Blood flow dynamics in heart failure

J. Kevin Shoemaker, Heather L. Naylor, Cynthia S. Hogeman, Lawrence I. Sinoway

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Background - Exercise intolerance in heart failure (HF) may be due to inadequate vasodilation, augmented vasoconstriction, and/or altered muscle metabolic responses that lead to fatigue. Methods and Results - Vascular and metabolic responses to rhythmic forearm exercise were tested in 9 HF patients and 9 control subjects (CTL) during 2 protocols designed to examine the effect of HF on the time course of oxygen delivery versus uptake (protocol 1) and on vasoconstriction during exercise with 50 mm Hg pressure about the forearm to evoke a metaboreflex (protocol 2). In protocol 1, venous lactate and H+ were greater at 4 minutes of exercise in HF versus CTL (P<0.05) despite similar blood flow and oxygen uptake responses. In protocol 2, mean arterial pressure increased similarly in each group during ischemic exercise. In CTL, forearm blood flow and vascular conductance were similar at the end of ischemic and ambient exercise. In HF, forearm blood flow and vascular conductance were reduced during ischemic exercise compared with the ambient trial. Conclusions - Intrinsic differences in skeletal muscle metabolism, not vasodilatory dynamics, must account for the augmented glycolytic metabolic responses to moderate-intensity exercise in class II and III HF. The inability to increase forearm vascular conductance during ischemic handgrip exercise, despite a normal pressor response, suggests that enhanced vasoconstriction of strenuously exercising skeletal muscle contributes to exertional fatigue in HF.

Original languageEnglish (US)
Pages (from-to)3002-3008
Number of pages7
JournalCirculation
Volume99
Issue number23
DOIs
StatePublished - Jun 15 1999

Fingerprint

Heart Failure
Exercise
Forearm
Blood Vessels
Vasoconstriction
Fatigue
Skeletal Muscle
Oxygen
Vasodilation
Lactic Acid
Arterial Pressure
Pressure
Muscles

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Shoemaker, J. K., Naylor, H. L., Hogeman, C. S., & Sinoway, L. I. (1999). Blood flow dynamics in heart failure. Circulation, 99(23), 3002-3008. https://doi.org/10.1161/01.CIR.99.23.3002
Shoemaker, J. Kevin ; Naylor, Heather L. ; Hogeman, Cynthia S. ; Sinoway, Lawrence I. / Blood flow dynamics in heart failure. In: Circulation. 1999 ; Vol. 99, No. 23. pp. 3002-3008.
@article{f4b3647e47b643f9b871d3e4df8d136f,
title = "Blood flow dynamics in heart failure",
abstract = "Background - Exercise intolerance in heart failure (HF) may be due to inadequate vasodilation, augmented vasoconstriction, and/or altered muscle metabolic responses that lead to fatigue. Methods and Results - Vascular and metabolic responses to rhythmic forearm exercise were tested in 9 HF patients and 9 control subjects (CTL) during 2 protocols designed to examine the effect of HF on the time course of oxygen delivery versus uptake (protocol 1) and on vasoconstriction during exercise with 50 mm Hg pressure about the forearm to evoke a metaboreflex (protocol 2). In protocol 1, venous lactate and H+ were greater at 4 minutes of exercise in HF versus CTL (P<0.05) despite similar blood flow and oxygen uptake responses. In protocol 2, mean arterial pressure increased similarly in each group during ischemic exercise. In CTL, forearm blood flow and vascular conductance were similar at the end of ischemic and ambient exercise. In HF, forearm blood flow and vascular conductance were reduced during ischemic exercise compared with the ambient trial. Conclusions - Intrinsic differences in skeletal muscle metabolism, not vasodilatory dynamics, must account for the augmented glycolytic metabolic responses to moderate-intensity exercise in class II and III HF. The inability to increase forearm vascular conductance during ischemic handgrip exercise, despite a normal pressor response, suggests that enhanced vasoconstriction of strenuously exercising skeletal muscle contributes to exertional fatigue in HF.",
author = "Shoemaker, {J. Kevin} and Naylor, {Heather L.} and Hogeman, {Cynthia S.} and Sinoway, {Lawrence I.}",
year = "1999",
month = "6",
day = "15",
doi = "10.1161/01.CIR.99.23.3002",
language = "English (US)",
volume = "99",
pages = "3002--3008",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "23",

}

Shoemaker, JK, Naylor, HL, Hogeman, CS & Sinoway, LI 1999, 'Blood flow dynamics in heart failure', Circulation, vol. 99, no. 23, pp. 3002-3008. https://doi.org/10.1161/01.CIR.99.23.3002

Blood flow dynamics in heart failure. / Shoemaker, J. Kevin; Naylor, Heather L.; Hogeman, Cynthia S.; Sinoway, Lawrence I.

