1 (-1.3-47.9) % during squatting (P = 0.02) and by 7.6 (0.4-19.6) % during abdominal compression (P = 0.014)). HR did not change significantly during the countermaneuvers. TPR increased significantly only during squatting (by 37.2 (11.8-48.2) %; P = 0.01). However, orthopedic problems or ataxia prevented several patients from performing some of the countermaneuvers. Additionally, many patients required assistance with the maneuvers.Squatting, bending forward and abdominal compression can improve orthostatic BP in FD patients, which is achieved mainly by an increased cardiac output. Squatting has the greatest effect on orthostatic blood pressure in FD patients. Suitability and effectiveness of a specific countermaneuver depends on the orthopedic or neurological complications of each FD patient and must be individually tested before a therapeutic recommendation can be given.■ Key words physical maneuvers · familial dysautonomia · syncope · autonomic failure · impedance cardiography 1 Published in "Journal of Neurology 253(1): 65-72, 2006" which should be cited to refer to this work.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: ■ Proceduresmentioning

confidence: 99%

“…Furthermore, relative changes in hemodynamic parameters during the countermaneuvers were calculated as percent changes from the preceding standing values [16,22].…”

Section: ■ Data Acquisition and Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of physical countermaneuvers on orthostatic hypotension in familial dysautonomia

et al. 2005

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Syncope

Bianco¹,

Nekkanti²,

Latif³

et al. 2016

Management of Complex Cardiovascular Problems

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Dysautonomia in the Ehlers–Danlos syndromes and hypermobility spectrum disorders—With a focus on the postural tachycardia syndrome

Owens

Iodice

Hakim

2021

American J of Med Genetics Pt C

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Dysautonomia (autonomic dysfunction) occurs in the Ehlers-Danlos syndromes (EDS) and hypermobility spectrum disorders (HSD). Symptoms include palpitations, dizziness, presyncope, and syncope, especially when standing upright. Symptoms of orthostatic intolerance are usually relieved by sitting or lying and may be exacerbated by stimuli in daily life that cause vasodilatation, such as food ingestion, exertion, and heat. Neurocardiovascular dysautonomia may result in postural tachycardia syndrome (PoTS), a major cause of orthostatic intolerance. It is defined by a rise in heart rate of >30 beats per minute (bpm) in adults and >40 bpm in teenagers while upright, without a fall in blood pressure (BP; orthostatic hypotension). In some, it can be compounded by the presence of low BP. For many, there is delay in clinicians recognizing the nature of the symptoms, and recognizing EDS or HSD, leading to delays in treatment. The onset of PoTS may be linked to an event such as infection, trauma, surgery, or stress. Gastrointestinal and urinary bladder involvement may occur, along with thermoregulatory dysfunction. In some, the mast cell activation syndrome may be contributary, especially if it causes vasodilatation. This paper reviews neurocardiovascular dysautonomia with an emphasis on PoTS, its characteristics, associations, pathophysiology, investigation, and treatment.

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Use of lower abdominal compression to combat orthostatic hypotension in patients with autonomic dysfunction

Cited by 117 publications

References 44 publications

Effect of physical countermaneuvers on orthostatic hypotension in familial dysautonomia

Effect of physical countermaneuvers on orthostatic hypotension in familial dysautonomia

Syncope

Dysautonomia in the Ehlers–Danlos syndromes and hypermobility spectrum disorders—With a focus on the postural tachycardia syndrome

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