Archiv für Kreislaufforschung

, Volume 50, Issue 3–4, pp 251–270 | Cite as

Circulatory reactions in the forearm and hand during and after exercise in patients with vasoregulatory asthenia

  • Klaus Graf
  • Gunnar Ström
Article
Received:

Summary

  1. 1.

    Investigations were made on 15 patients with vasoregulatory asthenia (VA) and 14 clinically healthy control subjects (CS) concerning the magnitude and variations of the circulation in the resting forearm and hand during supine leg exercise, and in the forearm after exhaustive forearm exercise. Measurements were performed of blood flows in forearm and hand (venous occlusion plethysmography), arterial blood pressure, heart rate, a-v O2 difference between the brachial artery and a deep forearm vein, and blood lactate concentration, and calculations were made of O2 uptake in deep forearm (musculature) and vascular resistances in forearm and hand.

     
  2. 2.

    The blood flowat rest and duringleg exercise was in VA on the average two to three times higher in the forearm, and significantly lower in the hand, than in CS. The difference was especially pronounced in those patients who showed a marked reduction of physical work capacity (W170).

     

The lactate concentration in arterial blood increased more in VA during leg exercise with loads of up to 400–600 kpm/min than in CS, when related to absolute work load (kpm/min), but less in VA when related to relative work load (heart rate).

Both at rest and during leg exercise, the a-v O2 difference between brachial artery and a deep forearm vein was considerably lower in VA than in CS, while the calculated O2 uptake in deep forearm (muscle) was similar in both groups.

Especially in VA, the blood flow increase during leg exercise was considerably higher in the forearm with blocked sympathetic vasoconstrictor tone than in the intact contralateral forearm.

  1. 3.

    The \lsmaximal\rs forearm blood flow, as measured immediately after exhaustive and in part ischemically performedforearm exercise, was on the average not significantly different in VA and CS. At the same time the calculated O2 uptake in deep forearm (muscle) in VA was only half that in CS; and the lactic acid concentration of blood from a deep forearm vein was slightly lower in VA than in CS.

     

The post-exercise return of the changed circulatory valces to the control levels was not retarded in VA and even occurred slightly faster than in CS.

  1. 4.

    The results are interpreted as indicating an abnormal blood flow distribution during exercise in VA, with a larger than normal part of the cardiac output flowing through resting muscles, and a smaller than normal part flowing through the active muscles. The results are discussed with regard to the cause of hyperkinetic circulation in skeletal musculature and the reduction of physical work capacity in VA.

     

Keywords

Brachial Artery Lactic Acid Concentration Control Subject Physical Work Capacity Venous Occlusion Plethysmography 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Zusammenfassung

Im Lungenparenchym:

  1. 1.

    Bei 15 Patienten mit vasoregulatorischer Asthenie (VA) und 14 klinisch gesunden Kontrollpersonen wurden die Kreislaufver\:anderungen in Unterarm und Hand w\:ahrend Beinarbeit im Liegen, sowie im Unterarm nach ersch\:opfender Arbeit der Unterarmmuskulatur untersucht. Gemessen wurden: die Durchblutung in Unterarm und Hand (Okklusionsplethysmographie), der arterielle Blutdruck, die Herzfrequenz, die a-vO2-Differenz zwischen A. brachialis und einer \lstiefen\rs Unterarmvene, und die Lactatkonzentration im Blut. Berechnet wurden: die O2-Aufnahme im \lstiefen\rs Unterarm (Skeletmuskulatur), und der Str\:omungswiderstand in Unterarm und Hand.

     
  2. 2.

    Bei k\:orperlicher Ruhe und w\:ahrend Beinarbeit war die Unterarmdurchblutung der VA-Patienten im Durchschnitt 2\2-3mal h\:oher, ihre Handdurchblutung dagegen geringer als bei den Kontrollpersonen. Diese Unterschiede waren besonders deutlich bei Patienten mit st\:arkerer Verminderung des k\:orperlichen Arbeitsverm\:ogens W170.

     

Bei VA stieg während Beinarbeit von 400–600 kpm/min die Lactatkonzentration im arteriellen Blut, wenn die Werte auf die absolute Arbeitsbelastung (kpm/min) bezogen wurden, stärker, wenn die Werte dagegen auf die relative Arbeitsbelastung (Herzfrequenz) bezogen wurden, geringer an als in der Kontrollgruppe.

Die a-vO2-Differenz zwischen A. brachialis und einer ‘tiefen’ Unterarmvene war in Ruhe und während Beinarbeit bei VA geringer als bei den Kontrollpersonen. Die errechneto O2-Aufnahme im ‘tiefen’ Unterarm (Skeletmuskulatur) war dagegen ähnlich groß bei beiden Gruppen.

Nach Blockade des lokalen sympathischen Vasokonstriktortonus im Unterarm nahm—besonders bei den VA-Patienten—der Anstieg der Unterarmdurchblutung während Beinarbeit erheblich zu.

  1. 3.

    Die unmittelbar nach Beendigung von ersch\:opfender, teilweise isch\:amisch ausgef\:uhrter Unterarmarbeit gemessene \lsmaximale\rs Unterarmdurchblutung war bei beiden Gruppen \:ahnlich gro\sB. Die O2-Aufnahme im \lstiefen\rs Unterarm (Skeletmuskulatur) betrug hier bei VA aber nur die H\:alfte des in der Kontrollgruppe gefundenen Wertes; auch die Lactatkonzentration in ven\:osem Blut aus der Unterarmmuskulatur war hier bei VA geringer als bei den Kontrollpersonen. Der R\:uckgang dieser Ver\:anderungen zu den Ausgangs-werten war bei VA nicht verz\:ogert.

     
  2. 4.

    Die Ergebnisse k\:onnen f\:ur das Vorliegen einer abnormen Durchblutungsverteilung w\:ahrend k\:orperlicher Arbeit bei VA sprechen, n\:amlich in der Weise, da\sB hier ein gr\:o\sBerer Teil des Herzminutenvolumens als normalerweise durch die ruhende Skeletmuskulatur flie\sBt auf Kosten einer ausreichenden Durchblutung der arbeitenden Skeletmuskulatur selbst. M\:ogliche Ursachen der hyperkinetischen Skeletmuskeldurchblutung und der Verminderung des k\:orperlichen Arbeitsverm\:ogens bei VA werden diskutiert.

     
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Copyright information

© Dr. Dietrich Steinkopff Verlag 1966

Authors and Affiliations

  • Klaus Graf
    • 1
    • 2
  • Gunnar Ström
    • 1
    • 2
  1. 1.Department of Clinical PhysiologyThe University Hospital (Akademiska Sjukhuset)UppsalaSweden
  2. 2.Department of Clinical PhysiologySerafimerlasarettetStockholmSweden

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