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Physical manoeuvres that reduce postural hypotension in autonomic failure

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A Young female with autonomic failure is described. She successfully reduced the symptoms of orthostatic hypotension by application of physical manoeuvres like leg-crossing, bending forward and placing a foot on a chair. The beneficial effects of these manoeuvres can be explained by a small (10–15 mmHg) increase in mean arterial pressure to a level just sufficient to maintain adequate cerebral blood flow. The underlying common mechanism appears to be an increase of thoracic blood volume by translocation of blood from the vascular beds below the diaphragm to the chest. Instruction in these physical manoeuvres should be part of the management programme to reduce the disabilities arising from postural hypotension in patients with autonomic failure.

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References

  1. Wagner HN. Orthostatic hypotension.Bull Johns Hopkins Hospital 1959;105: 322–359.

    Google Scholar 

  2. Bannister R, Mathias CJ. Clinical features and investigation of primary autonomic failure syndromes. In: Bannister R, Mathias CJ, eds.Autonomic Failure. A textbook of clinical disorders of the autonomic nervous system. Third edition. Oxford: Oxford University Press, 1992: 531–547.

    Google Scholar 

  3. Tarazi C, Fouad FM. Circulatory dynamics in progressive autonomic failure. In: Bannister R, ed.Autonomic Failure. A textbook of clinical disorders of the autonomic nervous system. Oxford: Oxford University Press, 1983: 96–114.

    Google Scholar 

  4. Schatz IJ.Orthostatic Hypotension. Philadelphia: FA Davis Comp, 1986.

    Google Scholar 

  5. Fealy RD, Robertson D. Management of chronic orthostatic hypotension. In: Low PA, ed.Clinical Autonomic Disorders. Evaluation and management. Boston: Little, Brown and Company, 1992: 731–746.

    Google Scholar 

  6. Davidson C, Smith D, Morgan DB. Diurnal pattern of water and electrolyte excretion and body weight in idiopathic orthostatic hypotension.Am J Med 1976;61: 709–715.

    PubMed  Google Scholar 

  7. Bannister R, Mathias C. The management of postural hypotension. In: Bannister R, Mathias C. ed.Autonomic Failure. A textbook of clinical disorders of the autonomic nervous system. Oxford: Oxford University Press, 1992; 622–645.

    Google Scholar 

  8. Ten Harkel ADJ, Van Lieshout JJ, Wieling W. Treatment of orthostatic hypotension with sleeping in the head-up position, alone and in combination with fludrocortisone.J Int Med 1992;232: 139–145.

    Google Scholar 

  9. Sieker HO, Burnum JF, Hickam JB, Penrod KE. Treatment of postural hypotension with a counter-pressure garment.JAMA 1956;161: 132–135.

    Google Scholar 

  10. Bevegard S, Jonsson B, Karlöff I. Circulatory response to recumbent exercise and head-up tilting in patients with disturbed sympathetic cardiovascular control (postural hypotension).Acta Med Scand 1962;172: 623–636.

    Google Scholar 

  11. Van Lieshout JJ, Wieling W, Van Montfrans GA, Settels JJ, Speelman JD, Endert E, Karemaker JM. Acute dysautonomia associated with Hodgkin's disease; a case-report.J Neurol Neurosurg Psych 1986;49: 830–832.

    Google Scholar 

  12. Van Lieshout JJ, Wieling W, Wesseling KH, Karemaker JM. Pitfalls in the assessment of cardiovascular reflexes in patients with sympathetic failure but intact vagal control.Clin Sci 1989;76: 523–528.

    PubMed  Google Scholar 

  13. Van Lieshout JJ, Ten Harkel ADJ, Wieling W, Van Leeuwen AM. Contrasting effects of acute and chronic volume expansion on orthostatic blood pressure control in a patient with autonomic circulatory failure.Neth J Med 1991;39: 72–82.

