, lightheadedness, dizziness, or loss of consciousness from IOH, affects up to
40% of the general population (all ages), while presyncope is probably even
more common. Despite this, the condition is relatively understudied and there
is minimal information available about the underlying mechanisms or symptom
management and treatment. Currently, there are very few options available to
patients with IOH and no pharmacological treatments. The most common
recommendations have been to stand up slowly or sit up first before standing.
"Almost everyone has probably experienced some lightheadedness at some time
after standing up," explained lead investigator Satish R. Raj, MD, MSCI, FHRS,
Professor of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School
of Medicine, University of Calgary, Calgary, AB, Canada. "For some people this
is a frequent occurrence and may happen several times a day, which can be very
frightening and negatively impact their quality of life. We wanted to explore
this further and provide novel and effective symptom management techniques with
the goal of improving the IOH patient's quality of life."
This study investigated physical maneuvers before or after standing and their
efficacy in reducing the drop in blood pressure as well as the symptoms
typically seen in IOH patients upon standing. Study participants included 24
young women (mean age 32 ? 8 years) with a high burden history of fainting
immediately after standing and more than four episodes of presyncope or syncope
per month. The study participants were required to have a significant drop in
systolic blood pressure of at least 40 mmHg upon standing to fulfill the
diagnostic criteria of IOH on the study day. Two participants had inadequate
heart rate recordings and were excluded from the analysis.
The 22 study participants completed three sit-to-stand maneuvers including a
stand with no intervention (control), and two interventions. Researchers found
that both lower body muscle preactivation (thighs) through repeated knee raises
prior to standing (PREACT) and lower body muscle tensing (thighs and buttocks)
through leg crossing and tensing immediately after standing (TENSE) effectively
improve the blood pressure drop. This led to a reduction in symptoms upon
standing. They found that the PREACT maneuver accomplished this by increasing
cardiac output, while the TENSE maneuver did so by increasing stroke volume.
"Our study provides a novel and cost-free symptom management technique that
patients with IOH can use to manage their symptoms," noted first author Nasia
A. Sheikh, MSc, Libin Cardiovascular Institute, Cumming School of Medicine,
University of Calgary, Calgary, AB, Canada. "Since it is a physical maneuver,
it simply requires the lower body limbs, which patients can utilize at any time
and from anywhere to combat their symptoms."
"Our study demonstrates the physiology of IOH and assesses the utility of
physical maneuvers that can help the IOH patient manage their symptoms. A
diagnosis of IOH is identified by patients as the critical first step to
empowering them to understand and master their symptoms and thus minimize the
disruptions to daily living caused by this common, but not commonly understood,
condition," added co-investigator Mary Runte, PhD, University of Lethbridge,
Lethbridge, AB, Canada.
In an accompanying editorial, Bert Vandenberk, MD, PhD, Department of Cardiac
Sciences, Libin Cardiovascular Institute, Cumming School of Medicine,
University of Calgary, Calgary, AB, Canada; and Department of Cardiovascular
Sciences, KU Leuven, Leuven, Belgium; and Carlos A. Morillo, MD, FHRS,
Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School
of Medicine, University of Calgary, Calgary, AB, Canada, commented that "PREACT
and TENSE provide an elegant and simple effective symptom relief option for
patients with IOH." However, they noted, "The study needs to be validated in
men, as well as being explored in the elderly where multiple confounders should
be addressed. Understanding the role of cardiopulmonary mechanoreceptors should
also provide further mechanistic insights into the effects of these simple yet
very effective physiologic maneuvers."
And?
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