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Blood pressure regulation X: what happens when the muscle pump is lost? Post-exercise hypotension and syncope

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Abstract

Syncope which occurs suddenly in the setting of recovery from exercise, known as post-exercise syncope, represents a failure of integrative physiology during recovery from exercise. We estimate that between 50 and 80 % of healthy individuals will develop pre-syncopal signs and symptoms if subjected to a 15-min head-up tilt following exercise. Post-exercise syncope is most often neurally mediated syncope during recovery from exercise, with a combination of factors associated with post-exercise hypotension and loss of the muscle pump contributing to the onset of the event. One can consider the initiating reduction in blood pressure as the tip of the proverbial iceberg. What is needed is a clear model of what lies under the surface; a model that puts the observational variations in context and provides a rational framework for developing strategic physical or pharmacological countermeasures to ultimately protect cerebral perfusion and avert loss of consciousness. This review summarizes the current mechanistic understanding of post-exercise syncope and attempts to categorize the variation of the physiological processes that arise in multiple exercise settings. Newer investigations into the basic integrative physiology of recovery from exercise provide insight into the mechanisms and potential interventions that could be developed as countermeasures against post-exercise syncope. While physical counter maneuvers designed to engage the muscle pump and augment venous return are often found to be beneficial in preventing a significant drop in blood pressure after exercise, countermeasures that target the respiratory pump and pharmacological countermeasures based on the involvement of histamine receptors show promise.

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Acknowledgments

This research was supported in part by grants from the American Heart Association, Grant-in-Aid 11GRNT5490000, and National Institutes of Health Grant HL115027.

Author contributions

All authors contributed directly to the writing of this review. Each drafted a substantial section, assisted in revising the entire review, and approved the final version.

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Authors and Affiliations

  1. Department of Human Physiology, 1240 University of Oregon, 122 Esslinger Hall, Eugene, OR, 97403–1240, USA

    John R. Halliwill, Dylan C. Sieck, Steven A. Romero, Tahisha M. Buck & Matthew R. Ely

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  1. John R. Halliwill
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  2. Dylan C. Sieck
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  3. Steven A. Romero
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  4. Tahisha M. Buck
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  5. Matthew R. Ely
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Correspondence to John R. Halliwill.

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Communicated by Nigel A. S. Taylor.

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Halliwill, J.R., Sieck, D.C., Romero, S.A. et al. Blood pressure regulation X: what happens when the muscle pump is lost? Post-exercise hypotension and syncope. Eur J Appl Physiol 114, 561–578 (2014). https://doi.org/10.1007/s00421-013-2761-1

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