    PubMed  Google Scholar 

  14. Van Lieshout JJ, Ten Harkel ADJ, Wieling W. Combatting orthostatic dizziness in autonomic failure by physical maneuvers.Lancet 1992;339: 897–898.

    PubMed  Google Scholar 

  15. Ghrist DG, Brown GE. Postural hypotension with syncope: its successful treatment with ephedrin.Am J Med Sci 1928;175: 336–349.

    Google Scholar 

  16. Jeffers WA, Montgomery H, Burton AC. Types of orthostatic hypotension and their treatment.Am J Med Sci 1941;202: 1–14.

    Google Scholar 

  17. Nylin G, Levander M. Studies on the circulation with the aid of tagged erythrocytes in a case of orthostatic hypotension.Ann Intern Med 1948;28: 723–746.

    Google Scholar 

  18. Bickelmann AG, Lippschutz EJ, Brunjes CF. Hemodynamics of idiopathic orthostatic hypotension.Am J Med 1961;30: 26–38.

    Google Scholar 

  19. Biaggioni I, Goldstein DS, Atkinson T, Robertson D. Dopamine-β-hydroxylase deficiency in humans.Neurology 1990;40: 370–373.

    PubMed  Google Scholar 

  20. Takishita S, Touma T, Kawazoe N, Muratani H, Fukiyama K. Usefulness of leg-crossing for maintaining blood pressure in a sitting position in patients with orthostatic hypotension-case reports.Angiology 1991;42: 421–425.

    PubMed  Google Scholar 

  21. Wesseling KH, de Wit B, Settels JJ, Klawer WH. On the indirect registration of finger blood pressure after Peñáz.Funkt Biol Med 1982;1: 245–250.

    Google Scholar 

  22. Imholz BPM, Settels JJ, Van den Meiracker AH, Wesseling KH, Wieling W. Noninvasive continuous finger blood pressure during orthostatic stress compared to intra-arterial pressure.Cardiovasc Res 1990;24: 214–221.

    PubMed  Google Scholar 

  23. Imholz BPM, Wieling W, Langewouters GJ, Van Montfrans GA. Continuous finger arterial pressure measurement: utility in the cardiovascular laboratory.Clin Auton Res 1991;1: 45–53.

    Google Scholar 

  24. Wieling W. Non-invasive continuous recording of heart rate and blood pressure in the evaluation of neurocardiovascular control. In: Bannister R, Mathias CJ, eds.Autonomic Failure. A textbook of clinical disorders of the autonomic nervous system. Third Edition. Oxford, Oxford University Press, 1992: 291–311.

    Google Scholar 

  25. Sharpey-Schafer EP. Effects of squatting on the normal and failing circulation.Br Med J 1956;1: 1072–1074.

    Google Scholar 

  26. Lewis BS, Lewis N, Gotsman MS. Effect of standing and squatting on echocardiographic left ventricular function.Eur J Cardiol 1980;11: 405–412.

    PubMed  Google Scholar 

  27. O'Donnel TV, McIlroy MB. The circulatory effects of squatting.Am Heart J 1962;64: 347–356.

    PubMed  Google Scholar 

  28. Gunteroth WG, Mortan BC, Mullins GL, Baum D. Venous return with knee-chest position and squatting in tetralogy of Fallot.Am Heart J 1968;75: 313–318.

    PubMed  Google Scholar 

  29. Shvartz E, Gaume JG, White RT, Reibold RC. Hemodynamic responses during prolonged sitting.J Appl Physiol (Resp Environ Exercise Physiol) 1983;54: 1673–1680.

    Google Scholar 

  30. Low PA, Fealy RD. Pathological studies of the sympathetic neuron. In: Bannister R, Mathias CJ, eds.Autonomic Failure. A textbook of clinical disorders of the autonomic nervous system. Third edition. Oxford, Oxford University Press, 1992: 586–592.

    Google Scholar 

  31. Wieling W, Wesseling KH. Importance of reflexes in the circulatory adjustments to postural change. In: Hainsworth R, ed.Cardiovascular Reflex Control in Health and Disease. London, WB Saunders Company, 1993 (in press).

