Profound Sympathoinhibition Complicating Hypovolemia in Humans
Authors: Jeffrey S. Sanders
Journal: Annals of Internal Medicine (1989)

Brief Reports1 September 1989Profound Sympathoinhibition Complicating Hypovolemia in HumansJeffrey S. Sanders, MD, David W. Ferguson, MDJeffrey S. Sanders, MD, David W. Ferguson, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-111-5-439 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTachycardia, increased sympathetic activity, and peripheral vasoconstriction have been described as the principal reflex adjustments to hypovolemic shock. However, experiments in animals suggest that bradycardia and sympathoinhibition can occur during severe hemorrhagic hypotension (1-5). In addition, recent observations indicate that a paradoxical bradycardia can occur during hypotensive hemorrhage in humans (6-8). The mechanisms of this response are not appreciated by most practicing physicians because hypovolemic shock is often promptly treated with volume expansion and because the acute manifestations of rapid, severe hypovolemia are rarely observed. Our observations in a normal, human subject help to delineate the autonomic responses to acute...References1. ObergWhite BS. The role of vagal cardiac nerves and arterial baroreceptors in the circulatory adjustments to hemorrhage in the cat. Acta Physiol Scand. 1970;80:395-403. CrossrefMedlineGoogle Scholar2. MoritaVatner HS. Effects of hemorrhage on renal nerve activity in conscious dogs. Circ Res. 1985;57:788-93. CrossrefMedlineGoogle Scholar3. Sjostrand T. Circulatory control via vagal afferents. VI. The bleeding bradycardia in the rat, its elicitation and relation to the release of vasopressin. Acta Physiol Scand. 1973;89:39-50. CrossrefMedlineGoogle Scholar4. ObergThoren BP. Increased activity in left ventricular receptors during hemorrhage or occlusion of caval veins in the cat. A possible cause of the vaso-vagal reaction. Acta Physiol Scand. 1972;85:164-73. CrossrefMedlineGoogle Scholar5. VictorThorenMorganMark RPDA. Differential control of adrenal and renal sympathetic nerve activity during hemorrhagic hypotension in rats. Circ Res. 1989;64:686-94. CrossrefMedlineGoogle Scholar6. SecherSander JensenWernerWarbergBie NKCJP. Bradycardia during severe but reversible hypovolemia shock in man. Circ Shock. 1984;14:267-74. MedlineGoogle Scholar7. RorsgaardSecher SN. Slowing of the heart during hypotension in major abdominal surgery. Acta Anaesthesiol Scand. 1986;30:507-10. CrossrefMedlineGoogle Scholar8. Sander-JensenSecherBieWarbergSchwartz KNPJT. Vagal slowing of the heart during hemorrhage: observations from 20 consecutive hypotensive patients. Br Med J [Clin Res]. 1986;292:364-6. CrossrefMedlineGoogle Scholar9. SandersFerguson JD. Cardiopulmonary baroreflexes fail to modulate sympathetic responses during isometric exercise in humans: direct evidence from microneurographic studies. J Am Coll Cardiol. 1988;12:1241-51. CrossrefMedlineGoogle Scholar10. WallinSundlof BG. Sympathetic outflow to muscles during vasovagal syncope. J Auton Nerv Syst. 1982;6:287-91. CrossrefMedlineGoogle Scholar11. MoritaNishidaMotochigawaUemuraHosomiVatner HYHNHS. Opiate receptor-mediated decrease in renal nerve activity during hypotensive hemorrhage in conscious rabbits. Circ Res. 1988;63:165-72. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: From the University of Iowa College of Medicine and Hospitals. For current author addresses, see end of text. 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Circulatory distress and paradoxical bradycardia.Dialysis hypotension: A hemodynamic analysisBlood Pressure Control in Chronic Hemodialysis Patients 1 September 1989Volume 111, Issue 5Page: 439-441KeywordsBradycardiaCardiology and cardiovascular diseasesHeartHospital medicineHypotensionLungsReflexesShockTachycardiaVasoconstriction Issue Published: 1 September 1989 PDF downloadLoading ...