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J Appl Physiol (October 8, 2004). doi:10.1152/japplphysiol.00738.2004
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Submitted on July 14, 2004
Accepted on October 3, 2004

Hemodynamic effects of legcrossing and skeletal muscle tensing during free standing in patients with vasovagal syncope

Nynke van Dijk1*, Ivar G.J.M. de Bruin1, Janneke Gisolf2, H.A.C.M. Rianne de Bruin-Bon3, Mark Linzer4, Johannes J van Lieshout1, and Wouter Wieling1

1 Departmetn of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
2 Department of Physiology, Academic Medical Center, Amsterdam, The Netherlands
3 Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
4 Department of Internal Medicine, University of Wisconsin, Madison, Wisconsin, USA

* To whom correspondence should be addressed. E-mail: n.vandijk{at}amc.uva.nl.

Physical maneuvers can be applied to abort or delay an impending vasovagal faint. These countermaneuvers would be more beneficial if applied as a preventive measure. We hypothesized that in patients with recurrent vasovagal syncope, legcrossing produces a rise in cardiac output (CO) and thereby in blood pressure (BP) with an additional rise in BP by muscle tensing. We analyzed the age- and gender effect on the BP response. To confirm that during the maneuvers, Modelflow CO changes in proportion to actual CO, 10 healthy subjects performed the study protocol with CO evaluated simultaneously by Modelflow and by inert gas rebreathing. Changes in Modelflow CO were similar in direction and magnitude to inert gas rebreathing determined CO changes. Eighty-eight patients diagnosed with vasovagal syncope applied legcrossing after a 5 min free standing period. Fifty-four of these patients also applied tensing of leg- and abdominal muscles. Legcrossing produced a significant rise in CO (+ 9.5%; p < .01) and thereby in mean arterial pressure (MAP) (+ 3.3 %; p < .01). Muscle tensing produced an additional increase in CO (+ 8.3 %; p < .01) and MAP (+ 7.8%; p < .01). The rise in BP during legcrossing was larger in the elderly.




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