Helge Refsum Ilmar A. Sulg Knut Rasmussen (Eds.) HEART BRAIN ~~ BRAIN HEART ~ With 159 Figures, Some in Color Springer-Verlag Berlin Heidelberg GmbH Prof. Dr. med. HELGE REFSUM University of Tromsl/l Department of Physiology Institute of Medical Biology Tromsl/l, Norway Prof. Dr. med. ILMAR A. SULG University of Tromsl/l Department of Neurology Institute of Clinical Medicine TromSI/l, Norway Prof. Dr. med. KNUT RASMUSSEN University of Tromsl/l Section of Cardiology Department of Internal Medicine Tromsl/l, Norway ISBN 978-3-642-83458-5 ISBN 978-3-642-83456-1 (eBook) DOI 10.1007/978-3-642-83456-1 Library of Congress Cataloging-in-Publication Data. Heart & brain, brain & heart / Helge Refsum, IImar A. Sulg, Knut Rasmussen (eds.). p. cm. Based on a symposium held at the University of Tromsl'l, Norway, June 24-27,1987. Includes bibliographies and index. ISBN 0-387-19186-0 (U.S.): 1. Heart - Diseases - Complications and sequelae - Congresses. 2. Brain - Diseases - Complica tions and sequelae - Congresses. 3. Heart - Physiology - Congresses. 4. Brain - Physiology - Con gresses. 5. Heart - Innervation - Congresses. 6. Brain - Blood-vessels - Congresses. I. Refsum, Helge. II. Sulg, IImar A., 1919- . III. Rasmussen, Knut. IV. Title: Heart & brain, brain & heart. [DNLM: 1. Autonomic Nervous System Diseases - congresses. 2. Cardiovascular Diseases - con gresses. 3. Central Nervous System Diseases - congresses. WG 100 H4345 1987] RC682.H35 1989 616.1'2 - dc19 DNLMIDLC for Library of Congress 88-39684 CIP This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broad casting, reproduction on microfilms or in other ways, and storage in data banks. Duplication of this publication or parts thereof is only permitted under the provisions of the German Copyright Law of September 9,1965, in its version of June 24, 1985, and a copyright fee must always be paid. Violations fall under the prosecution act of the German Copyright Law. © Springer-Verlag Berlin Heidelberg 1989 Originally published by Springer-Verlag Berlin Heidelberg New York in 1989 Softcover reprint of the hardcover 1st edition 1989 The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product Liability: The publisher can give no guarantee for information about drug dosage and applica tion thereof contained in this book. In every individual case the respective user must check its ac curacy by consulting other pharmaceutical literature . Typesetting and printing: Petersche Druckerei GmbH & Co. Offset KG, Rothenburg ob der Tauber Bookbinding: Konrad Triltsch, Graphischer Betrieb, D-8700 Wiirzburg 2121/3130-543210 - Printed on acid-free paper Preface The aim of this book is to focus on the important relationships between the heart and the brain in health and disease. The brain and nervous system may cause or influence heart disease, e.g., by causing arrhythmias or modi fying the response to ischemia. Disorders of the heart and circulation may cause brain damage, e.g., by releasing emboli resulting in cerebral infarc tion. Furthermore, both the brain and the heart are frequently targets of the same disease process. The heart and brain have electrophysiologically active cells, which may respond in similar ways to diseases and various interventions. Finally, many drugs affect both the brain and the heart, and drugs used for heart diseases usually have side effects on the brain and vice versa. With today's increasing subspecialization in medicine, we feel the time has come to present a book that integrates basic and clinical aspects of cardiology, neurology, cardiovascular surgery, and neurosurgery. We hope this cross fertilization will broaden horizons and advance both understand ing and practice. This book is based on a symposium held at the University of TromS!