Increased vasoconstriction predisposes to hyperpnea and postural faint

1 Department of Pediatrics, 2 Department of Medicine, 3 Department of Pharmacology, and 4 Department of Physiology, New York Medical College, Valhalla, New York Submitted 30 January 2008 ; accepted in final form 15 May 2008 Our prior studies indicated that postural fainting relates to splanchnic hypervolemia and thoracic hypovolemia during orthostasis. We hypothesized that thoracic hypovolemia causes excessive sympathetic activation, increased respiratory tidal volume, and fainting involving the pulmonary stretch reflex. We studied 18 patients 13–21 yr old, 11 who fainted within 10 min of upright tilt (fainters) and 7 healthy control subjects. We measured continuous blood pressure and heart rate, respiration by inductance plethysmography, end-tidal carbon dioxide (ET CO 2 ) by capnography, and regional blood flows and blood volumes using impedance plethysmography, and we calculated arterial resistance with patients supine and during 70° upright tilt. Splanchnic resistance decreased until faint in fainters (44 ± 8 to 21 ± 2 mmHg·l –1 ·min –1 ) but increased in control subjects (47 ± 5 to 53 ± 4 mmHg·l –1 ·min –1 ). Percent change in splanchnic blood volume increased (7.5 ± 1.0 vs. 3.0 ± 11.5%, P < 0.05) after the onset of tilt. Upright tilt initially significantly increased thoracic, pelvic, and leg resistance in fainters, which subsequently decreased until faint. In fainters but not control subjects, normalized tidal volume (1 ± 0.1 to 2.6 ± 0.2, P < 0.05) and normalized minute ventilation increased throughout tilt (1 ± 0.2 to 2.1 ± 0.5, P < 0.05), whereas respiratory rate decreased (19 ± 1 to 15 ± 1 breaths/min, P < 0.05). Maximum tidal volume occurred just before fainting. The increase in minute ventilation was inversely proportionate to the decrease in ET CO 2 . Our data suggest that excessive splanchnic pooling and thoracic hypovolemia result in increased peripheral resistance and hyperpnea in simple postural faint. Hyperpnea and pulmonary stretch may contribute to the sympathoinhibition that occurs at the time of faint. splanchnic resistance; total peripheral resistance; minute ventilation; regional blood flow Address for reprint requests and other correspondence: I. Taneja, The Center for Pediatric Hypotension, Suite 3050N, 19 Bradhurst Ave., New York Medical College, Hawthorne, NY 10532 (e-mail: indu_taneja{at}nymc.edu )