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Maintained exercise pressor response in heart failure

J K Shoemaker1, A R Kunselman, D H Silber

  • 1Section of Cardiology, Pennsylvania State University College of Medicine, The Milton S. Hershey Medical Center, Hershey, 17033, Pennsylvania.

Journal of Applied Physiology (Bethesda, Md. : 1985)
|November 6, 1998
PubMed
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Heart failure patients show intact blood pressure responses during exercise, but blood flow limitation doesn't improve muscle oxygen use. This suggests vasoconstriction may hinder benefits in heart failure exercise.

Area of Science:

  • Cardiovascular Physiology
  • Exercise Physiology
  • Skeletal Muscle Metabolism

Background:

  • Heart failure (HF) is associated with impaired exercise capacity.
  • The metaboreflex, a muscle reflex that increases blood pressure during exercise, is crucial for maintaining blood flow.
  • Understanding how forearm blood flow limitation affects the metaboreflex in HF is important for exercise prescription.

Purpose of the Study:

  • To investigate the impact of forearm blood flow limitation on metaboreflex activation during exercise in individuals with heart failure (HF) compared to controls (Ctl).
  • To assess the effects of ischemia on blood pressure, lactate, and hydrogen ion concentrations during handgrip exercise in HF and Ctl groups.

Main Methods:

  • 10 HF patients (NYHA class III-IV) and 9 Ctl subjects performed rhythmic handgrip contractions (25% MVC, 30/min for 5 min).
Keywords:
Non-programmatic

Related Experiment Videos

  • Exercise was conducted under ambient pressure or with +50 mmHg positive pressure (ischemia) applied to the exercising forearm.
  • Mean arterial blood pressure (MAP), venous effluent hemoglobin O2 saturation, lactate ([La]), and H+ ([H+]) concentrations were measured.

    • Main Results:

    • The increase in MAP during exercise (DeltaMAP) was similar in both groups under ambient conditions, despite higher Delta[La] and Delta[H+] in HF.
    • During ischemic exercise, DeltaMAP was significantly greater in HF than Ctl subjects.
    • Ischemia increased Delta[La] and Delta[H+] more in HF than Ctl, but Hb O2 saturation did not improve in either group, indicating no enhanced muscle oxidative metabolism.

    Conclusions:

    • The muscle reflex activation of the pressor response (metaboreflex) is intact in HF patients.
    • Despite increased blood perfusion pressure with ischemia, muscle oxidative metabolism and blood flow are not enhanced in HF.
    • Increased sympathetic vasoconstriction of active skeletal muscle may limit the benefits of improved perfusion pressure in HF during exercise.