Spectrum of orthostatic disorders: Classification based on an analysis of the short-term circulatory response upon standing

1991 ◽  
Vol 81 (2) ◽  
pp. 241-248 ◽  
Author(s):  
W. Wieling ◽  
A. D. J. ten Harkel ◽  
J. J. van Lieshout
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Steady State ◽  
Maximum Heart Rate ◽  
Circulatory Response ◽  
Group Iii ◽  
Additional Information ◽  
Postural Tachycardia ◽  
Group I ◽  
Circulatory Control

1. In 31 consecutively referred patients (20 females, 11 males) with overt or suspected orthostatic disorders, the changes in blood pressure and heart rate that occur in the first 2 min of standing were analysed. 2. Blood pressure was measured continuously by Finapres. The blood pressure and heart rate responses after 1–2 min of standing (early steady-state response) were used to classify the patients as follows: group I (n = 17, age 42 ± 17 years), normal early steady-state blood pressure and heart rate responses; group II (n = 5, age 40 ± 14 years), combination of normal early steady-state blood pressure and postural tachycardia; group III (n = 9, age 51 ± 14 years), hypotensive orthostatic response with (4/9) or without (5/9) postural tachycardia. We examined whether additional information could be obtained by beat-to-beat analysis of the initial circulatory response (first 30 s). It was quantified by identifying the blood pressure trough and overshoot and the maximum heart rate and relative bradycardia. 3. The initial drop in systolic and diastolic blood pressures did not differ between the three groups. A recovery of blood pressure with a systolic and/or diastolic blood pressure overshoot was present in all group I and II patients, but was absent in all except two patients in group III. The initial maximum heart rate increase did not differ between the three groups. The relative bradycardia was less in groups II and III than in group I. 4. We conclude that analysis of the beat-to-beat blood pressure changes in the first 30 s after the onset of standing provides almost all the information that is necessary to determine abnormalities in orthostatic circulatory control.

Circulatory adaptation to orthostatic stress in healthy 10–14-year-old children investigated in a general practice

1991 ◽  
Vol 81 (1) ◽  
pp. 51-58 ◽  
Author(s):  
J. H. A. Dambrink ◽  
B. P. M. Imholz ◽  
J. M. Karemaker ◽  
W. Wieling
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Steady State ◽  
Initial Phase ◽  
Time Course ◽  
Free Standing ◽  
Postural Tachycardia ◽  
Circulatory Control ◽  
Head Up Tilt ◽  
Blood Pressures

1. The magnitude and time course of circulatory adaptation to active standing were investigated in healthy premenarchic girls and boys (n = 24; 10–14 years old) by non-invasive measurement of heart rate and continuous finger blood pressure (Finapres). 2. Four subjects (two girls, two boys) showed presyncopal symptoms after 4–9 min of free standing. 3. In the 20 non-fainting subjects, changes in blood pressure and heart rate upon standing did not differ between girls (n = 10) and boys (n = 10). In the initial phase of standing (first 30 s) systolic and diastolic blood pressures dropped by 22 ± 14 (mean ± sd) and 16 ± 7 mmHg, respectively, at 8 ± 2 s. Blood pressure subsequently recovered and showed an overshoot in all subjects. The transient drop in blood pressure was accompanied by an increase in heart rate of 40 ± 7 beats/min. These characteristic transient changes were not observed with passive head-up tilt. During the early steady-state phase (2 min), systolic blood pressure was similar to the supine value and diastolic blood pressure rose by 11 ± 5 mmHg. Heart rate increased by 25 ± 11 beats/min. In six of the subjects (three girls, three boys) the increase in heart rate exceeded 30 beats/min (postural tachycardia). Little further changes were observed during prolonged (10 min) standing. 4. Typical findings in the four near-fainting subjects were higher supine heart rates, no blood pressure overshoot in the initial phase (in three out of four subjects), postural tachycardia in the early steady-state phase and progressive decreases in blood pressure and heart rate afterwards. 5. In conclusion, for investigation of orthostatic circulatory adaptation in childhood it is important to pay attention to the dynamics of the circulatory response. No important differences appear to exist in orthostatic circulatory control between premenarchic girls and boys: orthostatic tachycardia and fainting appear to be common in both.

