OVERVIEW
Hyperdynamic circulation, also known as hyperdynamic circulatory state, is defined as a cardiac index of more than 4 L/(min-m2) [normal 2.2 to 3.9 L/(min-m2)] in the resting state of an adult, where the increase in cardiac output is produced by either an increase in heart rate or an increase in cardiac output (or both), and the causes include physiologic and pathologic. The syndrome can occur at all ages, with an age distribution of 7 to 80 years, 80% between 20 and 40 years, and more females than males, 3:1 to 6:1.
Causes of disease
The causes of the disease include physiologic and pathologic categories.
1. Physiological
Physical activity, emotional excitement, heavy eating, pregnancy, fever, hot and humid environment.
2. Pathologic
Severe anemia, hyperthyroidism, vitamin B1 deficiency due to pedal heart disease, arteriovenous fistula, carcinoid syndrome, cirrhosis of the liver, a few pulmonary heart disease, and certain bone diseases, such as metaplastic osteitis, multiple bone fibrous heteroproliferative disease, and so on.
3. Others
Some of the hyperdynamic circulation of unknown cause, i.e. primary hyperdynamic circulation.
Symptoms
There are obvious mental factors before the disease, such as overwork, high tension, mental trauma, etc. There are also some medical sources, and a few have no causative factors. Symptoms are varied, mainly manifest cardiovascular and psychoneurological symptoms, with chest tightness, palpitation, dizziness, fatigue, precordial pain is most common, chest pain lasts for a long time, mostly tingling, followed by low-grade fever, hyperhidrosis, insomnia, numbness of the limbs, self-consciousness of shortness of breath, not enough gas, sighing after the comfort, a few have a transient fainting spells, and a sense of pharyngeal obstruction. It is aggravated when standing, nervous excitement, relieved by lying down, nausea, vomiting, mild shortness of breath after exertion, but work is generally unaffected, and there will be telangiectasia in case of heart failure.
Examination
Half of the patients have high basal metabolic rate and reduced glucose tolerance.
1. Electrocardiogram
There may be high voltage and even ST-T changes.
2. X-ray
X-ray shows strong heart beat and normal heart shadow. If the disease is of long duration, the heart shadow will be enlarged, and the vascular texture of the lung field may be increased.
3. Cardiac function tests
Cardiac index (CI) and ejection fraction (EF) are often increased.
Diagnosis
1. Most common in young and middle-aged men, mostly asymptomatic, a few have palpitation, exertional shortness of breath, fatigue.
2. Physical examination shows strong and rapid apical beats, increased systolic blood pressure, and increased differential pulse pressure.
3. Except other causes of hyperdynamic circulatory state.
Treatment
The pathogenesis of this disease may be related to myocardial adrenergic receptor hyperfunction, so the treatment is preferred to β-blocking drugs, according to the condition of the adjustment of drug dosage, such as propranolol, metoprolol, both 3 times / day. Cardiac output can be completely normalized during the medication period. Individual heart failure due to hyperdynamic circulation can still be routinely treated with cardiotonic, diuretic, vasodilator and other drugs, but because of the poor response to digitalis, the dosage should be individualized and the adverse effects should be closely observed. Primary hyperdynamic circulation can be treated with β-blockers first, and the dosage can be gradually increased depending on the condition. Application of sympathetic nerve terminal inhibitors is also effective. In addition, sedatives should be given as appropriate. Heart failure due to hyperdynamic circulation can still be used although it responds poorly to digitalis, and other drugs such as diuretics, vasodilators, angiotensin-converting enzyme inhibitors, and angiotensin II receptor AT1 antagonists are still effective. As for hyperdynamic circulation with a clear etiology, such as hyperthyroidism, vitamin B1 deficiency, anemia, etc., the treatment should be directed to the etiology.
Prognosis
The hyperdynamic circulatory state is due to the excessive release of catecholamines in the patient’s body, therefore, the cardiac output is increased and the burden on the heart is increased. Especially if combined with acute myocardial infarction and other diseases, it can increase the rate of death. Therefore, it should be actively treated.