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Cardiovagal And Cardiac Sympathetic Co-activation During The Valsalva Maneuver

R Schondorf, J Benoit, M Genoulaz, MJ Lafitte. Cardiovagal And Cardiac Sympathetic Co-activation During The Valsalva Maneuver. “If the glottis be closed after a deep inspiration, and a strenuous and prolonged expiratory effort be then made, such pressure can be exerted upon the heart

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Cardiovagal And Cardiac Sympathetic Co-activation During The Valsalva Maneuver

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  1. R Schondorf, J Benoit, M Genoulaz, MJ Lafitte Cardiovagal And Cardiac Sympathetic Co-activation During The Valsalva Maneuver

  2. “If the glottis be closed after a deep inspiration, and a strenuous and prolonged expiratory effort be then made, such pressure can be exerted upon the heart and intrathoracic vessels that the movement and flow of the blood are temporarily arrested”. Antonio Maria Valsalva 1666 - 1723

  3. Normal Valsalva Leon and Shaver Am. Heart J. 1970; 80:729.

  4. Valsalva After Propranolol Leon and Shaver Am. Heart J. 1970; 80:729.

  5. Valsalva After Atropine Leon and Shaver Am. Heart J. 1970; 80:729.

  6. Valsalva After Combined Leon and Shaver Am. Heart J. 1970; 80:729.

  7. Eckberg Am. J. Physiol. 1980;239:581.

  8. The Valsalva Maneuver Is Complex • Discordance between carotid and aortic baroreceptor input during initial Valsalva • Discordance between MSNA, RRI and BP • Role of central command, chemoreceptors, “Hainsworthian” afferents, somatic afferents

  9. Renormalization Group Theory For Dummies • The current state of any dynamical system strongly depends on the previous states of that system • It is possible to apply feature extraction techniques that assign parameters that describe the current state of the system • This approach is not model driven

  10. Renormalization Group Theory For Dummies 2 • When these techniques are applied to analysis of RRI, two and only two parameters emerge • Atropine significantly reduces one of these parameters • Thoracic epidural anesthetic reduces the other whereas head-up tilt increases it • Both parameters are reduced in autonomic neuropathy

  11. Momentum For Dummies

  12. Sympathetic Index Increases During HUT

  13. Normal 1

  14. Normal 2

  15. Normal 3

  16. Graded Valsalva

  17. Autonomic Failure 1

  18. Autonomic Failure 2

  19. Autonomic Failure 3

  20. Averaged Normals

  21. AveragedAutonomicFailure

  22. Brain Res Rev

  23. Conclusions • There appears to be coactivation of the sympathetic and parasympathetic during phase 2 of the Valsalva maneuver in normal subjects • This robust interaction is not present in patients with autonomic failure • Coactivation may serve to improve cardiac output during the strain phase of the Valsalva

  24. “Ignorance never settles a question” Fortune Cookie Quote

  25. POTS

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