MSGID: 1:153/757.1315 30f7d089
CHRS: CP866 2
TZUTC: 0300
, 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?



--- WinPoint Beta 5 (359.1)
 * Origin: 21-st century (1:153/757.1315)
SEEN-BY: 1/120 123 15/0 18/0 90/1 105/81 106/201 116/116 120/340 123/0
SEEN-BY: 123/25 115 131 180 200 755 129/305 330 331 134/100 135/300
SEEN-BY: 138/146 153/105 135 757 7001 7715 154/10 221/6 222/2 226/30
SEEN-BY: 227/114 229/110 206 317 400 424 426 452 664 700 240/1120
SEEN-BY: 240/5832 250/1 261/1466 266/512 275/100 1000 280/464 282/1038
SEEN-BY: 299/6 300/4 301/1 317/3 320/219 322/757 342/11 200 396/45
SEEN-BY: 633/280 640/1321 712/848 3634/0 12 15 24 27 50 5020/1042
PATH: 153/757 3634/12 153/7715 229/426