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DOI 10.14526/2070-4798-2018-13-4-170-176
Central and peripheral hemodynamics in pre-pathologic and pathologic
diagnostics among swimmers
Eduard V. Feroyan E. V.
Georgian State Teaching University of Physical Education and Sport
Tbilisi, Georgia ORCID: 0000-0003-4177-7206, [email protected]
Abstract: In terms of the volume and intensity increase of the training and competitive loads the demands claimed on athletes' blood circulation apparatus also increased. Blood circulation apparatus provides athletes' high working capacity and is the most important limiting factor in the system of oxygen transfer. Materials. The main hemodynamic parameters complex study at central and peripheral levels. Methods. Information sources analysis and summarizing, Doppler sonography, tetrapolar chest rheography methods, rheohepatography, rheoencephalography and peripheral rheovasography, methods of mathematical statistics. Results. According to the received results, an important factor in pathogenesis of chronic overtension of athletes' myocardium is circulatory injuries. It should be taken into consideration during medioprophylactic scheme of influence organization. As a result, it is reasonable to include into the recommended complex of therapy among the athletes with myocardosis hepatoprotectors, the preparations, which influence directly vascular system together with generally adopted means of rehabilitation. Intensive muscular activity causes direct bloodstream decrease through liver. It can become the reason for hepatic cells hypoxia. Damaged hepatic cells are more susceptible to hypoxia, than normal ones. Blood flow decrease in liver during the physical load can lead to severe necrotic tissues injury in liver, if there are some changes in liver parenchima. That is why it is important to control the state of liver at all stages of yearly cycle of training among athletes. Its early diagnostics is also necessary. Conclusion. A complex change of blood circulation apparatus in case of different pathological states, typical of sports-medical practice, demands practical material accumulation and activity-based research. The main aim of all scientific-research works, held in this direction is the following: early diagnostics, timely and purposeful therapy and pathology in sport effective prevention.
Keywords: swimming, physical working capacity, blood circulation apparatus.
For citation: Eduard V. Feroyan. Central and peripheral hemodynamics in pre-pathologic and pathologic diagnostics among swimmers. The Russian Journal of Physical Education and Sport. 2018; 13 (4): 141-145. DOI 10.14526/2070-4798-2018-13-4-170-176
Introduction
The notion "highly-qualified athletes' health" is conditioned not only by normal and pathological state of organs and systems in an organism, but also by the opportunity to adapt to intensive and continuous physical loads without pathological states [9,11,12]. Athletes' health and functional state of an organism are estimated on the basis of the complex of methods, directed toward clinical-diagnostic objectives solution for pre-pathologic and pathologic states revelation and for functional state estimation, athletes' working capacity physiological support [8,9,10,11,12].
In terms of the volume and intensity increase of the training and competitive loads the demands claimed on athletes' blood circulation apparatus also increased. Blood circulation apparatus provides athletes' high working capacity and is the most important limiting factor in the system of oxygen transfer.
Great amount of research works in sports-medical literature is connected with hemodynamics of the separate vascular basins during intensive muscular activity [1,2,7,9,12]. However, such kind of an approach doesn't help to estimate in complex functional state of cardiovascular system in general and present the state of interactions of central and peripheral parts of blood circulation apparatus.
The aim of the research is the main hemodynamic parameters complex study at central and peripheral levels.
Physiology
As peripheral vascular spheres brain, liver and the functioning extremities blood circulation was studied.
These questions study becomes urgent. Studying central and peripheral hemodynamic functioning and interaction between them helps to solve the problems of functional state estimation of cardiovascular system and pre-pathologic and pathologic changes early diagnostics. It provides disorders purposeful prevention in health state and also effective rehabilitation and medical measures taking.
Materials and Methods
28 highly-qualifies swimmers at the age of 16-27 took part in the research. A complex blood circulation apparatus was held at a relative muscular rest state, lying and during the 10th minute of rehabilitation after test loads. As the load the work on bicycle ergometer of incrementally increasing power "to the limit" (maximum load) was used.
Central hemodynamics was studied by means of tetrapolar chest rheography with its main indices determination: cardiac stroke volume (CSV), minute blood volume (MBV), stroke index (SI), cardiac index (CI), volumetric blood regurgitating (VBR), heart rate [7,8].
