各種循環器疾患の運動負荷における交感神経活動に関する研究
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概要
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Treadmill exercise tests were performed in normal subjects (NS) (n=26) and pateints with neurocirculatory asthenia (NCA) (n=18), essential hypertension (EHT) (n=17), mitral stenosis (MS) (n=14) and ischemic heart disease (IHD) (n=16) for assessing comparatively their responses of sympathetic nerve activity. Hemodynamic changes, urinary excretion of catecholamine and serum dopamineβ-hydroxylase activity (DBH) were observed. Each patient had a cardiac function corresponding to class I or II of NYHA functional classification. 1) In EHT, the exercise-induced elevations of blood pressure and sympathetic activity were markedly greater than in NS despite no difference of the increase in cardiac rate was found between EHT and NS. 2) Exercise capacity of IHD was significantly lowered becauce of the apperearance of ischemic change in ECG and/or chest pain during exercise. The exercise-induced increases in cardiac rate and sympathetic activity were higher in IHD than in MS, though there was no difference in systolic blood pressure between both groups. 3) In MS, exercise capacity was markedly lowered with a poor response in blood pressure and marked increases in cardiac rate and sympathetic activity. 4) Exercise capacity and responses of cardiac rate and blood pressure during exercise in NCA were similar to those of NS, but the recovery of blood pressure and sympathetic activity after the end of exercise were delayed as compared to NS. These results indicate that the sympathetic hyperactivity may partipate greatly in the pathogensesis of EHT and may also act as a compensatory mechanism to heart failure in valvular heart diseases such as MS. It is also revealed that the hypersensitive state of sympathetic activity may possibly induce a hyperkinetic condition in NCA and on the other hand may be caused in IHD as a response to chest pain or myocardial ischemia during exercise. It is, thus, suggested that the sympathetic nerve activity plays an important pathophysiologic role in various cardiovasular diseases whatever may be the mode of action.
- 神戸大学の論文