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J Appl Physiol (May 25, 2006). doi:10.1152/japplphysiol.00759.2005
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Submitted on June 27, 2005
Accepted on May 18, 2006

Increased pulmonary vascular resistance and reduced stroke volume, in association with CO2 retention and inferior vena cava dilatation

Darija Bakovic1, Davor Eterovic2, Zoran Valic1, Zana Saratlija-Novakovic1, Ivan Palada1, Ante Obad1, and Zeljko Dujic1*

1 Department of Physiology and Biophysics, University of Split School of Medicine, Split, Croatia
2 Department of Physiology and Biophysics, University of Split School of Medicine, Croatia

* To whom correspondence should be addressed. E-mail: zdujic{at}bsb.mefst.hr.

Changes in cardiovascular parameters elicited during a maximal breath hold are well described. However, the impact of consecutive maximal breath holds on central hemodynamics in the post-apneic period is unknown. Eight trained apnea divers and eight control subjects performed five successive maximal apneas, separated by two minute resting interval, with face immersing in cold water. Ultrasound examinations of inferior vena cava (IVC) and the heart were carried out at times 0, 10, 20, 40, and 60 minutes after. The arterial oxygen saturation level and blood pressure, heart rate and transcutaneous partial pressures of CO2 and O2 were monitored continuously. At 20 minutes after breath-holds IVC diameter increased (27.6% and 16.8% for apnea divers and controls, respectively). Subsequently, pulmonary vascular resistance increased and cardiac output decreased both in apnea divers (62.8% and 21.4%, respectively) and the control group (74.6% and 17.8%, respectively). Cardiac output decrements were due to reductions in stroke volumes, in presence of reduced end-diastolic ventricular volumes. Transcutaneous partial pressure of CO2 increased in all participants during breath-holding, returned to baseline between apneas, but remained slightly elevated during the post-dive observation period (~ 4.5%). Thus, increased right ventricular afterload and decreased cardiac output were associated with CO2 retention and signs of peripheralization of blood volume. These results indicate that repeated apneas may cause prolonged hemodynamic changes after resumption of normal breathing, which may suggest what happens in sleep apnea syndrome.




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