Asymptomatic Severe Vagal and Sympathetic Cardiac Denervation in Holmes-Adie's Syndrome.

A 40-year-old woman was found to have bilateral Adie's pupils and generalized muscle stretch areflexia. She did not have orthostatic hypotension but, in an ECG strip in the office, she appeared to have an almost fixed heart rate. We thus studied the heart rate variability (HRV) and the systolic blood pressure variability (SBPV) in supine and standing position and also during rhythmic breathing. We found a decreased HRV in the time domain with very low standard deviation in supine and standing position and during rhythmic breathing. HRV in the frequency domain was low with a decrease in the absolute power of HF and LF and a decrease in the sympathovagal balance in supine and standing positions. SBPV in the time and frequency domains was found to be normal. This patient with Holmes-Adie syndrome had an asymptomatic severe loss of HRV and a preserved SBPV. The global decrease in the HRV in the time and frequency domains indicated that she had both vagal and sympathetic cardiac denervation, whereas the preserved SBPV suggested normal innervation of the blood vessels.

[The two faces of veno-arteriolar reflex: cutaneous vasodilatation and vasoconstriction to raise and to lower the arm]. / Las dos caras del reflejo venoarteriolar: vasoconstriccion y vasodilatacion cutanea al bajar y subir el brazo.

INTRODUCTION: The veno-arteriolar reflex (VAR) is triggered by an increase in the transmural venous pressure on placing a part of the body in the same direction as the gravitational acceleration below the heart. AIM: To assess the VAR in healthy subjects on raising a part of the body above the level of the heart. SUBJECTS AND METHODS: VAR was studied in 16 healthy subjects (20-65 years old) by means of changes in the blood flow in the skin detected using a digital infrared photoplethysmograph attached to the fingertip under the following conditions: right arm at the height of the heart, right arm below the heart and right arm below the level of the heart. The variables measured were: amplitude of the blood flow in the skin with the arm raised to the height of the heart (baseline amplitude), percentage decrease of the blood flow in the skin with the arm below the heart and percentage increase in blood flow with the arm above the heart. RESULTS: The percentage of vasoconstriction with the right arm below the heart was 35%, and that of vasodilation, 50%. CONCLUSIONS: Evaluation of the VAR with the arm below the heart causes vasoconstriction, and elevation of the arm causes an important degree of vasodilation. Vasoconstriction and vasodilation are maintained while the limb is kept above or below the heart. This is an economical and potentially very useful way of studying the innervation of the microcirculation in a number of different peripheral neuropathies of thin and mixed fibres.

TITLE: Las dos caras del reflejo venoarteriolar: vasoconstriccion y vasodilatacion cutanea al bajar y subir el brazo.Introduccion. El reflejo venoarteriolar (RVA) lo provoca un incremento en la presion venosa transmural al colocar una parte del cuerpo en el sentido de la aceleracion gravitatoria por debajo del corazon. Objetivo. Evaluar el RVA en sujetos sanos al levantar una parte del cuerpo por encima del corazon. Sujetos y metodos. En 16 sujetos sanos (20-65 años) se estudio el RVA mediante cambios en el flujo sanguineo de la piel con un fotopletismografo digital infrarrojo colocado en el pulpejo en sujetos sanos durante las siguientes condiciones: brazo derecho a la altura del corazon, brazo derecho 40 cm por debajo del corazon y brazo derecho 40 cm por encima del corazon. Las variables medidas fueron: amplitud del flujo sanguineo de la piel con el brazo a la altura del corazon (amplitud basal), porcentaje de disminucion del flujo sanguineo de la piel con el brazo por debajo del corazon y porcentaje de aumento del flujo sanguineo de la piel con el brazo por encima del corazon. Resultados. El porcentaje de vasoconstriccion con el brazo derecho por debajo del corazon fue del 35%, y el de vasodilatacion, del 50%. Conclusiones. La evaluacion del RVA con el brazo por debajo del corazon provoca vasoconstriccion, y la elevacion del brazo produce una importante vasodilatacion. La vasoconstriccion y la vasodilatacion se mantienen mientras la extremidad se mantenga por encima o por debajo del corazon. Este es un estudio potencialmente muy util y economico para estudiar la inervacion de la microcirculacion en diversas neuropatias perifericas de fibras delgadas y mixtas.

