Skip to main content
NCBI home page
The Journal of Physiology logoLink to The Journal of Physiology
. 1971 Jun;215(2):411–431. doi: 10.1113/jphysiol.1971.sp009477

Cardiovascular responses to tilting in tetraplegic man

J L Corbett, H L Frankel, P J Harris
PMCID: PMC1331891  PMID: 5145726

Abstract

1. A study has been made of the effect of head-up tilt on blood pressure, heart rate, forearm blood flow and occluded vein pressure in the hand and foot in non-bedridden patients with chronic, closed, complete, localized traumatic transection of the cervical spinal cord.

2. In typical responses the blood pressure fell and the heart rate rose progressively for about 2 min, tending to plateau thereafter. The average falls in mean blood pressure for tilts of +30, +45 and +60° were from 68 to 44, 74 to 36 and 70 to 44 mm Hg respectively, and the corresponding heart rate increases were from 67 to 85, 62 to 97 and 62 to 103 beats/min respectively. One patient lost consciousness when his blood pressure was 29/19 mm Hg and one other patient experienced symptoms suggesting cerebral ischaemia.

3. Following the return to horizontal, the blood pressure and heart rate usually returned to their previous values within 1 min and the blood pressure tended to overshoot slightly in the following few minutes. No immediate blood pressure overshoot occurred after the tilt except in association with a spasm of skeletal muscles.

4. There was consistently a decrease in forearm blood flow, sometimes to unrecordably low levels and a venoconstriction with postural change and it is argued that these changes are the result of spinal cardiovascular reflexes to peripheral vessels. Following the return to the horizontal position, there was occasionally a large immediate increase in forearm blood flow.

5. Following the intravenous administration of 3 mg atropine on two occasions, head-up tilting produced further small heart rate increases.

6. Spasms of skeletal muscle occur frequently in these patients and greatly modify the effects of postural stimuli. Bladder percussion also modifies the normal response.

