(Circulation. 1998;98:2154-2159.)
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports |
Chronic Orthostatic Intolerance
A Disorder With Discordant Cardiac and Vascular Sympathetic Control
From the Syncope Service in the Autonomic Dysfunction Unit (M.S., D.R., R.M.-G.) and Division of Clinical Pharmacology (R.F., G.J., D.R., P.H., R.M.-G.), Department of Medicine (D.R., R.M.-G.), Vanderbilt University Medical Center, Nashville, Tenn, and Dipartimento di Bioingegneria, Politecnico di Milano, Milan, Italy (A.P.).
Background—Chronic orthostatic intolerance (COI) is a debilitating autonomic condition in young adults. Its neurohumoral and hemodynamic profiles suggest possible alterations of postural sympathetic function and of baroreflex control of heart rate (HR).
Methods and Results—In 16 COI patients and 16 healthy volunteers,
intra-arterial blood pressure (BP), ECG, central venous
pressure (CVP), and muscle sympathetic nerve activity (MSNA) were
recorded at rest and during 75° tilt. Spectral analysis
of RR interval and systolic arterial pressure (SAP)
variabilities provided indices of sympathovagal modulation of the
sinoatrial node (ratio of low-frequency to high-frequency components,
LF/HF) and of sympathetic vasomotor control (LFSAP).
Baroreflex mechanisms were assessed (1) by the slope of the regression
line obtained from changes of RR interval and MSNA evoked by
pharmacologically induced alterations in BP and (2) by the index 
,
obtained from cross-spectral analysis of RR and SAP
variabilities. At rest, HR, MSNA, LF/HF, and LFSAP were
higher in COI patients, whereas BP and CVP were similar in the two
groups. During tilt, BP did not change and CVP fell by the same extent
in the 2 groups; the increase of HR and LF/HF was more pronounced in
COI patients. Conversely, the increase of MSNA was lower in COI than in
control subjects. Baroreflex sensitivity was similar in COI and control
subjects at rest; tilt reduced similarly in both groups.
Conclusions—COI is characterized by an overall enhancement of noradrenergic tone at rest and by a blunted postganglionic sympathetic response to standing, with a compensatory cardiac sympathetic overactivity. Baroreflex mechanisms maintain their functional responsiveness. These data suggest that in COI, the functional distribution of central sympathetic tone to the heart and vasculature is abnormal.
Key Words: syncope • baroreceptors • blood pressure • norepinephrine • nervous system, autonomic
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