published_or_final_version / Physiology / Master / Master of Philosophy

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In man, tolerance to an orthostatic stress varies widely. Compensatory cardiovascular responses to orthostatic stressors such as head-up tilt, +Gz acceleration, and lower body negative pressure (LBNP) have been identified. However, physiologic reactions associated with the capacity to withstand a presyncopal- limited orthostatic exposure requires additional clarification. The relationship between maximal oxygen uptake (‘VO₂ max) and presyncopal-limited LBNP tolerance was examined in adult male subjects categorized into high (HAC) and low (LAC) aerobic capacity groups. In addition to similar (N.S.) cardiovascular responses, the (mean) and cumulative LBNP stress indices (CS)) observed in the HAC (722 torr•min) and LAC (784 torr•min) groups were also similar (N.S.). These data fail to support a relationship between LBNP tolerance and ‘VO₂ max. Cardiovascular responses associated with LBNP tolerance were measured during the control period (pre-LBNP) and final minute (peak LBNP) of decompression. The CSI criterion distinguished high (HT, n = 10) and low (LT, n = 8) LBNP tolerant groups was 640 torr•min. A greater (p < 0.05) end-diastolic volume and cardiac output was observed in the HT subjects during pre-LBNP may have provided a larger reserve to utilize throughout exposure to LBNP. At peak LBNP, both groups demonstrated similar (N.S.) cardiac outputs despite a higher (p < 0.05) HT heart rate. These data suggest that a major mechanism in prolonging LBNP tolerance may have been a greater LBNP-induced tachycardia. Blood samples were drawn to determine group differences in vasoactive neuroendocrine response. During peak LBNP, concentrations of norepinephrine increased (p < 0.05) in both groups. The HT group displayed greater (p < 0.05) LBNP-induced increases in vasopressin and plasma renin activity. These data suggest that HT subjects may have supplemented the catecholamine pressor response by involving the vasopressin and renin-angiotensin systems. The affect of cholenergic and beta-adrenergic blockades on cardiovascular responses to LBNP were examined in six HT and five LT subjects. CSI in both groups were unchanged (N.S.) by administration of atropine as compared to a placebo LBNP exposure. Propranolol however, reduced (p < 0.05) LBNP tolerance in both groups. This CSI reduction was greater (p < 0.05) in the HT subjects. The reduction in LBNP tolerance appeared closely associated with the negative chronotropic effect.

Chronic obstructive pulmonary disease (COPD) is characterized by an expiratory flow limitation, as well as an evident reduced exercise capacity compared to that of healthy age-matched individuals. Clearly, the expiratory flow limitation plays a significant role in this exercise intolerance; however, the extent of the contributions of other systemic factors remains unclear. More specifically, there is little data thus far on the role of blood flow delivery as a possible exercise limitation in COPD, especially in light of the potential interactions between cardiac output (Qc) and pulmonary hyperinflation. Thus, the purpose of this study was to compare the slope of the Qc versus oxygen uptake (VO 2) response through several submaximal cycling loads in patients with moderately severe COPD with that of age-matched healthy control subjects (CTRL). Also examined was the possibility that ventilatory constraints such as dynamic hyperinflation contribute to an abnormal Qc response. Cardiac output was measured using the CO2-rebreathing equilibrium technique during baseline conditions and cycling at 20, 40 and 65% of peak power in 17 COPD (Age: 64 +/- 8 yrs; FEV1/FVC: 37 +/- 11%; FEV1: 41 +/- 15% predicted) and 10 age-matched CTRL subjects. Inspiratory capacity (IC) was also measured for the determination of dynamic hyperinflation during the steady state exercise bouts. The results indicate that while the absolute Qc values are lower in COPD than in CTRL during moderately intense (65% peak power) cycling (11.30 +/- 2.38 vs. 15.63 +/- 2.15 L⋅min -1, p < 0.01), likely due to their lower exercise metabolic demand, the Qc/VO2 response to increasing levels of exercise intensity is normal or hyperdynamic in COPD. Indeed, the majority of patients with COPD exhibited Qc/VO2 slopes greater than 7.0, which may be indicative of a peripheral muscle bioenergetic disturbance that may drive the need for greater oxygen delivery, and thus result in an exaggerated ce