Parameters of regional liver and intracerebral blood circulation, peripheral vascular zones (of shin) hemodynamic registration was realized with the help of the following methods: rheohepatography, rheoencephalography and peripheral rheovasography [3,4,5,6,7]. Rheograms analysis included qualitative and quantitative curve characteristics and also amplitude and time indices calculation:
• rheography stroke volume index (RSVI), which reflects intensity of pulse blood filling of the studied zone;
• amplitudes of pulse wave (As), which characterizes the volume of blood filling of the studied vascular zone;
• diastolic-systolic index (DSI), which reflects the ratio of blood inflow and flow-out;
• period of rheography wave (a) maximum increase, which characterizes the ability of big and small arteries to expand;
• rheography coefficient (RC), which reflects the state of tonus and flexibility of arteries.
Results and Discussion
On the basis of medical check—up and the complex of central and peripheral hemodynamic indices estimation we defined the main syndromes, which combine different symptomatic features of swimmers' organism adaptation and rehabilitation processes violation.
The first group (53,6%) included swimmers, who had no complaints, with normal pulse and arterial pressure indices. All parameters of central and peripheral blood circulation and also ECG results were within physiological norms and corresponded with values registered among healthy highly-qualified athletes with an optimal and more efficient variant of organism hemodynamic support: CSV-132,0±4,8 ml, MBV-7,1±0,9 l.min.-1,SI- 70,1±1,5 ml.m2, CI - 4,3±0,03 l.min-1.m2, VBR - 432±45,5 ml.s, HR (heart rate) - 52,8±1,3 beats per minute-1.
Table - Quantitative indices of peripheral hemodynamic at rest among healthy highly-qualified
swimmers
Vascular zones RSVI As, DSI, a, RC (a/T x 100),
relative units O relative units s %
Brain 1,1±0,1 0,2±0,02 0,6i±0,04 0,12±0,03 12,2±0,40
Liver 1,2±0,05 0,10±0,07 0,52±0,05 0,10±0,09 16,1±0,05
Shin 0,55±0,05 0,051±0,08 0,44±0,02 0,13±0,02 11,8±0,51
The reaction of central hemodynamics and all studied vascular zones (brain, liver, active extremities) to testing load was adequate in case of high physical working capacity.
For such kind of athletes it is reasonable to use a complex of rehabilitation physical means of general and local influence after the training loads in order to optimize rehabilitation processes and prevent fatigue. At the same time, rehabilitation means choice and dosing are conditioned by the character of the load of the definite training micro cycle.
The second group (28,6%) included athletes, who had subjectively the sense of fatigue, didn't want to train. They demonstrated psychoemotional instability, sluggishness, irritability. During an objective study central blood circulation and also arterial pressure and ECG indices were within the limits of normal values. However, the athletes from the second group had pulse increase at rest (till 73,0±4,0 beats per minute-1). During rheoencephalographies study we observed intracerebral blood circulation decrease, arterial tonus of brain vessels increase and instability, venous outflow from cavity of skull violation. Peripheral vessels also were in the state of tonus. Rheohepatograms, registered among athletes of the second group, reflected phenomena of intracranial haemostasia a result of venous outflow worsening. Reaction of central and peripheral blood circulation to the load was tense. At the same time, there was slow pulse rehabilitation, pathological types of arterial pressure reaction (hypertonic, dystonic, reaction with graded systolic arterial pressure increase) in terms of physical working capacity decrease.
Thus, evident swimmers' functional state worsening in the second group helped to consider the described symptocomplex as the index of adaptive-compensatory mechanisms of blood circulation apparatus tension, which go before the state of general overfatigue. The athletes had some definite complaints and functional state level decrease in general. Changes, which appear during this state development in different organs and systems, can be demonstrated not equally. They are very often combined with immunoreactivity disorders. If we consider fatigue as physiological reaction of an organism to the load, overfatigue among athletes is a pre-pathologic state, which demands special correctional measures of the definite orientation toward the parts, which limit sports working capacity in each definite case.
The third group (17,9%) included swimmers, who had considerable disorders in central blood circulation state and regional vascular zones together or separately. As a result of a complex medical checkup it was revealed that they have pathological changes of different degree in the separate and several organs and systems of an organism.