Full text

PDF
411

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ADAMS-RAY J., NORLEN G. Bladder distension reflex with vasoconstriction in cutaneous venous capillaries. Acta Physiol Scand. 1951 Aug 25;23(2-3):95–109. doi: 10.1111/j.1748-1716.1951.tb00799.x. [DOI] [PubMed] [Google Scholar]
  2. Ardill B. L., Bannister R. G., Fentem P. H., Greenfield A. D. Circulatory responses of supine subjects to the exposure of parts of the body below the xiphisternum to subatmospheric pressure. J Physiol. 1967 Nov;193(1):57–72. doi: 10.1113/jphysiol.1967.sp008343. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. BARD P. Anatomical organization of the central nervous system in relation to control of the heart and blood vessels. Physiol Rev Suppl. 1960 Apr;4:3–26. [PubMed] [Google Scholar]
  4. BORS E., FRENCH J. D. Management of paroxysmal hypertension following injuries to cervical and upper thoracic segments of the spinal cord. AMA Arch Surg. 1952 Jun;64(6):803–812. doi: 10.1001/archsurg.1952.01260010823012. [DOI] [PubMed] [Google Scholar]
  5. BURTON A. C. Relation of structure to function of the tissues of the wall of blood vessels. Physiol Rev. 1954 Oct;34(4):619–642. doi: 10.1152/physrev.1954.34.4.619. [DOI] [PubMed] [Google Scholar]
  6. CUNNINGHAM D. J., GUTTMANN L., WHITTERIDGE D., WYNDHAM C. H. Cardiovascular responses to bladder distension in paraplegic patients. J Physiol. 1953 Sep;121(3):581–592. doi: 10.1113/jphysiol.1953.sp004966. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Cole T. M., Kottke F. J., Olson M., Stradal L., Niederloh J. Alterations of cardiovascular control in high spinal myelomalacia. Arch Phys Med Rehabil. 1967 Jul;48(7):359–368. [PubMed] [Google Scholar]
  8. Corbett J. L., Frankel H. L., Harris P. J. Cardiovascular changes associated with skeletal muscle spasm in tetraplegic man. J Physiol. 1971 Jun;215(2):381–393. doi: 10.1113/jphysiol.1971.sp009475. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Corbett J. L., Frankel H. L., Harris P. J. Cardiovascular reflex responses to cutaneous and visceral stimuli in spinal man. J Physiol. 1971 Jun;215(2):395–409. doi: 10.1113/jphysiol.1971.sp009476. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Downey J. A., Chiodi H. P., Miller J. M., 3rd The effect of inhalation of 5 per cent carbon dioxide in air on postural hypotension in quadriplegia. Arch Phys Med Rehabil. 1966 Jul;47(7):422–426. [PubMed] [Google Scholar]
  11. EGER E. I., 2nd Atropine, scopolamine, and related compounds. Anesthesiology. 1962 May-Jun;23:365–383. doi: 10.1097/00000542-196205000-00012. [DOI] [PubMed] [Google Scholar]
  12. Freyschuss U., Knutsson E. Cardiovascular control in man with transverse cervical cord lesions. Life Sci. 1969 Apr 1;8(7):421–424. doi: 10.1016/0024-3205(69)90237-9. [DOI] [PubMed] [Google Scholar]
  13. GARNIER B., IMHOF P., HEDIGER F., STEINMANN B. [On the behavior of blood pressure in paraplegics]. Cardiologia. 1963;42:103–112. [PubMed] [Google Scholar]
  14. GUTTMANN L., MUNRO A. F., ROBINSON R., WALSH J. J. EFFECT OF TILTING ON THE CARDIOVASCULAR RESPONSES AND PLASMA CATECHOLAMINE LEVELS IN SPINAL MAN. Paraplegia. 1963 May;1:4–18. doi: 10.1038/sc.1963.2. [DOI] [PubMed] [Google Scholar]
  15. Johnson R. H., Smith A. C., Spalding J. M. Blood pressure response to standing and to Valsalva's manoeuvre: independence of the two mechanisms in neurological diseases including cervical cord lesions. Clin Sci. 1969 Feb;36(1):77–86. [PubMed] [Google Scholar]
  16. KOSTER M., BETHLEM J. Paroxysmal hypertension and hypotension in patients with spinal cord lesions (poikilopiesis spinalis). Acta Psychiatr Scand. 1961;36:347–368. doi: 10.1111/j.1600-0447.1961.tb01050.x. [DOI] [PubMed] [Google Scholar]
  17. MILLER P. B., JOHNSON R. L., LAMB L. E. EFFECTS OF FOUR WEEKS OF ABSOLUTE BED REST ON CIRCULATORY FUNCTIONS IN MAN. Aerosp Med. 1964 Dec;35:1194–1200. [PubMed] [Google Scholar]
  18. Miller J. M., 3rd, Downey J. A., Darling R. C. The cardiovascular effects of breathing 5 per cent carbon dioxide. Arch Phys Med Rehabil. 1969 Aug;50(8):442–447. [PubMed] [Google Scholar]
  19. NALEFSKI L. A., BROWN C. F. G. Action of atropine on the cardiovascular system in normal persons. AMA Arch Intern Med. 1950 Dec;86(6):898–907. doi: 10.1001/archinte.1950.00230180103009. [DOI] [PubMed] [Google Scholar]
  20. POLLOCK L. J., BOSHES B., CHOR H., FINKELMAN I., ARIEFF A. J., BROWN M. Defects in regulatory mechanisms of autonomic function in injuries to spinal cord. J Neurophysiol. 1951 Mar;14(2):85–93. doi: 10.1152/jn.1951.14.2.85. [DOI] [PubMed] [Google Scholar]
  21. RODDIE I. C., SHEPHERD J. T., WHELAN R. F. Reflex changes in vasoconstrictor tone in human skeletal muscle in response to stimulation of receptors in a low-pressure area of the intrathoracic vascular bed. J Physiol. 1957 Dec 31;139(3):369–376. doi: 10.1113/jphysiol.1957.sp005897. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. SARNOFF S. J., YAMADA S. I. Evidence for reflex control of arterial pressure from abdominal receptors with special reference to the pancreas. Circ Res. 1959 May;7(3):325–335. doi: 10.1161/01.res.7.3.325. [DOI] [PubMed] [Google Scholar]
  23. Samueloff S. L., Bevegård B. S., Shepherd J. T. Temporary arrest of circulation to a limb for the study of venomotor reactions in man. J Appl Physiol. 1966 Jan;21(1):341–346. doi: 10.1152/jappl.1966.21.1.341. [DOI] [PubMed] [Google Scholar]
  24. Samueloff S. L., Browse N. L., Shepherd J. T. Response of capacity vessels in human limbs to head-up tilt and suction on lower body. J Appl Physiol. 1966 Jan;21(1):47–54. doi: 10.1152/jappl.1966.21.1.47. [DOI] [PubMed] [Google Scholar]
  25. Vallbona C., Lipscomb H. S., Carter R. E. Endocrine responses to orthostatic hypotension in quadriplegia. Arch Phys Med Rehabil. 1966 Jul;47(7):412–421. [PubMed] [Google Scholar]

Articles from The Journal of Physiology are provided here courtesy of The Physiological Society

RESOURCES