Case-Studies in Physiology: The exercise pressor response to indoor rock climbing

Introduction. This paper assessed the blood pressure, heart rate, and mouth-pressure responses to indoor rock climbing (bouldering) and associated training exercises. Case Presentation. Six well-trained male rock climbers (mean ± SD age = 27.7 ± 4.7 y; stature = 177.7 ± 7.3 cm; mass = 69.8 ± 12.1 kg) completed two boulder problems (6b and 7a+ on the Fontainebleau Scale) and three typical training exercises (Maximum voluntary contraction [MVC] isometric pull-up, 80% MVC pull-ups to fatigue, campus-board to fatigue). Blood pressure and heart rate were measured via an indwelling femoral arterial catheter, and mouth pressure via a mouthpiece manometer. Bouldering evoked a peak systolic pressure of 200 ± 17 mmHg (44 ± 21% increase from baseline), diastolic pressure of 142 ± 26 mmHg (70 ± 32% increase), mean arterial pressure of 163 ± 18 mmHg (56 ± 25% increase), and heart rate of 157 ± 20 b⸱min−1 (81 ± 30% increase). The highest systolic pressure was observed during the campus-board exercise (218 ± 33 mmHg), although individual values as high as 273/189 mmHg were recorded. Peak mouth pressure during climbing was 31 ± 46 mmHg, and this increased independent of climb difficulty. Conclusions. Indoor rock climbing and associated exercises evoke a substantial pressor response, resulting in high blood pressures that may exceed those observed during other resistance exercises. These findings may inform risk stratification for climbers

Clinical characteristics and survival in cardiogenic shock admissions to a UK heart transplant unit

Aim: We describe the characteristics and outcomes of cardiogenic shock (CS) admissions to a UK transplant unit, which is previously unreported. Patients & methods: Fifty-nine unselected, consecutive patients over a 38-month period in CS (INTERMACS ≤2) and potentially eligible for transplant were retrospectively reviewed. Results: Patients were predominantly male (76.3%), young (mean age 42.2 years) and with severe end-organ dysfunction (acute liver/kidney injury 83%, mean lactate 3.5 mmol/l). 57.6% required mechanical support and 28.8% cardiac transplant. 30 days, discharge and 1-year survival were 78, 68 and 63%, respectively. Predictors of death included no transplant, increasing age and increasing creatinine. Conclusion: Patients with CS and potential for transplant require significant resource input but demonstrate favorable outcomes in our experience