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Effects of Changing Heart Rate in Man by Electrical Stimulation of the Right AtriumStudies at Rest, during Exercise, and with Isoproterenol

 

作者: John Ross,   Joseph Linhart,   Eugene Braunwald,  

 

期刊: Circulation  (OVID Available online 1965)
卷期: Volume 32, issue 4  

页码: 549-558

 

ISSN:0009-7322

 

年代: 1965

 

出版商: OVID

 

数据来源: OVID

 

摘要:

A technic is described for controlling the heart rate in patients with normal atrioventricular conduction by means of an electrical pacemaker catheter that stimulated the right atrium. When the heart rates of 17 patients in the resting state were elevated from an average of 80 to 121 beats/min., the cardiac indices remained virtually unchanged and averaged 3.67 and 3.72 L./min./M.2, respectively. Further increases in the heart rates resulted in small reductions in the cardiac indices to an average value of 3.21 L./min./M.2at 148 beats/min. The stroke volumes, ejection periods, and mean rates of ejection decreased as heart rate was increased.The role of heart rate in the circulatory response to exercise was examined in seven patients. When the heart rates were controlled by electrical stimulation at rates comparable to those previously achieved spontaneously during exercise, it was observed that cardiac output rose normally with exercise and that this rise was accomplished entirely through an increase in the stroke volume. In five patients the effects of isoproterenol infusion were also studied before and during control of the heart rate at the level reached spontaneously during isoproterenol administration. Again, when the heart rate was not permitted to rise, the increases in cardiac output with isoproterenol were mediated through increases in the stroke volume. These studies indicate that in the absence of augmented metabolic requirements, homeostatic mechanisms maintain cardiac output relatively constant despite large induced changes in the heart rate. However, when metabolic demands are increased by muscular exercise, or the circulation is stimulated by catecholamines, cardiac output can rise through an increase in stroke volume, even when alterations in the heart rate are prevented.

 

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