Bone circulation in Hemorrhagic Shock was studied in 35 male mongrel dogs. The term hemorrhagic shock is defined in this thesis as persistent profound hypotensive syndrome, due to acute hemorrhage of more than one third of blood volume. The method of induction of shock consisted of removal of one third of estimated blood volume (8% of body weight) at a rate of 25 - 50 ml/min, and subsequently dropping the systemic blood pressure in a stepwise manner until the maintaining level of 30 - 35 mmHg is reached. The central venous pressure, pulse and respiratory rates were also recorded. Bone circulation was studied by (1) recording the blood flow through a cannula inserted into the tibial nutrient vein or artery and (2) recording the intramedullary pressure of tibia. When one third of estimated blood volume was removed, the bone blood flow through the nutrient vessel decreased to 22.5 ± 3.4% of control level. The decreased bone blood flow persisted as long as the hemorrhagic shock was maintained for 4-18 hours. The decreased bone blood flow was also evidenced by a profound and persistent fall of the intramedullary pressure of bone. Reinfusion into the animal of lost blood within fifteen minutes to six hours after hemorrhage resulted in a complete or partial recovery of the control systemic blood pressure as well as the control rate of bone blood flow and the control level of intramedullary pressure of bone. The curve showing relationship between the changes in bone blood flow and the systemic blood pressure is an exponential one with concavity towards the flow axis. This indicates that bone has a vasomotor control mechanism of increasing peripheral resistance during hemorrhagic shock. This was substantiated by the following observations: (1) The severity of decrease in bone blood flow on the side of lumbar sympathectomy was much milder (16% less) compared to the side of the intact sympathetic nerve; (2) Dibenzyline (phenoxybenzamine) a sympatholytic drug or alpha-receptor blocking agent alters the pressure-flow curve of bone circulation in chock to a linear pattern which indicates that the drug blocks the bone vasoconstricting mechanism(s). It is concluded that bone blood flow decreases in hemorrhagic shock and is not merely due to a decrease in circulatory blood volume, but also due to sympathetic and catecholamine hormonal vasoconstrictor mechanisms. / Surgery, Department of / Medicine, Faculty of / Graduate

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It has been deduced from indirect evidence that significant adjustments of vascular resistance take place in the venous network when blood flow changes in a organ. In the following experiments, we attempted to test the hypotheses that changes in postcapillary resistance in skeletal muscle may be due to changes in venous diameter, changes in the number of venules with blood flow, and/or changes in the apparent viscosity of blood in venules. The hypotheses were tested by observing the response of cat sartorius muscle venules (7-200 μm diameter) during arterial pressure reduction and muscle contraction. There was no observable change in venular diameter during any of the above perturbations. There was a significant decrease in the already low normalized velocity of blood in venules from a mean of 13 sec⁻¹ under control conditions to 5 sec⁻¹ during arterial pressure reduction to 20 mm Hg. At very low pressures, the number of venules with blood flow decreased. Combining our findings with Lipowsky's (1975) in vivo viscometry data, it was predicted that resistance in venules would increase 100% as a result of increases in blood viscosity when blood flow was reduced 60%. During post-contraction hyperemia the normalized velocity of blood in venules increased from 16 sec⁻¹ to 38 sec⁻¹ and the number of venules with blood flow increased a modest amount. Combining our observations with Lipowsky's data, we predict that venular resistance would fall 54% when blood flow increased 250% If shear rate changes cause substantial changes in blood viscosity in venules as suggested by the findings cited above, hydrostatic pressure in the small venules should tend to remain relatively constant as flow is altered. To determine whether this is the case, pressures of venules were measured using the servo-null technique during arterial pressure reduction. Pressures in the larger venules were a linear function of blood pressure and blood flow with an intercept not significantly different from the systemic venous pressure. Pressures in the smallest venules studied (24 μm), however, were somewhat insensitive to alterations in blood pressure (intercept of 10.4 mm Hg) and blood flow (intercept of 13.2 mm Hg). The stability of pressure in 40 venules supports the hypothesis that variable blood viscosity maintains the pressure drop in the venous network and the capillary hydrostatic pressure somewhat constant during changes in blood flow.

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Increasing numbers of old and sick patients who are no longer eligible for prolonged invasive implantation surgery have encouraged many researchers to investigate the development of a Mechanical Circulatory Support (MCS) device with more reliability and less possible invasive complications, which would benefit the majority of patients. This thesis will test experimentally and numerically the feasibility of installing an MCS device, as a bridge to destination, in the descending aorta, in a series configuration with the heart. To this end, a multi-chamber Simulator of the Cardio-Vascular blood-flow Loop (SCVL) was designed to simulate the in-vitro flow rates, pressures and other parameters representing normal and diseased conditions of the human cardiovascular system. The multi-chamber SCVL includes models for all four chambers of the heart, and the systemic as well as the pulmonic circulations. Next, a comprehensive study was conducted using the SCVL system to compare the novel in-series placement of the pump, in the descending aorta, with traditional in-parallel placements. Then, a comprehensive numerical study was conducted using the modified Concentrated Lumped Parameter (CLP) model developed by the same team. The numerical results are compared and verified by the experimental results under various conditions. The results for the pump installed in the descending aorta show that the pressure drop, upstream of the pump, facilitates the cardiac output as a result of after-load reduction. However, at the same time the generated pressure drop at the proximal part of the descending aorta induces a slight drop in the carotid perfusion which will be autoregulated by the brain in a native system. Further, the pressure rise downstream of the pump improves the blood perfusion in the renal artery. The pulse wave analysis show that the placement of the pump in the descending aorta leads to improved pulsatility which is beneficial for end-organ functionality in the native cardiovascular system.