The effect of alphaxalone–alphadolone, propofol, and pentobarbitone anaesthesia on the β-endorphin and ACTH response to haemorrhage in the pig

2011 ◽  
Vol 89 (7) ◽  
pp. 521-526 ◽  
Author(s):  
Therese Ruane-O’Hora ◽  
W.J. Hall ◽  
F. Markos
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Anaesthetic Agent ◽  
Adrenocorticotrophic Hormone ◽  
Hormone Response ◽  
Mechanically Ventilated ◽  
Group Iii ◽  
Anaesthetic Agents ◽  
Group I ◽  
Significant Difference

In the literature there appears to be variability in reported levels of certain hormones during haemorrhage, specifically adrenocorticotrophic hormone (ACTH) and β-endorphin. It is possible that this variability may be due to the choice of anaesthetic. Therefore, the effect of 3 common research-only anaesthetic agents (alphaxalone–alphadolone, propofol, and pentobarbitone) on ACTH and β-endorphin levels during haemorrhage was assessed in pigs. Animals were divided into 3 groups: group I received alphaxalone–alphadolone (n = 5), group II received propofol (n = 6), and group III received pentobarbitone (n = 6). Pigs were subjected to a continuous fixed-volume haemorrhage under one of the above anaesthetics while being mechanically ventilated. ACTH and β-endorphin levels increased significantly during haemorrhage under propofol and pentobarbitone anaesthesia but not with alphaxalone–alphadolone. For ACTH there was no significant difference between the groups, whereas for β-endorphin there was a significant difference between the propofol- and pentobarbitone-anaesthetized pigs. The increase in heart rate during haemorrhage was significantly different between the alphaxalone–alphadolone and propofol as well as between the propofol and pentobarbitone groups. The drop in blood pressure was only significantly different between the alphaxalone–alphadolone- and propofol-anaesthetized pigs. These results indicate that the choice of anaesthetic agent can affect the hormone response to haemorrhage and may account for the variable hormone levels reported in the published literature to date.

scholarly journals THE SUCCESS OF HEART RATE VARIABILITY BIOFEEDBACK PARAMETERS IN PERSONS WITH DIFFERENT LEVELS OF BLOOD PRESSURE

2013 ◽  
Vol 68 (7) ◽  
pp. 20-23
Author(s):  
L. V. Poskotinova ◽  
D. B. Demin ◽  
E. V. Krivonogova ◽  
M. N. Dieva ◽  
N. M. Khasanova
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Antihypertensive Drugs ◽  
Heart Rhythm ◽  
Total Power ◽  
Heart Rate Variability Biofeedback ◽  
Group Iii ◽  
Group I ◽  
Group Ii

Objective. The aim was to determine the nature of cardiovascular reactions during a single session of heart rate variability (HRV) biofeedback in order to increase vagal effects on heart rhythm in patients with different initial levels of blood pressure (BP). Participants and methods. 33 people with normal blood pressure (group I), 20 people with uncorrected arterial hypertension (AH) grade 1-2 (group II) and 22 people with AH grade 1-2 taking antihypertensive drugs (group III) were observed. The parameters of heart rate variability (HRV), BP and pulse oximetry in the initial stage, during a single HRV biofeedback session and after this session in order to increase the total power of the HRV spectrum (each stage was 5 min). Results. In patients of group II low success of HRV biofeedback session, a high sympathetic reactivity and reduced oxygen blood saturation were determined. A reactivity of vagal mechanism is more pronounced in persons of group III than in those of group II. It is reflected in a significant increase in their total power of the HRV spectrum compared to the initial values and in uptrend saturation levels during the biofeedback session. Conclusions. The ability to HRV biofeedback in order to increase the total power of the HRV spectrum for standard short recording (5 min) can be seen as a test to determine the safety reserves of vagal autonomic cardiovascular regulation in persons with increased blood pressure. 

scholarly journals Optimization of postoperative analgesia after adenoidectomy in children

