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The Relation Between Venous Reserve Capacity and Low Plasma Volume

Departments of Obstetrics and Gynecology, Radboud University of Nijmegen Medical Centre, i.krabbendam{at}obgyn.umcn.nl

Ben J. Janssen, PhD

Department of Pharmacology and Toxicology, University of Maastricht, Maastricht, the Netherlands

Arie P. J. Van Dijk, MD, PhD

Department of Cardiology, Radboud University of Nijmegen Medical Centre

Henk W. Jongsma, PhD

Departments of Obstetrics and Gynecology, Radboud University of Nijmegen Medical Centre

Wim J. G. Oyen, MD, PhD

Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands

Fred K. Lotgering, MD, PhD

Departments of Obstetrics and Gynecology, Radboud University of Nijmegen Medical Centre

Marc E. A. Spaanderman, MD, PhD

Departments of Obstetrics and Gynecology, Radboud University of Nijmegen Medical Centre

Objective: Prepregnant low plasma volume (LPV) is associated with subsequent gestational hypertensive disease. It is unknown to what extent an LPV affects the venous reserve capacity (VRC). We tested the hypothesis that LPV reduces the VRC, as indicated by presyncope or altered cardiovascular changes in response to head-up tilt. Study design: In 52 nonpregnant women with a history of preeclampsia or recurrent miscarriage, the authors assessed plasma volume, stroke volume, and cardiac output and determined blood pressure, heart rate, and autonomic responses to stepwise inflicted head-up tilt. Results: 12 participants had LPV, which related to presyncope when compared with subjects with normal plasma volume (NPV). Women with LPV without presyncope demonstrated a circulatory response comparable to NPV women at the expense of consistently higher heart rate. Conclusion: LPV decreases the capacity to cope with head-up tilt without affecting the response pattern, suggesting reduced VRC.

Key Words: Plasma volume • orthostatic stress • presyncope.

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