/l, Norway, 24-27 June 1987, organized by Ilmar A. Sulg, Knut Rasmussen, Svein Ivar Mellgren, Dag S!/lrlie, and Helge Refsum of the Departments of Clinical Neurophysiology, Medicine, Neurology, Surgery, and Physiology, respectively. Weare grateful to the distinguished group of contributors for not only outlining their pioneering studies, but also describing their recent work and indicating important possibilities for the future. The excellent secretarial work of Elisabeth Richardsen is greatly appreciated. We hope the book will prove to be of use to a wide variety of clinicians as well as basic scientists and students. Troms!/l HELGE REFSUM ILMAR A. SULG KNuT RASMUSSEN Contents Part I: Physiology and Pharmacology Chapter 1 Spasm of Cerebral and Coronary Vessels: Effects of Calcium Antagonists K.-E.ANDERSSON, L.BRANDT, and B.LJUNGGREN ...... . 3 Chapter 2 Opioid Peptides and the Cardiovascular System with Especial Reference to Low Perfusion States J. R. PARRATI. With 4 Figures .......... . 20 Chapter 3 Cardiac and Cerebral Effects of Local Anesthetics R. HOTVEDT and H. REFSUM. With 10 Figures .......... 37 Chapter 4 Neurotoxins as Tools in Studying Cardiac Excitation-Contraction Coupling U. RAVENS and E. WE'ITWER. With 8 Figures ........... 51 Chapter 5 Adenosine and ATP Interactions with Autonomic Neural Control of the Heart A. PELLEG. With 1 Figure . . . . . . . . . . . . . . . . . . . . .. 62 Part II: Autonomic Nervous System and Arrhythmias Chapter 6 Sympathetic Influences on Arrhythmogenesis in the Ischemic Heart K. A. YAMADA, G. P. HEATHERS, S. M. POGWIZD, and P. B. CORR . . .. 79 Chapter 7 Sympathetic Nervous System and Malignant Arrhythmias: Evidence for Further Links S.G. PRIORI and P. J. SCHWARTZ. With 6 Figures ...... . 98 Contents VII Chapter 8 Modulation of Cardiac Arrhythmias by the Autonomic Nervous System R. F. GILMOUR JR., J. J. SALATA, and D. P. ZIPES. With 8 Figures . 108 Chapter 9 Supraventricular Tachycardia and the Autonomic Nervous System D. L. Ross. With 8 Figures ...................... 120 Chapter 10 Heart Rate Changes and ECG Rhythm Disturbances in the Cluster Headache Syndrome D. RUSSELL. With 10 Figures ..................... 131 Chapter 11 Blood Pressure Assessment in a Broad Chronobiologic Perspective F. HALBERG, E. BAKKEN, G. CORNELISSEN, J. HALBERG, E. HALBERG, and P. DELMORE. With 8 Figures ................... 142 Part III: Syncope and Sudden Death Chapter 12 Mechanisms of Syncope and of Sudden Death Due to Ventricular Tachyarrhythmias G. BREITHARDT, M. BORGGREFE, A. PODCZECK, and A. MARTINEZ-RuBIO With 8 Figures ............................ 165 Chapter 13 Possible Role of the Fear Paralysis Reflex in Sudden Cardiac Death B.KAADA. With 3 Figures ...................... 185 Chapter 14 Some Clinical Neurological Aspects of Syncope O.JOAKIMSEN ............................. 199 Chapter 15 Differential Diagnosis in Syncope and Epilepsy: Clinical Neurophysiological and Cardiological Aspects I.A.SuLG. With 1 Figure ....................... 202 Part IV: Thromboembolism and Ischemia Chapter 16 Thromboembolic Complications in Atrial Fibrillation J. GODTFREDSEN and P. PETERSEN ................... 225 Chapter 17 Echocardiography and Embolic Sources in the Heart K.-A.JOHANNESSEN. With 3 Figures .................. 