VAGAL SLOWING OF THE HEART DURING HEMORRHAGE - OBSERVATIONS FROM 20 CONSECUTIVE HYPOTENSIVE PATIENTS

Heart rate and arterial blood pressure were monitored in 20 consecutive patients during resuscitation from haemorrhagic shock. The mean blood loss (2.3 (SEM 0.3) l) correspond to 36(4%) of their estimated mean blood volume. During shock the mean blood pressure was 81/55 (3/2) mm Hg and heart rate 73 (3) beats/min. Administraton of blood and crystalloids resulted in immediate increases to 111/72 (2/2) mm Hg and 102 (3) beats/min followed by steady state values of 131/79 (6/3) mm Hg and 82 (2) beats/min. In three otherwise healthy patients plasma concentrations of the vagally regulated hormone pancreatic polypeptide rose from resting values of 64-77 pmol/l (272-327 pg/ml) to 198-280 pmol/l (842-1190 pg/ml). These findings suggest that reversible hypotensive hypovolaemic shock is characterised by a decrease in heart rate conceivably reflecting an increase in vagal tone.