In: Circulation, Vol. 99, No. 23, 15.06.1999, p. 3002-3008.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Blood flow dynamics in heart failure

AU - Shoemaker, J. Kevin

AU - Naylor, Heather L.

AU - Hogeman, Cynthia S.

AU - Sinoway, Lawrence I.

PY - 1999/6/15

Y1 - 1999/6/15

N2 - Background - Exercise intolerance in heart failure (HF) may be due to inadequate vasodilation, augmented vasoconstriction, and/or altered muscle metabolic responses that lead to fatigue. Methods and Results - Vascular and metabolic responses to rhythmic forearm exercise were tested in 9 HF patients and 9 control subjects (CTL) during 2 protocols designed to examine the effect of HF on the time course of oxygen delivery versus uptake (protocol 1) and on vasoconstriction during exercise with 50 mm Hg pressure about the forearm to evoke a metaboreflex (protocol 2). In protocol 1, venous lactate and H+ were greater at 4 minutes of exercise in HF versus CTL (P<0.05) despite similar blood flow and oxygen uptake responses. In protocol 2, mean arterial pressure increased similarly in each group during ischemic exercise. In CTL, forearm blood flow and vascular conductance were similar at the end of ischemic and ambient exercise. In HF, forearm blood flow and vascular conductance were reduced during ischemic exercise compared with the ambient trial. Conclusions - Intrinsic differences in skeletal muscle metabolism, not vasodilatory dynamics, must account for the augmented glycolytic metabolic responses to moderate-intensity exercise in class II and III HF. The inability to increase forearm vascular conductance during ischemic handgrip exercise, despite a normal pressor response, suggests that enhanced vasoconstriction of strenuously exercising skeletal muscle contributes to exertional fatigue in HF.

AB - Background - Exercise intolerance in heart failure (HF) may be due to inadequate vasodilation, augmented vasoconstriction, and/or altered muscle metabolic responses that lead to fatigue. Methods and Results - Vascular and metabolic responses to rhythmic forearm exercise were tested in 9 HF patients and 9 control subjects (CTL) during 2 protocols designed to examine the effect of HF on the time course of oxygen delivery versus uptake (protocol 1) and on vasoconstriction during exercise with 50 mm Hg pressure about the forearm to evoke a metaboreflex (protocol 2). In protocol 1, venous lactate and H+ were greater at 4 minutes of exercise in HF versus CTL (P<0.05) despite similar blood flow and oxygen uptake responses. In protocol 2, mean arterial pressure increased similarly in each group during ischemic exercise. In CTL, forearm blood flow and vascular conductance were similar at the end of ischemic and ambient exercise. In HF, forearm blood flow and vascular conductance were reduced during ischemic exercise compared with the ambient trial. Conclusions - Intrinsic differences in skeletal muscle metabolism, not vasodilatory dynamics, must account for the augmented glycolytic metabolic responses to moderate-intensity exercise in class II and III HF. The inability to increase forearm vascular conductance during ischemic handgrip exercise, despite a normal pressor response, suggests that enhanced vasoconstriction of strenuously exercising skeletal muscle contributes to exertional fatigue in HF.

UR - http://www.scopus.com/inward/record.url?scp=0033564376&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033564376&partnerID=8YFLogxK

U2 - 10.1161/01.CIR.99.23.3002

DO - 10.1161/01.CIR.99.23.3002

M3 - Article

C2 - 10368117

AN - SCOPUS:0033564376

VL - 99

SP - 3002

EP - 3008

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 23

ER -

Shoemaker JK, Naylor HL, Hogeman CS, Sinoway LI. Blood flow dynamics in heart failure. Circulation. 1999 Jun 15;99(23):3002-3008. https://doi.org/10.1161/01.CIR.99.23.3002