Giorgio Baccelli

The exercise pressor reflex and changes in radial arterial pressure and heart rate during walking in patients with arteriosclerosis obliterans.

Little is known about the time course and extent of the changes in radial arterial pressure and heart rate taking place in patients with arteriosclerosis obliterans during walking, as well their subtending mechanisms. For this reason the authors measured these variables in 23 patients with arteriosclerosis obliterans and in nine normal subjects (control group), during treadmill walking and several tests. In the patients a rapid and marked increase in radial arterial pressure was recorded during walking, whereas the same parameter either fell abruptly or persisted at elevated levels during recovery. This pattern markedly differed from that recorded in normal subjects, and it was mainly brought about by the activation of the exercise pressor reflex. The following findings suggested that the exercise pressor reflex was activated: the conditions required for activation of the reflex were present in our patients; the pressure changes observed during walking tightly paral leled the changes due to this reflex activation; the hypertensive response to walking was enhanced by increases in severity of disease and in walking speed and duration; the reflex activity persisted during recovery; and the pressure pattern during walking was reproduced by walking with arrested blood circulation to a lower limb. On the contrary, the behavior of heart rate was similar in patients and normal subjects both during walking and recovery because it was not influenced by the exercise pressor reflex.

Interactions between sino-aortic reflexes and cardiovascular effects of sleep and emotional behavior in the cat.

The role of sino-aortic reflexes in the control of circulation during normal behavior was investigated by comparing cardiovascular reactions during various but reproducible types of behavior before and after bilateral sino-aortic deafferentation. Chronic deafferentation caused little change in baseline blood pressure, but a subtler, important role of sino-aortic reflexes was revealed by examining the integrated cardiovascular responses to behavioral stimuli. During desynchronized sleep, the buffering action of sino-aortic reflexes prevented a marked and diffuse vasodilation, with an action that was particularly evident on muscle blood vessels. During emotional behavior, especially when emotion was accompanied by movement, sino-aortic reflexes opposed the consequences of muscle vasodilation by inducing tachycardia and vasoconstriction in the viscera and in noncontracting muscles. A reciprocal type of interaction between behavior and sino-aortic reflexes was shown by testing the amplitude of the carotid occlusion response before and during desynchronized sleep; the latter condition was consistently associated with decreased effectiveness of the reflex response. The possibility is considered that this might indicate central suppression of the carotid sinus reflex during desynchronized sleep and that a similar inhibitory interference might occur during emotional behavior. Alternatively, reduction of the reflex response might result from a shift of the stimulus-response curve on either side of its steep portion.

Hemodynamic Patterns during Desynchronized Sleep in Intact Cats and in Cats with Sinoaortic Deafferentation

In unanesthetized, unrestrained cats, placed in a sound-attenuated cage, stroke volume and cardiac output were continuously monitored by an electromagnetic flow transducer chronically implanted around the ascending aorta, arterial pressure was measured by means of a femoral catheter connected to a strain-gauge transducer, and heart rate by a cardiotachograph. Total resistance was computed by dividing arterial pressure by cardiac output. Electroencephalograms, cervical electromyogram, and ocular movements were also monitored to obtain evidence of naturally occurring sleep. In animals with intact sinoaortic reflexes the fall in arterial pressure occurring during desynchronized sleep was associated with a small decrease in cardiac output and a relatively greater reduction in total resistance. After sinoaortic deafferentation, the conspicuously exaggerated fall in arterial pressure occurring during the same type of sleep was almost entirely due to a parallel exaggeration of the reduction in total resistance; changes in cardiac output were only slightly greater than before deafferentation. Only in the few episodes of desynchronized sleep in which extreme hypotension was accompanied by signs of cerebral anoxia, did cardiac output greatly decrease; in these cases, calculated resistance was found to increase. Both small and large changes in cardiac output were independent of heart innervation.

Central and Reflex Regulation of Sympathetic Vasoconstrictor Activity to Limb Muscles during Desynchronized Sleep in the Cat

Desynchronized sleep (DS) in the cat is accompanied by a long-lasting (tonic) constriction of muscle blood vessels (conductance decrease 5–30%), on which are superimposed short-lasting (phasic) vasoconstrictor waves that occur simultaneously with bursts of rapid eye movements and body twitches. Both the tonic and the phasic vasoconstrictions are abolished after regional sympathectomy (conductance increase 5–10%). Tonic vasoconstriction can also be prevented by hind-limb deafferentation (bilateral section of the dorsal roots from L5 down) or by transection of the spinal cord at L4 in such a way as to separate sympathetic innervation from afferent input from the hind limbs. These procedures do not affect the phasic vasoconstrictions. After lumbar sympathectomy or hind-limb deafferentation, iliac blood flow decreases during the tonic fall in blood pressure associated with DS by exactly the amount (1–2 ml/min) predicted by pressure flow relationships observed during artificial lowering of iliac blood pressure. We conclude that tonic and phasic vasoconstrictions are both due to sympathetic discharges. However, phasic sympathetic discharges are driven by central descending influences, and tonic sympathetic vasoconstriction depends on reflex influences originating from the limbs themselves. When tonic sympathetic vasoconstriction is prevented, muscle blood vessels exhibit autoregulatory behavior during DS.

