The sympathetic nervous system in heart failure physiology, pathophysiology, and clinical implications.

http://happierhuman.wpengine.netdna-cdn.com/wp-content/uploads/2014/06/P10.-Depression-as-a-disease-of-modernity-explanations-for.pdf

Depression as a disease of modernity: explanations for increasing prevalence.

Cardiopulmonary exercise testing (CPET) has become an important clinical tool to evaluate exercise capacity and predict outcome in patients with heart failure and other cardiac conditions. It provides assessment of the integrative exercise responses involving the pulmonary, cardiovascular and skeletal muscle systems, which are not adequately reflected through the measurement of individual organ system function. CPET is being used increasingly in a wide spectrum of clinical applications for evaluation of undiagnosed exercise intolerance and for objective determination of functional capacity and impairment. This review focuses on the exercise physiology and physiological basis for functional exercise testing and discusses the methodology, indications, contraindications and interpretation of CPET in normal people and in patients with heart failure.

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Cardiopulmonary exercise testing and its application

Sleep disturbance as transdiagnostic: Consideration of neurobiological mechanisms

Prior studies on the association between weather and psychological changes have produced mixed results. In part, this inconsistency may be because weather's psychological effects are moderated by two important factors: the season and time spent outside. In two correlational studies and an experiment manipulating participants' time outdoors (total N = 605), pleasant weather (higher temperature or barometric pressure) was related to higher mood, better memory, and "broadened" cognitive style during the spring as time spent outside increased. The same relationships between mood and weather were not observed during other times of year, and indeed hotter weather was associated with lower mood in the summer. These results are consistent with findings on seasonal affective disorder, and suggest that pleasant weather improves mood and broadens cognition in the spring because people have been deprived of such weather during the winter.

/pdf/a-warm-heart-and-a-clear-head-the-contingent-effects-of-3e3ktd1u5g.pdf

A Warm Heart and a Clear Head The Contingent Effects of Weather on Mood and Cognition

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(02)11737-5.pdf

Effect of sunlight and season on serotonin turnover in the brain

Congestive heart failure occurs when myocardial dysfunction is advanced. Although clinical manifestations and diminished functional capacity can be traced back to the poor cardiac contractile state, there are major modifying influences from a complex series of compensatory responses. These particularly involve the heart, vessels, kidneys, sympathetic nervous system, the renin-angiotensin system, and other hormone systems. Functional capacity is, therefore, determined by the sum of the effects of the original cardiac insult and the effects, beneficial and adverse, of the secondary events. Functional capacity relates closely to prognosis only in the most severely disabled patients. The latter is mainly related to the extent of ventricular dysfunction, and there can be independent contributions from arrhythmias and sympathetic activity. Measures of resting parameters of cardiac contractility, hemodynamics, or neurohumoral responses are, therefore, of no value in predicting functional capacity but can be useful in examining outlook or examining mechanisms of disease and therapy. Exercise measurements are necessary because adequate resting performance can disguise major limitations in cardiac reserve. Measurement of functional capacity can be used to quantify the effects of therapy on daily living and to give an indication of the overall response of the body to major cardiac inadequacy. Limitation of exercise capacity, the earliest symptom of heart failure, can be quantified during a graded exercise test. Measurements of cardiac output and hemodynamic variables during exercise quantify the extent to which the cardiovascular system can increase performance to meet the demands of exercise. Work capacity and maximum oxygen capacity indicate the limits of physical performance, whereas determination of the anaerobic threshold indicates the highest level of exercise at which cardiorespiratory mechanisms are able to provide adequate oxygen supply to maintain aerobic metabolism in working skeletal muscle.

Circulatory regulation at rest and exercise and the functional assessment of patients with congestive heart failure.

The overall rate of release of noradrenaline to plasma was increased in 31 patients with essential hypertension; the median value was 32% (526 pmol/min) higher than in 22 subjects with normal blood pressure. To ascertain the pattern of sympathetic nervous system activation underlying this abnormality, regional sympathetic nervous activity was estimated, from radiotracer-derived estimates of organ-specific noradrenaline release to plasma, in the kidneys, heart and hepatomesenteric circulation. Renal sympathetic nervous tone was preferentially increased in essential hypertension, especially in young patients with hypersecretion of renin. Cardiac noradrenaline release (and possibly cardiac sympathetic tone) was also higher in hypertensive patients; the difficulty in interpretation here arises because left ventricular mass is also increased in essential hypertension. Approximately half of the surfeit in total noradrenaline release to plasma noted in hypertensive patients was accounted for by the increased cardio-renal noradrenaline release. The balance comes from undetermined sites, but not from the splanchnic circulation, in which sympathetic nervous activity was not increased.

Estimation of 'total' renal, cardiac and splanchnic sympathetic nervous tone in essential hypertension from measurements of noradrenaline release.

Long-term therapy (1.5-27 years, average 7.5 years) was ceased in 11 patients with essential hypertension. The return of supine hypertension during the ensuing 10 weeks was slow and incomplete, contrasting with previous studies when blood pressure (BP) had been lowered for shorter periods. After prolonged therapy in these patients, non-autonomic total peripheral resistance index (TPRI) was near normal, but left ventricular mass index (LVMI) was still high in six of the 11 patients. The latter was directly related to duration of effective treatment of BP and to BP when therapy was stopped. These findings may indicate that with antihypertensive therapy, structural changes in the peripheral vasculature regress more quickly than cardiac hypertrophy.

How hypertension redevelops after cessation of long-term therapy.

In chronic renovascular hypertension the amplifier properties of the hypertrophied heart and vessels contribute considerably more to the maintenance of the elevated blood pressure (BP) than the basic underlying cause. This must also occur in chronic primary hypertension. Accordingly, we hypothesized that after reversal of hypertrophy by antihypertensive medication the cause(s) of hypertension should be easier to detect during the redevelopment of hypertension once medication was stopped, than in the chronic phase of the disorder. We have studied three groups of patients with moderate to severe hypertension in whom BP was controlled for (1) 1 month (2) 1 year and (3) 15 months to 5 years. The rate of subsequent redevelopment of hypertension between the series was inversely related to the duration of therapy, which was mostly with beta-blockers and diuretics. Redevelopment of hypertension was slowest after obtaining regression of both vascular hypertrophy and left ventricular hypertrophy (LVH). Preliminary findings suggest that sympathetic overactivity is present during the redevelopment phase in most patients. Our findings have suggested a new therapeutic strategy, where the effectiveness of non-pharmacological methods of controlling BP is enhanced by first causing regression of cardiovascular hypertrophy by drug treatment. Moderate regular exercise has proved to be an effective non-pharmacological antihypertensive method which has now maintained five patients at normal BP for 1 year, following an initial period of drug treatment.

Pathogenesis of human primary hypertension: a new approach to the identification of causal factors and to therapy.

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