[Development of a canine model of chronic progressive right ventricular hypertension]. / Desarrollo de un modelo canino de hipertensión ventricular derecha crónica progresiva.

INTRODUCTION: Several animal models of right ventricle hypertension (RVH) have been produced through pulmonary artery banding with linen, tygon or teflon. Nevertheless few devices attempting a progressive, step by step graduated chronic development of RVH have been reported. The present study describes the results in our animal model of chronic RVH. MATERIAL AND METHODS: We designed a software programmed to obtain hemodynamic data and installed a small occlusive hydraulic device (OHD) at the pulmonary artery trunk producing a raise in the right ventricular systolic pressure (RVSP); this pressure can be modified externally through the OHD. We studied 12 healthy mongrel dogs (18 to 28 kg of weight) in the course of 6 months. Hemodynamic measurements were performed at different RVSP at two months intervals; (Baseline, 40 mmHg and 60 mmHg). RESULTS: The software was useful to analyze several hemodynamic variables at each RVSP. At 60 mmHg, the end diastolic pressure of the right ventricle (RVEDP) increased from 4.2 +/- 0.4 mmHg to 13.2 +/- 1.1 mmHg, p < 0.000, accompanied with a fall in cardiac output adjusted to the dogs weight from 0.16 +/- 0.03 L/min/kg to 0.09 +/- 0.01 L/min/kg, p > 0.000. Also an increase of the end diastolic pressure of the left ventricle (LVEDP) from 7.4 +/- 0.8 mmHg to 16.3 +/- 2.8 mmHg, p < 0.000, was observed. RVSP was maintained in chronic condition and the intraclass correlation coefficient was 0.83, P < 0.005. CONCLUSIONS: Right ventricular chronic hypertension is created. The device is useful and reliable to maintain chronic increments of RVSP. The software permits a versatile analysis.

[A system for non-invasive measurement of arterial pulse velocity in different vascular territories]. / Sistema para la medición no invasiva de la velocidad del pulso arterial en diferentes territorios vasculares.

Blood pulse wave velocity (PWV) is a known index of arterial rigidity and its measurement has proved its usefulness in the study of some cardiovascular pathologies. In this study we describe the design and implementation of a system for noninvasive PWV determination in the aorto-braqui-humero-radial (A-->h), aorto-ileo-femoro-pedial (A-->f) and aorto-carotid (A-->c) regions. This system was examined with 36 normotensives (NT) and 34 hypertensives (HT) patients with (LVH, n = 20) and without (WLVH, n = 14) left ventricular hypertrofy. The equipment consist of a personal computer with an analog to digital converter and hardware and software items adapted to take simultaneously the electrocardiogram (ECG), two photopletismographic pulses and one oscilometric pulse. The Q-pP interval (time between a Q ECG wave and distal blood pulse) and the distance to the register sites are taken into account to calculate the beginning of cardiac prexpulsive period (time zero of pulse trip) which allow the determination of the PWV (in meters/second) from the aortic root to the distal point of the via. PWV was significant higher (p < 0.001) in HT vs. NT (A-->h: 9.3 +/- 2.6 vs. 7.2 +/- 0.8, A-->c: 9.5 +/- 2.8 vs. 6.0 +/- 1.9 and A-->f: 9.5 +/- 1.8 vs. 7.2 +/- 0.9) in each evaluated arterial region. Same thing occurred in cases with LVH vs. WLVH (A-->h: 10.5 +/- 1.6 vs. 8.0 +/- 1.9, A-->c: 10.2 +/- 1.9 vs. 8.0 +/- 1.9 and A-->f: 10.5 +/- 2.0 vs. 8.6 +/- 1.2) (p < 0.025). This is consistent with the relationship more pressure [symbol: see text] more rigidity and with other reports. This method may have clinical application.