Model simulations of cardiovascular changes at the onset of moderate exercise in humans

We have tested whether the cardiovascular changes at the onset of exercise could be simulated only by an increase in the baroreflex set point and locally induced vasodilatation in the exercising muscles. The mathematical model consists of a heart, a linear elastic arterial reservoir and two parallel resistive vascular beds. The arterial baroreflex loop is modelled by three separate time domain processing objects, each with its own gain, time constant and delay. These are intended to simulate the action of a sympathetic signal to the peripheral vascular bed, a parasympathetic signal to the heart and a sympathetic signal to the heart. We used this model with previously published experimental data to estimate the unknown parameters in the reflex control loop. In all 10 subjects and in the global averaged response, the short-term cardiovascular responses were adequately simulated by using individual sets of parameters in the model. An increase in the baroreflex set point and locally induced vasodilatation in the exercising muscles can explain almost all of the cardiovascular changes in the recorded variables (mean arterial pressure, RR interval and stroke volume) at the onset of exercise

Does cardiovascular autonomic dysfunction contribute to fatigue in myasthenia gravis?

Myasthenia gravis (MG) is an autoimmune disease characterized by fatigable muscle weakness. Despite full spontaneous or pharmacological remission some MG patients still complain of physical and mental fatigue. Fatigue has been related to autonomic dysregulation. The aim of this study was to assess autonomic responses in a group of MG patients in complete remission but complaining of persistent fatigue. Seventeen well-regulated but persistently fatigued MG patients and 17 individually matched controls underwent echocardiography assessing systolic and diastolic heart function. Beat to beat cardiovascular responses at rest and to 30o head-up tilt, tilt-back, and 2-min static handgrip contraction were recorded. Fatigued MG patients had a statistically significant higher resting HR than their matched controls (p=0.03). The difference in resting heart rate between MG patients not using acetylcholine esterase inhibitors (AChEi) and their matched controls was even more pronounced (p=0.007). The autonomic cardiovascular adjustments to head-up tilt, tilt-back and handgrip contraction were not statistically significant different between patients and controls. We found a higher resting heart rate in all well-regulated but fatigued MG patients compared with controls. The difference was more pronounced between patients not taking AChEi compared to their matched controls. This finding may reflect a disturbed resting sympathovagal balance and this might be a contributing factor to the fatigue symptoms

Rapid, Large, and Synchronous Sweat and Cardiovascular Responses Upon Minor Stimuli in Healthy Subjects. Dynamics and Reproducibility

Purpose: The aim of the study was to investigate steady state levels, dynamics and reproducibility of cardiovascular variables and electrodermal activity in different skin areas in response to minor physiological and mental stimuli in healthy subjects in the thermoneutral zone, carried out in high time resolution. Methods: Thirteen healthy subjects underwent experiments on two separate days. Non-invasive electrodermal activity in five different skin areas was measured continuously using a skin conductance method, including resting supine and sitting positions, performing deep inspirations, a mental challenge and being exposed to a sudden loud sound. Blood pressure, heart rate, radial artery blood flow, and skin perfusion were measured simultaneously. Results: Electrodermal activity in the right and left palms was almost identical, with rapid and large increases within a few seconds in response to stimuli, whereas no such significant changes were seen in the face, back, and abdomen. Radial artery blood flow and palmar skin perfusion changed synchronously with electrodermal activity for each stimulus, and were correlated to changes in blood pressure and heart rate. The response patterns in each subject were very similar on the two experimental days. There was very low spontaneous electrodermal activity in the supine position, contrary to the resting sitting position. Conclusion: The electrodermal activity increased rapidly and synchronously in both palms within a few seconds as a response to minor physiological and mental stimuli, synchronous with fluctuations in radial artery blood flow, palmar skin perfusion, and cardiovascular variables. The responses are reproducible from day to day, making them a stable and constant stimuli to be used for studies in patients with hyperhidrosis