These analysis proved the fact that etiologic factor in their development was chronic physical overtension, which appeared as a result of disparity between the loads and functional abilities of an organism. In this case the states of so called "adaptation breakdown" were demonstrated by pathologic deviations in health state (central nervous system, heart, liver, extremities).
We will discuss only two nosological forms, typical to sports activity.
Chronic myocardium overtension. Clinically this syndrome didn't have vivid symptomatology. It is typical of many diseases among athletes. The main specific feature was ECG change in a form of myocardium repolarization processes. The indices of central part of hemodynamics work at rest were not changed, except for some pulse increase. Moreover, among some athletes cardiovascular system had considerable functional abilities, which provided high working capacity. It helped these athletes to demonstrate good sports results.
However, even at early stages of myocardial dystrophy athletes had considerable disorders in liver blood circulation in a form of evident blood circulation decrease and intracranial stasis phenomena, connected with venous outflow disorder. The character of adaptation of blood circulation apparatus to physical load was violated both at central and peripheral levels.
At the same time the most not efficient, inadequate type of cardiohemodynamics reaction to the testing load was revealed. It proved functional reserves of heart decrease, when necessary during an early rehabilitation period MBV was not provided with low values of cardiac stroke volume, even in terms of
Physiology
a long-term tachycardia. Insufficient cardiac output led to considerable ischemia of the studied vascular brain, liver, lower extremities regions in terms of evident tonus of vessels increase and the phenomena of blood congestion because of venous outflow violation. During intensive muscular load cardiac output can have 5-6 times increase in comparison with the state of rest and be 24 l/min. among men and 18 l/min among women [2]. Heart beats become weaker and the amount of blood, released into vascular system, can't satisfy the increased needs of an organism [3]. After the load there was a slow pulse renewal, atypical types of arterial blood pressure reaction. The revealed heart reserves deficiency during adaptation to maximum load, undoubtedly restricts sports results improvement and even their stability at the achieved level.
Adaptive abilities decrease of cardiovascular system was revealed among actively training people, who had no complaints, very often with not stable ECG changes and their random daily variations. That is why in case of chronic heart overtension syndrome we should take intensive testing load as the main method of study with the main parameters of central and peripheral hemodynamics determination.
Liver-pain syndrome. This pathological state appears most of all as an independent nosological form, however, sometimes it goes together with chronic overtension of myocardium. The athletes with this syndrome even at rest had a clear blood filling decrease in liver and at the same time, had the phenomenon of interliver statis connected with venous outflow disorder. Character of adaptation of liver hemodynamics during rehabilitation period among these athletes was clearly violated (inadequate level of adaptation with further blood flow decrease).
Apart from objective changes, registered at rheohepatograms, such kind of athletes had pure clinical symptomatology. This symptomatology included pain in the right hypochondrium at rest and during physical loads, different dyspeptic disorders (acid indigestion, belching, sickness). All swimmers also had disorders in bile-excreting system in a form of gall bladder dyskinesia with its hypertonia predominance. There were no features of chronic hepatitis.
There was a clear dependence between the level of athletes' qualification and the frequency of liver-pain syndrome: the higher the qualification is, the more intensive is the level of pain syndrome. It is explained by considerable training process intensification and the increase of competitive loads among athletes of high qualification. Negative influence of such kind of super-loads is evident, especially in terms of the focuses of chronic infections. All these factors (separately or combined) lead to dyskinetic disorders of digestive tract development, including bile-excreting system, and it is the main reasons for liver-pain syndrome appearance.
It should be noted that there existed a group of athletes (10,7%), who had evident disorders in liver blood circulation in a form of a steady arterial inflow and portal vein blood supply decrease, in terms of normal indices of central part of hemodynamics and also vascular brain zones and extremities. Dynamic research works in a yearly training cycle and also during several years proved irreversibility of circulatory disorders. Rheohepatograms analysis showed quantitative and qualitative changes of rheographic curve with its gross deformation and complete absence of a correct picture. The received results prove that among such athletes hemodynamic disorders appear because of morphological changes in liver tissues in a form of its parenchyma destruction. These athletes need thorough medical-diagnostic check-up at hospital in order to specify the character of liver injury and clinical diagnosis. On diagnosis depends correct treatment prescription.