2017 ◽  
Vol 8 (2) ◽  
pp. 277-282
Author(s):  
M. A. Georgiyants ◽  
M. B. Pushkar ◽  
O. V. Vysotska ◽  
A. P. Porvan
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Postoperative Pain ◽  
Pain Intensity ◽  
Postoperative Analgesia ◽  
Group Iii ◽  
Group I ◽  
Pain Scales ◽  
Group Ii ◽  
Fentanyl Group

It is known that pharyngalgia is very common after tonsillectomy. It should be emphasized that the intensity of pain after adenoidectomy in children is not less important than after adenotonsillectomy. Despite the availability of standardized pain assessment scales and existing postoperative analgesia recommendations, unresolved postoperative pain still occurs in children. The research included 117 children with an average age of 7.5 ± 0.4 years, who underwent adenoidectomy at the Department of Anesthesiology and Intensive Care of "Regional Children’s Clinical Hospital" of Kharkov city in 2014. Depending on the method of general anesthesia, patients were divided into 3 groups: group I (n = 41) those who received propofol in combination with fentanyl; group II (n = 40) those who received sevoflurane in combination with fentanyl; group III (n = 36) those who received thiopental sodium combined with fentanyl. We monitored the heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, BIS-index, heart rate variability, respiration rate, and SpO2. We determined the levels of cortisol and insulin in the blood serum, glucose level, the ratio of cortisol/insulin was calculated. Assessment of the efficiency of postoperative analgesia was performed using the Wong-Baker FACES Pain Scale («Faces») and the Oucher Scale. The result of analysis of the intensity of postoperative pain determined that at the 1st hour after the operation by the «Faces» and Oucher scales, it was significantly higher in patients of group II compared with the patients of group I and group III. The morning after the operation there was no significant difference in the pain scales, and the number of scale points showed that children from all groups did not have pain. According to the data of ANOVA it was determined that only the patients in group I with indicator ΔBIS-index «intubation – traumatic moment of operation» experienced postoperative pain intensity on the «Faces» scale. A very strong correlation between «cortisol – BIS index» was observed during the traumatic moment of operation and unidirectional positive correlations were seen both between ΔBIS-index «intubation-the traumatic moment of operation» and between the level of cortisolemia (Δcortisol before surgery – the traumatic moment of operation, Δcortisol extubation – the 1st day after the surgery and Δcortisol before surgery – the 1st day after the surgery) and the intensity of postoperative pain by the «Faces» and Oucher scales. The around-the-clock prescribed administration of ibuprofen at dose 10 mg/kg after adenoidectomy provided effective postoperative analgesia. At the 1st hour after the operation lower pain intensity was revealed in patients using propofol in combination with fentanyl by both pain scales. We believe that propofol is able to influence the level of cortisol and assume that due to minimal changes in the level of cortisol during the perioperative period, propofol can reduce the intensity of postoperative pain. 

scholarly journals Autonomic dysfunction in post-COVID patients with and witfhout neurological symptoms: a prospective multidomain observational study

2021 ◽  
Author(s):  
Alex Buoite Stella ◽  
Giovanni Furlanis ◽  
Nicolò Arjuna Frezza ◽  
Romina Valentinotti ◽  
Milos Ajcevic ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Orthostatic Intolerance ◽  
Neurological Symptoms ◽  
Postural Tachycardia Syndrome ◽  
Symptom Scale ◽  
Autonomic Symptom ◽  
Postural Tachycardia ◽  
Ambulatory Services