    Google Scholar 

  32. Hill L. The influence of the force of gravity on the circulation of the blood.J Physiol 1895;18: 15–53.

    Google Scholar 

  33. Rushmer, RF. Effects of posture. In: Rushmer RF, ed.Cardiovascular Dynamics. Philadelphia: WB Saunders, 1979: 192–219.

    Google Scholar 

  34. Rowell LB.Human Cardiovascular Control. Oxford: Oxford University Press, 1993: 1–162.

    Google Scholar 

  35. Smith ML, Hudson DL, Raven PB. Effect of muscle tension on the cardiovascular responses to lower body negative pressure in man.Med Sci Sports Exerc 1987;19: 436–442.

    PubMed  Google Scholar 

  36. Hainsworth R. Syncope and fainting. In: Bannister R, Mathias CJ, eds.Autonomic Failure. A textbook of clinical disorders of the autonomic nervous system. Third edition. Oxford, Oxford University Press, 1992: 761–782.

    Google Scholar 

  37. Guyton AC, Douglas BH, Langston JB, Richardson TQ. Instantaneous increase in mean circulatory pressure and cardiac output at onset of muscular activity.Circ Res 1962;11: 431–441.

    PubMed  Google Scholar 

  38. Van Lieshout JJ, Wieling W, Karemaker JM, Eckberg DL. The vasovagal response.Clin Sci 1991;81: 575–586.

    PubMed  Google Scholar 

  39. Gordon GA. Observations on the effect of prolonged and severe exertion on the blood pressure in healthy athletes.Edinburgh Med J 1907;22: 53–56.

    Google Scholar 

  40. Bannister R. Banquet Lecture. Am Physiol Soc Conf on integrative biology of exercise. Colorado Springs, September 1992.

  41. Eichna LW, Horvath SM, Bean WB. Post-exertional orthostatic hypotension.Am J Med 1947;213: 641–654.

    Google Scholar 

  42. Bjurstedt H, Rosenhamer G, Balldin U, Katkov V. Orthostatic reactions during recovery from exhaustive exercise of short duration.Acta Physiol Scand 1983;119: 25–31.

    PubMed  Google Scholar 

  43. Dambrink JHA, Imholz BPM, Karemaker JM, Wieling W. Initial orthostatic dizziness in two teenagers.Clin Auton Res 1991;1: 281–288.

    PubMed  Google Scholar 

  44. Stead EA, Ebert RV. Postural hypotension—a disease of the sympathetic nervous system.Arch Int Med 1941;17: 546–562.

    Google Scholar 

  45. Bannister R. Introduction and classification. In: Bannister R, ed.Autonomic Failure. A textbook of clinical disorders of the autonomic nervous system. Oxford: Oxford University Press, 1983: 1–13.

    Google Scholar 

  46. Bannister R, Mathias CJ. Introduction and classification of autonomic disorders. In: Bannister R, Mathias CJ, eds.Autonomic Failure. A textbook of clinical disorders of the autonomic nervous system. 3rd Edition. Oxford: Oxford University Press, 1992: 1–12.

    Google Scholar 

  47. Ten Harkel ADJ, Van Lieshout JJ, Van Lieshout EJ, Wieling W. The assessment of cardiovascular reflex tests: influence of posture and period of preceding rest.J Appl Physiol 1990;68: 147–153.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Academic Medical Centre, Amsterdam, The Netherlands

    W. Wieling, J. J. van Lieshout & A. M. van Leeuwen

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  1. W. Wieling
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  2. J. J. van Lieshout
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  3. A. M. van Leeuwen
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Wieling, W., van Lieshout, J.J. & van Leeuwen, A.M. Physical manoeuvres that reduce postural hypotension in autonomic failure. Clinical Autonomic Research 3, 57–65 (1993). https://doi.org/10.1007/BF01819146

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