Exercise stress testing in healthy subjects during cholinergic stimulation after a single dose of pyridostigmine.

OBJECTIVE: The evaluation, by exercise stress testing, of the cardiorespiratory effects of pyridostigmine (PYR), a reversible acetylcholinesterase inhibitor. METHODS: A double-blind, randomized, cross-over, placebo-controlled comparison of hemodynamic and ventilation variables of 10 healthy subjects who underwent three exercise stress tests (the first for adaptation and determination of tolerance to exercise, the other two after administration of placebo or 45mg of PYR). RESULTS: Heart rate at rest was: 68+/-3 vs 68+/-3bpm before and after placebo, respectively (P=0.38); 70+/-2 vs 59+/-2bpm, before and after pyridostigmine, respectively (P<0.01). During exercise, relative to placebo: a significantly lower heart rate after PYR at, respectively, 20% (P=0.02), 40% (P=0.03), 80% (P=0.05) and 100% (P=0.02) of peak effort was observed. No significant differences were observed in arterial blood pressure, oxygen consumption at submaximal and maximal effort, exercise duration, respiratory ratio, CO2 production, ventilation threshold, minute ventilation, and oxygen pulse. CONCLUSION: Pyridostigmine, at a dose of 45mg, decreases heart rate at rest and during exercise, with minimal side effects and without interfering with exercise tolerance and ventilation variables.

Cholinergic stimulation with pyridostigmine, hemodynamic and echocardiographic analysis in healthy subjects.

OBJECTIVE: Growing evidence suggests that sudden death after an acute myocardial infarction (AMI) correlates with autonomic nervous system imbalance. Parasympathomimetic drugs have been tested to reverse these changes. However, their effects on ventricular function need specific evaluation. Our objective was to analyze pyridostigmine's (PYR) effect on hemodynamic and echocardiographic variables of ventricular function. METHODS: Twenty healthy volunteers underwent Doppler echocardiographic evaluations, blood pressure (BP), and heart rate (HR) assessment at rest, before and 120 min after ingestion of 30 mg PYR or placebo, according to a double-blind, placebo-controlled, crossed and randomized protocol, on different days. RESULTS: PYR was well tolerated and did not cause alterations in BP or in ventricular systolic function. A reduction in HR of 10.9 +/- 1.3% occurred (p < 0.00001). There was an A wave reduction in the mitral flow (p < 0.01) and an E/A ratio increase (p < 0.001) without changes in the other diastolic function parameters (p > 0.05). CONCLUSION: PYR reduces HR and increases E/A ratio, without hemodynamic impairment or ventricular function change.

Skeletal muscle function and body composition of patients with hyperthyroidism.

The purpose of this study was to determine whether the improvement in muscle performance after treatment of hyperthyroidism is only a result of an increased muscle mass or if it also depends on the improvement of intrinsic contractile function. Nine patients with Graves' disease were evaluated 1) at the time of diagnosis, 2) after 1 wk of monotherapy with propranolol, and 3) after the euthyroid state had been achieved with antithyroid drugs. At each evaluation the patients were submitted, on the dominant side, to anthropometric measurements and to skeletal muscle function tests to determine the maximal static voluntary contraction (MAX) and endurance (END); "endurance" is defined as the time limit at maintaining 30% of MAX. Three movements were tested: hip flexion, ankle dorsiflexion, and handgrip. Body weight changed from 53.4 +/- 3.2 to 58.2 +/- 2.9 kg (P = 0.004) and the sum of skinfold-corrected limb circumferences changed from 90.7 +/- 3.1 to 94.4 +/- 3.1 cm (P = 0.017). MAX and END of all movements increased at the end of the study even if adjusted for the sum of skinfold-corrected limb circumferences: Hip flexion: MAX 20.60 +/- 3.32 to 31.26 +/- 5.07 g.cm-1, END 0.43 +/- 0.18 to 1.18 +/- 0.42 kg.s-1.cm-1. Ankle dorsiflexion: MAX 12.34 +/- 1.97 to 26.88 +/- 2.46 g.cm-1, END 0.97 +/- 0.28 to 2.50 +/- 0.58 kg.s-1.cm-1; Handgrip: MAX: 2.20 +/- 0.23 to 2.9 +/- 0.2 g.cm-1, END 0.13 +/- 0.01 to 0.20 +/- 0.02 kg.s-1.cm-1. In conclusion, improved muscle performance resulting from the treatment of hyperthyroidism is a consequence of an enhanced intrinsic muscle function as well as a greater muscle mass.

[Initial heart rate transient at dynamic exercise performed in apnea. Influence of the variation rate of previous lung volume]. / Transiente inicial de freqüência cardíaca no exercício dinâmico realizado em apnéia. Influência da taxa de variação do volume pulmonar precedente.

PURPOSE: To study the influence of inspiratory flow on the heart rate (HR) responses during the four-second exercise test (4sET) as a method to estimate cardiac vagal activity. METHODS: Fifteen healthy subjects performed the 4sET under two experimental situations: a) with maximal individual inspiratory flow (MIF) and b) with a slow inspiratory flow adjusted to reach total lung capacity in 4s (SIF). Vagal activity was estimated from B/C ratio obtained in ECG tracings, where B is the last R-R interval before the onset of exercise and C is the shortest R-R interval during exertion. RESULTS: Similar inspiratory capacities were reached, with significantly different inspiratory flows [mean (se)] [MIF = 2.23 (0.28) 1.s-1 and SIF = 0.59 (0.06) 1.s-1; t = 6.69; p < 0.0001]; as a result, it was observed a greater B/C ratio in MIF [1.36 (0.05)] as compared to SIF [1.13 (0.04); t = 4.42; p = 0.0006]. The inspiratory flow influenced HR responses in the 4sET. The biphasic transient induced by inspiration, with a HR acceleration followed by a relative bradycardia, has not been completed before exercise in the 4sET with SIF. CONCLUSION: Lower values of B/C in the 4sET with SIF seemed to be due to overlapping effects of apnea and exertion on HR during cycling. On the other hand, when the inspiration was performed at MIF, the oscillatory effect of respiration upon HR was completed before the onset of exercise. Therefore, the tachycardia observed during the 4sET performed after individual maximal inspiratory flow represents the isolated effect of dynamic exercise.