AbstractThe autonomic nervous system (ANS) can be affected by COVID-19, and dysautonomia may be a possible complication in post-COVID individuals. Orthostatic hypotension (OH) and postural tachycardia syndrome (POTS) have been suggested to be common after SARS-CoV-2 infection, but other components of ANS function may be also impaired. The Composite Autonomic Symptom Scale 31 (COMPASS-31) questionnaire is a simple and validated tool to assess dysautonomic symptoms. The aim of the present study was to administer the COMPASS-31 questionnaire to a sample of post-COVID patients with and without neurological complaints. Participants were recruited among the post-COVID ambulatory services for follow-up evaluation between 4 weeks and 9 months from COVID-19 symptoms onset. Participants were asked to complete the COMPASS-31 questionnaire referring to the period after COVID-19 disease. Heart rate and blood pressure were manually taken during an active stand test for OH and POTS diagnosis. One-hundred and eighty participants were included in the analysis (70.6% females, 51 ± 13 years), and OH was found in 13.8% of the subjects. Median COMPASS-31 score was 17.6 (6.9–31.4), with the most affected domains being orthostatic intolerance, sudomotor, gastrointestinal and pupillomotor dysfunction. A higher COMPASS-31 score was found in those with neurological symptoms (p < 0.01), due to more severe orthostatic intolerance symptoms (p < 0.01), although gastrointestinal (p < 0.01), urinary (p < 0.01), and pupillomotor (p < 0.01) domains were more represented in the non-neurological symptoms group. This study confirms the importance of monitoring ANS symptoms as a possible complication of COVID-19 disease that may persist in the post-acute period.

scholarly journals Comparison of Ropivacaine-Fentanyl with Bupivacaine-Fentanyl for Labour Epidural Analgesia

2020 ◽  
Vol 14 (1) ◽  
pp. 108-114
Author(s):  
Kalpana Kulkarni ◽  
Rahul Patil
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Epidural Analgesia ◽  
Diastolic Blood Pressure ◽  
Diastolic Pressure ◽  
Vas Score ◽  
Group I ◽  
Significant Difference ◽  
Labour Epidural Analgesia ◽  
Group Ii

Background: Bupivacaine with opioid is commonly used for labour epidural analgesia. Ropivacaine is considered as an alternative to bupivacaine due to its lower cardiovascular complications. However, there is a controversy regarding the efficacy of these drugs as some studies suggest equivalent action, whereas others report that ropivacaine produces less motor blockade. The study aimed to compare the effect of ropivacaine-fentanyl and bupivacaine-fentanyl for labour analgesia. Materials and Methods: The prospective randomized study was performed on 60 parturients, divided into two groups of 30 subjects each. Group I received 10ml of bupivacaine 0.1% + fentanyl 2µg/ml and Group II received 10ml of ropivacaine 0.1% + fentanyl 2µg/ml by epidural catheter. Pre-anaesthetic evaluation was performed on all the participants and all were administered metoclopramide 0.25mg/kg and ondansetron 0.08-0.1mg/kg intravenously as premedication. The baseline and post anaesthesia systolic, diastolic blood pressure, heart rate, VAS score, degree of motor block, sedation and APGAR score of the baby were recorded. The data were tabulated and statistically analyzed. Results: When compared, there was no significant difference in systolic/diastolic blood pressure in two groups except at 360 min where diastolic pressure was low in group II. Significantly higher heart rate at 30 min (P=0.0003), 120 min (0.006), and 300 min (P=0.001) was observed in group I subjects. VAS score was significantly less at 180 min (P=0.019) and 300 min (P=0.019) in group II. Adverse effects such as fetal bradycardia, nausea/vomiting and hypotension observed were clinically insignificance when compared in two groups. Conclusion: Bupivacaine and ropivacaine produce an equal degree of analgesia and hemodynamic stability in 0.1% of concentration when added with 2µg/ml fentanyl . However, heart rate was well maintained with lower VAS scores in group II receiving ropivacaine. No significant difference in the side effects between the two groups. Hence, Ropivacaine can be used as a safe alternative to bupivacaine for labour epidural analgesia.

scholarly journals Perbedaan Respon Hemodinamik dengan Penambahan Blok Scalp Levobupivakain pada Operasi Kraniotomi

2020 ◽  
Vol 9 (1) ◽  
pp. 8-15
Author(s):  
Arya Justisia Sani ◽  
Ardhana Tri Arianto ◽  
Muhammad Husni Thamrin
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Hemodynamic Response ◽  
Anesthesia Induction ◽  
Group I ◽  
Significant Difference ◽  
Scalp Block ◽  
One Way Anova