230 VIII Contents Chapter 18 31p Nuclear Magnetic Resonance Spectroscopy of Cerebral and Cardiac Ischemia M.M.CoHEN, S.J.Kopp, J.W. PEITEGREW, and T. GLONEK ... 239 Chapter 19 Oxygen Radicals in Heart and Brain Tissue Injury K.YTREHus and O.D.MJ0s. With 8 Figures .. 244 Chapter 20 Prevention of Ischemic Brain Damage Following Cardiac Arrest L.MoGENSEN .......................... . . . 255 Part V: Sleep and Sleep Apnea Chapter 21 Influence of Sleep, Activity and Circadian Rhythm on Heart Rate, QT Interval and Cardiac Arrhythmias C. GUILLEMINAULT and A. M. GILLIS .................. 263 Chapter 22 Pulmonary Hemodynamics in Obstructive Sleep Apnea Syndromes J. KRIEGER, E. WEITZENBLUM, B. REITZER, and D. KURTz. With 1 Figure 272 Chapter 23 Sleep Apnea Syndrome as an Occupational Disease P. MONsTAD, I. A. SULG, A. K. ROM, T. NISSEN, and S. I. MELLGREN With 2 Figures ............................ 280 Part VI: Disease in the Cardiovascular and Nervous System Chapter 24 Concomitant Manifestations of Disease in the Cardiovascular and Nervous System: An Overview K. RASMUSSEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287 Chapter 25 Cardiac Involvement in Kearns-Sayre Syndrome B. SCHWARTZKOPFF, G. BREITHARDT, M. BORGGREFE, B. LOSSE, K.-Y. TOYKA, and H. FRENZEL. With 6 Figures ....... . 293 Chapter 26 Some Neurological and Hereditary Aspects of Progressive External Ophthalmoplegia and Mitochondrial Encephalomyopathy S. I. MELLGREN, T. TORBERGSEN, E.B.MATHIESEN, N.J.BRAUTAsET, and S. LINDAL. With 3 Figures ............... . .. 311 Chapter 27 Neurological and Cardiological Findings in Systemic Lupus Erythematosus R.OMDAL, S. I. MELLGREN, and G.HuSBY ............... 318 Contents IX Part VII: Hypo-and Hyperbaric Environment Chapter 28 High Altitude Physiology and Pathophysiology: Medical Observations During the Norwegian Mount Everest Expedition K. T. SWKKE. With 3 Figures .............. . . . 327 Chapter 29 Heart and Brain Under Hyperbaric Conditions in Man A. O. BRuBAKK. With 8 Figures .................... 343 Chapter 30 Effects of Positive End-Expiratory Pressure Ventilation on Intracranial Pressure and Cerebral Blood Flow O.HEVR0Y, N.-E.KL0W, 0. NYGAARD, and J.H.TRUMPY With 3 Figures ............................ 357 Chapter 31 Positive End-Expiratory Pressure and Cardiac Function: The Role of Extraventricular Constraint O.A.SMISETH, I. KINGMA, N.W. ScoTI-DoUGLAs, E.RSMITH, and J. V. TYBERG. With 6 Figures ................... 364 Part VIn: Cerebral Function and Cardiac Surgery Chapter 32 Neuromonitoring in High Risk Surgery: Physiological Tolerance Limits for Central Nervous System I. A. SULG. With 10 Figures . . . . . . . . . . . . . . . . . . . 375 Chapter 33 Monitoring Brain Function During Cardiovascular Surgery: Hypoperfusion vs Microembolism as the Major Cause of Neurological Damage During Cardiopulmonary Bypass E. RJoHN, L.S.PRiCHEP, RJ.CHABOT, and W.O.ISOM. With 9 Figures 405 Chapter 34 Cerebral Blood Flow During Cardiopulmonary Bypass L.HENRIKSEN. With 7 Figures ..................... 422 Chapter 35 Cerebral Hemodynamics During Nonpulsatile Cardiopulmonary Bypass T. LUNDAR. With 7 Figures ...................... 432 Chapter 36 Cerebral Outcome After Open Heart Surgery: A Long-term Multidimensional Follow-up of Valvular Replacement Patients K. SOTANIEMI. With 5 Figures ...... . . . . . . . . . . . . . . . 440 x Contents Chapter 37 Cerebral Protection During Open Heart Surgery: Clinical, Psychometric, Enzymological, and Radiological Data T. ABERG. With 3 Figures 452 Subject Index . . . . . . 459