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J Appl Physiol (April 5, 2002). doi:10.1152/japplphysiol.00817.2001
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Articles in PresS, published online ahead of print April 5, 2002
J Appl Physiol, 10.1152/jap.00817.2001
Submitted on August 2, 2001
Accepted on January 24, 2002

Limb venous compliance in patients with idiopathic orthostatic intolerence and postural tachycardia

Roy Freeman1*, Vasilios A Lirofonis1, William B Farquhar2, and Marcelo Risk3

1 Center for Autonomic and Peripheral Nerve Disorders, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
2 Center for Autonomic and Peripheral Nerve Disorders, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Laboratory of Cardiovascular Research, HRCA Reseach and Training Institute, Harvard Medical School Division on Aging, Boston, MA, USA
3 Center for Autonomic and Peripheral Nerve Disorders, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Autonomic and Peripheral Nerve Disorders, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

* To whom correspondence should be addressed. E-mail: rfreeman{at}caregroup.harvard.edu.

Background and Purpose: Venous denervation and increased venous pooling may contribute to symptoms of orthostatic intolerance in selected patients. Against expectations, we previously demonstrated decreased venous compliance using a single-step method in patients with orthostatic intolerance. We examined venous compliance in the calf and forearm in 11 orthostatic intolerant patients and 15 age-matched controls over a range of pressures, during basal conditions and sympathetic excitation. Methods: Occlusion cuffs placed around the upper arm and thigh were inflated to 60 mmHg and deflated to 10 mmHg over 1 minute. Limb volume was measured continuously using a mercury-in-silastic strain gauge. Compliance was calculated as the numerical derivative of the pressure-volume curve. Results: The pressure-volume relationship in the upper and lower extremities in the basal and sympathetically activated state was significantly lower in the orthostatic intolerant patients compared with controls (all P < 0.05). Sympathoexcitation lowered the pressure volume relationship in the lower extremity in patients (P < 0.001) and controls (P < 0.01). Venous compliance was significantly less in patients in the lower extremity in the basal state over a range of pressures (P < 0.05). Venous compliance was less in patients in comparison to controls in the upper (P < 0.005) and lower extremities (P < 0.01) in the sympathetically activated state but there were no differences at individual pressure levels. Sympathetic activation did not change venous compliance in the upper and lower extremity in patients and controls. Conclusion: Patients with orthostatic intolerance have reduced venous compliance in the lower extremity. Reduced compliance may limit the dynamic response to orthostatic change and thereby contribute to symptoms of orthostatic intolerance in this population group.




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