Latar Belakang dan Tujuan: Peningkatan respon hemodinamik yang disebabkan oleh nyeri dapat menyebabkan peningkatan aliran darah otak dan tekanan intrakranial. Blok scalp pada kraniotomi menumpulkan respon hemodinamik karena rangsangan nyeri serta mengurangi penambahan analgesi lain. Penelitian ini bertujuan untuk mengetahui efektifitas blok scalp sebagai analgetik pada kraniotomi.Subjek dan Metode: Penelitian ini menggunakan uji klinik acak tersamar ganda pada 36 pasien dengan status fisik ASA 1–3 dilakukan operasi kraniotomi eksisi dan memenuhi kriteria inklusi. Sampel dibagi menjadi kelompok I (dengan blok scalp) dan kelompok II (tanpa blok scalp). Blok dilakukan sesaat setelah induksi anestesi. Digunakan levobupivakain 0,375% sebanyak 3 ml tiap insersi, pada masing-masing saraf. Tekanan darah, tekanan arteri rata-rata, detak jantung sebelum intubasi dan setelah intubasi, pemasangan pin, insisi kulit dan insisi duramater serta total kebutuhan fentanyl tambahan dicatat. Data yang diperoleh dianalisis dengan program komputer SPSS versi 17 lalu diuji menggunakan uji Kruskal-Wallis atau One-way ANOVA. Batas kemaknaan yang diambil adalah p < 0,05.Hasil: Selama kraniotomi, detak jantung, tekanan darah, tekanan arteri rata-rata secara signifikan lebih tinggi pada pasien tanpa blok scalp terutama pada saat pemasangan pin. Hasil uji statistik menunjukkan perbedaan signifikan, penambahan fentanyl pada pasien dengan blok scalp lebih sedikit dibandingkan tanpa blok scalp, p=0,000 (p<0,05).Simpulan: Blok scalp levobupivakain efektif dalam menurunkan respon hemodinamik terutama pada saat pemasangan pin. Pasien kraniotomi dengan blok scalp membutuhkan penambahan fentanyl lebih sedikit. Differences on Hemodynamic Response with Levobupivacaine Scalp Block in Craniotomy SurgeryAbstractBackground and Objective: Increased hemodynamic response caused by pain can lead to increased cerebral blood flow and intracranial pressure. Scalp block in craniotomy blunts hemodynamic response due to pain and reduce other analgesics addition. This study aims to determine effectiveness of scalp blocks as analgesic in craniotomy.Subject and Method: This study used a double-blind randomized clinical trial in 36 patients with physical status ASA 1-3 who underwent craniotomy and met inclusion criteria. Samples were divided into group I (with scalp block) and group II (without scalp block). Scalp Block was performed right after anesthesia induction. Using levobupivacaine 0.375% 3 ml for each insertion. Blood pressure, mean arterial pressure, heart rate before and after intubation, during pin placement, skin incision and duramater incision and total need for additional fentanyl were recorded. SPSS version 17 was used and data were analysed using Kruskal-Wallis or One-way ANOVA. Statistical significance was accepted at p < 0.05.Result: During craniotomy, heart rate, blood pressure, mean arterial pressure were significantly higher in patients without scalp block especially during pin placement. Statistical test showed significant difference, additional fentanyl in patients with scalp blocks was lesser, p = 0.000 (p <0.05). Conclusion: Levobupivacaine scalp block was effective to blunt hemodynamic response especially during pin placement. Scalp block also decreased additional fentanyl in craniotomy.

scholarly journals Fentanyl Pretreatment Modifies Anaesthetic Induction with Etomidate

1988 ◽  
Vol 16 (2) ◽  
pp. 171-176 ◽  
Author(s):  
R. J. Stockham ◽  
T. H. Stanley ◽  
N. L. Pace ◽  
S. Gillmor ◽  
F. Groen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Side Effects ◽  
Linear Regression ◽  
Anaesthetic Induction ◽  
Arterial Blood ◽  
Group I ◽  
Haemodynamic Changes ◽  
Induction Of Anaesthesia ◽  
Fentanyl Group