Conclusion
According to the received results, an important factor in pathogenesis of chronic overtension of athletes' myocardium is circulatory injuries. It should be taken into consideration during medioprophylactic scheme of influence organization. As a result, it is reasonable to include into the recommended complex of therapy among the athletes with myocardosis hepatoprotectors, the preparations, which influence directly
vascular system together with generally adopted means of rehabilitation.
Intensive muscular activity causes direct bloodstream decrease through liver. It can become the reason for hepatic cells hypoxia. Damaged hepatic cells are more susceptible to hypoxia, than normal ones. Blood flow decrease in liver during the physical load can lead to severe necrotic tissues injury in liver, if there are some changes in liver parenchima. That is why it is important to control the state of liver at all stages of yearly cycle of training among athletes. Its early diagnostics is also necessary.
A complex change of blood circulation apparatus in case of different pathological states, typical of sports-medical practice, demands practical material accumulation and activity-based research. The main aim of all scientific-research works, held in this direction is the following: early diagnostics, timely and purposeful therapy and pathology in sport prevention.
References
1. Abzalov R.A., Vakhitov I.K., Safin R.S., Kabysh E.G. Cardiac stroke volume indices among boys, who go in for physical exercises of dynamic and static character. Teoriya I praktika fizicheskoy kultury = Theory and practice of physical culture. 2002; 2:13 (in Russ., in Engl.).
2. Demidov V.A., Gusakov, I.L., Mavliev F.A. Peculiarities of interparametric connections of cardio-hemodynamics among young men, who go in for sport. Pedagogiko-psikhologicheskie imediko-biologicheskie problem fizicheskoy kultury i sporta = Pedagogico-psychological and medico-biological problems of physical culture and sport. 2008; 4(9): 20-2(in Russ., in Engl.).
3. Dorofeikov V.V., Kuryanovich E.N. New laboratory technologies in estimating athletes' heart injuries and overloads. Aktualnye problem fizicheskoy I spetsialnoy podgotovki silovykh struktur. 2015; 3: 38-45 (in Russ.).
4. Ilukhin O.V. Speed of pulse wave propagation and elastic characteristics of magistral arteries: factors, influencing their mechanical features, opportunities of diagnostic estimation. Vestnik VolGMU. 2006; - 1: 3 (in Russ.).
5. Katushkin A.P. Modernized methodology of central hemodynamics indices calculation according to rheography. Anesteziologiya I reanimatologiya. 1987; 4: 28 (in Russ.).
6. Kedrov A.A. Rheography: essence, prospects, directions and mistakes of the research. Klinicheskaya meditsina.1989; 1: 13 (in Russ.).
7. Merkulov V.I. Pulse wave development in big blood vessels. Aktualnye problemy sovremennoy nauki. 2011; 5:132-140 (in Russ.).
8. Salapina E.V., Ryvkin A.I., Kuznetsova O.V., Kapruk N.L. Peripheral hemodynamics among children with arterial hypotension. Meditsinskiy almanakh. 2015; 2 (37): 86-88 (in Russ.).
9. Feroyan E.V. Athletes' blood circulation in terms of middle mountains. The Olimpiyskiy sport I sport dlya vsekh: materialy XXIIMezhdunarodno-nauchnoj konferencii [Olympic sport and sport for all: materials of the XXII International scientific congress]. Tbilisi, Georgia. 2018; 352-356.
10. Baskurt O.K. Hemorheology and vascular control mechanisms. 12th ECCH. Sofia. June 22-26,
2003; 15.
11. Crisafulli A., Carta C., Melis F. et al. Hemodynamic responses following intermittent supramaximal exercise in athletes. Exp. Physiol., 2004; 89(6): 665-74.
12. Huonker M., Schmid A., Scmidt-Trucksass et al. Size and blood flow of central and peripheral arteries in highly trained able-bodied and disabled athletes. J. Appl. Physiol. 2003; 95(2): 685-91.
Submitted: 12.11.2018 Author's information:
Eduard V. Feroyan - Candidate of Biologics, Associate Professor, Georgian State Teaching University of Physical Education and Sport, Georgia, Tbilisi, e-mail: e-mail: [email protected]
