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Do You Have Dysautonomia And Pulmonary Hypertension?


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Are adrenergic receptors contraindicated in PHP--link to full article

J Card Fail. 2009 Dec;15(10):882-9. Epub 2009 Jul 16.

Impairment of autonomic nervous system activity in patients with pulmonary arterial hypertension: a case control study.

Dimopoulos S, Anastasiou-Nana M, Katsaros F, Papazachou O, Tzanis G, Gerovasili V, Pozios H, Roussos C, Nanas J, Nanas S.

3rd Cardiology Department, NKUA, Athens, Greece.

Abstract

BACKGROUND: Chronotropic response to exercise (CR) and heart rate recovery (HRR) immediately after exercise are indirect indices of sympathetic and parasympathetic activity, respectively. The aim of this study was to evaluate CR and HRR in patients with pulmonary arterial hypertension (PAH) in relation to disease severity. METHODS AND RESULTS: Ten PAH patients (6 females/4 males, mean age: 48+/-12 years) and 10 control subjects matched for age, gender, and body mass index (6 females/4 males, mean age: 46+/-6 years) performed a ramp incremental symptom-limited cardiopulmonary exercise test on a cycle ergometer. Main measurements included heart rate at rest (HR), CR=[(peak HR-resting HR/220-age-resting HR)x100, %], HRR(1)=HR difference from peak exercise to 1minute after, ventilatory efficiency during exercise (VE/VCO(2) slope), peak oxygen uptake (VO(2)p), and the first-degree slope of VO(2) for the first minute of the recovery period (VO(2)/t-slope). PAH patients had a significantly decreased CR (58+/-31 vs 92+/-13, %, P < .001) and HRR(1) (10+/-5 vs 29+/-6, beats/min, P < .001) as well as VO(2)p (11.9+/-3.5 vs 26.9+/-6.6, mL.kg.min) and VO(2)/t-slope (0.2+/-0.1 vs. 0.9+/-0.2, mL.kg.min(2)) compared with controls. CR and HRR(1) correlated well with VO(2)p (r=0.7; P < .001 and r=0.85; P < .001, respectively) and VO(2)/t-slope (r=0.66; P < .001 and r=0.85; P < .001, respectively) and had a significant inverse correlation with VE/VCO(2) slope (r=-0.47; P < .01 and r=-0.77; P < .001, respectively). CONCLUSIONS: PAH patients present a significant impairment of CR and HRR(1) in relation to disease severity, indicating profound autonomic nervous system abnormalities.

PMID: 19944365

Just a couple more.

Out of curiosity, how were you diagnosed with Pulmonary Hypertension?

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Ramakentesh is going to love this one! Maybe he can dovetail it with POTS:

J Hypertens. 2009 Oct;27(10):1929-40.

Control of systemic and pulmonary blood pressure by nitric oxide formed through neuronal nitric oxide synthase.

Toda N, Ayajiki K, Okamura T.

Department of Pharmacology, Shiga University of Medical Science, Otsu, Japan. n.toda.toyama-bldg@orion.ocn.ne.jp

Abstract

Nitric oxide formed by neuronal nitric oxide synthase (nNOS) in the brain, autonomic inhibitory (nitrergic) nerves, and heart plays important roles in the control of blood pressure. Activation of nitrergic nerves innervating the systemic vasculature elicits vasodilatation, decreases peripheral resistance, and lowers blood pressure. Impairment of nitrergic nerve function, as well as endothelial dysfunction, results in systemic and pulmonary hypertension and decreased regional blood flow. Blockade of nNOS activity in the brain, particularly the medulla and hypothalamus, causes systemic hypertension. Under hypertensive states, such as those in spontaneously hypertensive and Dahl salt-sensitive rats, the expression of the nNOS gene in the brain is increased; this appears to counteract the activated sympathetic function in the vasomotor center. The present article summarizes information concerning the modulation of systemic and pulmonary hypertension through nNOS-derived nitric oxide produced in the brain and periphery.

PMID: 19587610

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