Comput Math Methods Med - Simulation of exercise-induced syncope in a heart model with severe aortic valve stenosis.

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Resumo

Severe aortic valve stenosis (AVS) can cause an exercise-induced reflex syncope (RS). The precise mechanism of this syncope is not known. The changes in hemodynamics are variable, including arrhythmias and myocardial ischemia, and one of the few consistent changes is a sudden fall in systemic and pulmonary arterial pressures (suggesting a reduced vascular resistance) followed by a decline in heart rate. The contribution of the cardioinhibitory and vasodepressor components of the RS to hemodynamics was evaluated by a computer model. This lumped-parameter computer simulation was based on equivalent electronic circuits (EECs) that reflect the hemodynamic conditions of a heart with severe AVS and a concomitantly decreased contractility as a long-term detrimental consequence of compensatory left ventricular hypertrophy. In addition, the EECs model simulated the resetting of the sympathetic nervous tone in the heart and systemic circuit during exercise and exercise-induced syncope, the fluctuating intra-thoracic pressure during respiration, and the passive relaxation of ventricle during diastole. The results of this simulation were consistent with the published case reports of exertional syncope in patients with AVS. The value of the EEC model is its ability to quantify the effect of a selective and gradable change in heart rate, ventricular contractility, or systemic vascular resistance on the hemodynamics during an exertional syncope in patients with severe AVS.

Resumo Limpo

sever aortic valv stenosi av can caus exerciseinduc reflex syncop rs precis mechan syncop known chang hemodynam variabl includ arrhythmia myocardi ischemia one consist chang sudden fall system pulmonari arteri pressur suggest reduc vascular resist follow declin heart rate contribut cardioinhibitori vasodepressor compon rs hemodynam evalu comput model lumpedparamet comput simul base equival electron circuit eec reflect hemodynam condit heart sever av concomit decreas contractil longterm detriment consequ compensatori left ventricular hypertrophi addit eec model simul reset sympathet nervous tone heart system circuit exercis exerciseinduc syncop fluctuat intrathorac pressur respir passiv relax ventricl diastol result simul consist publish case report exert syncop patient av valu eec model abil quantifi effect select gradabl chang heart rate ventricular contractil system vascular resist hemodynam exert syncop patient sever av

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