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Profound Sympathoinhibition Complicating Hypovolemia in Humans

Jeffrey S. Sanders, MD; and David W. Ferguson, MD
[+] Article and Author Information

Grant Support: Partial support by grants HL-39340 and HL-24962 from the National Heart, Lung, and Blood Institute; and by a grant-in-aid from the Iowa Affiliate, American Heart Association.

Requests for Reprints: David W. Ferguson, MD, Cardiovascular Division, Department of Internal Medicine, University of Iowa Hospitals, Iowa City, IA 52242.

Current Author Addresses: Drs. Sanders and Ferguson: Cardiovascular Division, Department of Internal Medicine, University of Iowa Hospitals, Iowa City, IA 52242.


Ann Intern Med. 1989;111(5):439-441. doi:10.7326/0003-4819-111-5-439
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Tachycardia, increased sympathetic activity, and peripheral vasoconstriction have been described as the principal reflex adjustments to hypovolemic shock. However, experiments in animals suggest that bradycardia and sympathoinhibition can occur during severe hemorrhagic hypotension (1-5). In addition, recent observations indicate that a paradoxical bradycardia can occur during hypotensive hemorrhage in humans (6-8). The mechanisms of this response are not appreciated by most practicing physicians because hypovolemic shock is often promptly treated with volume expansion and because the acute manifestations of rapid, severe hypovolemia are rarely observed. Our observations in a normal, human subject help to delineate the autonomic responses to acute

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