Hemodynamic Factors Changing Blood Flow Velocity Waveform and Profile in Normal Human Brachial Artery

We have investigated the influence of changes of perfusion pressure and local peripheral resistance on blood flow velocity waveform and profile in normal human peripheral arteries. Blood flow velocity and profile were recorded from the distal end of the left brachial artery in ten normal subjects by means of an ultrasonic device. The records were obtained in basal conditions and after blood pressure in the brachial artery and local peripheral vascular resistance were changed, separately or together, by progressive inflation of two arm cuffs, one encircling the proximal half of the left arm and the other the middle part of the left forearm. Both blood flow velocity waveform and profile were shown to be markedly modified by changes in perfusion pressure and local peripheral vascular resistance. Reduction of perfusion pressure decreased both forward and reverse peak velocities, but had the largest effect upon reverse velocity. The upslope and the downslope of the forward velocity wave were left unchanged. Increase in local peripheral vascular resistance markedly augmented reverse peak velocity, whether perfusion pressure was normal or reduced. Increased resistance only slightly influenced peak forward velocity.

HAEMODYNAMIC EFFECTS OF ISOMETRIC HANDGRIP EXERCISE IN PATIENTS CONVALESCENT FROM MYOCARDIAL INFARCTION

1. Cardiac performance in response to 30% maximal isometric handgrip exercise was studied in fourteen patients convalescing uneventfully from a first myocardial infarction. In each patient, heart rate, mean arterial blood pressure and cardiac index were measured, and total peripheral resistance was calculated. The covariance of changes in the mean arterial blood pressure and cardiac index in these patients was matched against tolerance limits calculated from published data for normal subjects.

Regional blood flows during desynchronized sleep in the cat

Durante il sonno desincronizzato del gatto, non si ha una vasodilatazione generalizzata a tutti i letti vascolari. Mentre il distretto mesenterico si dilata, quello muscolare si costringe. La vasodilatazione viscrale dipende da una diminuita attività simpatica; per la vasocostrizione muscolare, invece, bisogna pensare, oltre che a meccanismi nervosi, anche a fattori meccanici e metabolici.

Hemodynamic changes in the lower limbs during treadmill walking in normal subjects and in patients with arteriosclerosis obliterans

The effects of arteriosclerosis obliterans on the hemodynamic changes that occur during walking are largely unknown. For this reason, the authors measured blood pressure by transducer from the posterior tibial artery and vein at both ankles in 23 patients with arteriosclerosis obliterans of different severity and at the left ankle in 8 normal subjects. Radial artery pressure was also measured, and the differences between mean radial and ankle arterial pressures (pressure gradient) and between mean arterial and venous ankle pressures (foot perfusion pressure) were calculated. All measurements were made simul taneously and continuously during standing, treadmill walking at five different speeds, and during recovery. Compared with the normal subjects, the patients exhibited a greater pressure gradient and lower ankle arterial pressure and foot perfusion pressure at rest. During walking and recovery these intergroup hemodynamic differences were markedly enhanced, and ankle venous pressure was lower in the patients than in the normal subjects. In the patients the hemodynamic pattern depended on disease severity at rest and on both disease severity and walking speed during walking and recovery.

A Non-Invasive Index of Leg Arterial Perfusion Pressure During Walking, Derived From Cutaneous Toe Temperature

This article describes and evaluates a non-invasive technique for continuous monitoring of hemodynamic changes in the legs during walking. The method involves monitoring of cutaneous toe temperature. In six normal subjects we have shown that, during exercise under carefully controlled conditions, a unique steady-state toe temperature exists for any given leg arterial perfusion pressure, when perfusion pressure is varied by means of an external occluding ankle cuff. Further, we have demonstrated a strong correlation between this external ankle cuff pressure and the time rate of changes of toe temperature during the test-period following occlusion. Correlation coefficients, r1, were be tween -1 and -0.88 (mean -0.95; standard deviation±0.03) for big toe and between -1 and -0.87 (mean -0.94; standard deviation ±0.03) for third toe. We conclude that during walking the time profile of toe temperature changes is a useful index of changes in leg perfusion pressure. Therefore, toe tempera ture may be used to study the dynamics of leg arterial circulation in atheroscler otic occlusive diseases.