Haemodynamic changes and side-effects of induction of anaesthesia with etomidate were evaluated in 60 ASA Class I or II patients. The objective was to find an optimal pre-induction dose of fentanyl which eliminated haemodynamic changes and side-effects during induction and intubation without introducing other problems. Patients were randomly assigned to four groups according to the pretreatment dose of fentanyl (Group I= 2 ml normal saline; Group II= 100 μg of fentanyl; Group III= 250μg of fentanyl; Group IV = 500 μg of fentanyl) administered intravenously five minutes prior to induction of anaesthesia with etomidate, 0.3 mg/kg. There was an increasing incidence of apnoea (53, 87, 87 and 100% in Groups I-IV respectively) and a decreasing incidence of myoclonus (60, 33, 13 and 0% in Groups I-IV respectively) and injection pain (53, 13, 7 and 0% in Groups I-IV respectively), P< 0.002 chi-square test for linear trends, with increasing fentanyl dosage. The incidences of postoperative nausea and vomiting were similar in the four groups. There were also significant linear regression relationships (P< 0.01 ANOVA for linear regression) between increasing doses of fentanyl administered before etomidate and the prevention of increases in systolic blood pressure and heart rate during the induction-intubation sequence. The data demonstrate that increasing pre-induction doses of fentanyl are more effective at minimising side-effects and preventing increases in systolic arterial blood pressure and heart rate but also increase the incidence of apnoea during induction. The results suggest that 500 μg of fentanyl is an ideal pretreatment dose in fit patients prior to anaesthetic induction with etomidate.

scholarly journals The preponderance of initial orthostatic hypotension in postural tachycardia syndrome

2020 ◽  
Vol 129 (3) ◽  
pp. 459-466
Author(s):  
Julian M. Stewart ◽  
Archana Kota ◽  
Mary Breige O’Donnell-Smith ◽  
Paul Visintainer ◽  
Courtney Terilli ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Blood Flow ◽  
Heart Rate Variability ◽  
Cerebral Blood Flow ◽  
Orthostatic Hypotension ◽  
Pressure Recovery ◽  
Postural Tachycardia Syndrome ◽  
Postural Tachycardia ◽  
Initial Orthostatic Hypotension

Significant initial orthostatic hypotension (IOH) occurs in ~50% of postural tachycardia syndrome (POTS) patients and 13% of controls. Heart rate and blood pressure recovery are prolonged in IOH sustaining lightheadedness; IOH is more prevalent and severe in POTS. Altered cerebral blood flow and cardiorespiratory regulation are more prevalent in POTS. Altered heart rate variability and baroreflex gain may cause nearly instantaneous lightheadedness in POTS. IOH alone fails to confer a strong probability of POTS.

scholarly journals Cardiac parameters during the estrous cycle of canine bitches

2017 ◽  
Vol 37 (3) ◽  
pp. 295-299 ◽  
Author(s):  
Rute C.A. de Souza ◽  
Regiane Peres ◽  
Marlos G. Sousa ◽  
Aparecido A. Camacho
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Nervous System ◽  
Estrous Cycle ◽  
Cardiac Rhythm ◽  
Gradual Increase ◽  
Maximal Heart Rate ◽  
Group I ◽  
Mean Heart Rate ◽  
Prospective Investigation

ABSTRACT: The cardiovascular parameters of canine bitches were assessed during the estrous cycle. A total of eleven mongrel female dogs were enrolled in a longitudinal prospective investigation. Six animals were bred during the study and were assigned into group I, in which evaluations were performed during proestrus, estrus, gestational diestrus and anestrus. The five remaining bitches were not bred and underwent evaluations during proestrus, estrus, nongestational diestrus and anestrus. The holter data showed a gradual increase in the minimum and mean heart rate along pregnancy, as well as a reduction during anestrus, which differed significantly among the distinct periods. The values for maximal heart rate documented during pregnancy were significantly lower than those recorded during anestrus, and a variation in the heart rate circadian rhythm was also found, as demonstrated by decreases at night and rises during the day. Cardiac rhythm had a similar performance in both pregnancy and anestrus. Likewise, the blood pressure, electrocardiography, and echocardiography data did not vary during the estrous cycle. The results support the role played by the autonomic nervous system during these two distinct periods in order to attain a heart rate that provides the blood needed by the female’s body during the various stages of the reproductive cycle. Further studies are needed to better clarify the cardiovascular compensatory neuroendocrine events that accompany gestation in this species.

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