ON THE OCCURRENCE OF DYSPNEA, DIZZINESS AND PRECORDIAL DISTRESS OCCASIONED BY THE POOLING OF BLOOD IN VARICOSE VEINS

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Abstract
Because certain persons with large varicose veins suffer fatigue, dyspnea, dizziness and precordial distress, the role of pooling of blood in varicose veins in leading to a decrease in the efficiency of cardiac and circulatory function was investigated. The results in 7 normal, untrained subjects were compared with those in 12 varicose patients. From 3-17 mos. after saphenous liga-tion and inj. (to alleviate the varicosities) the studies were repeated on 7 of 12 subjects. The basal metabolic rate, vital capacity, pulse rate and blood pressure were measured in the recumbent position on a tilt table. An estimation of the A-V O2 difference was also made by the acetylene method. The subject was then tilted passively to a 45[degree] angle (with head up) and the observations repeated. In most subjects ECG''s were taken in both positions. Blood val. dets. were done in the recumbent position. In patients with large bilateral varicose veins the cardiac index and stroke vol. are higher than normal when recumbent. This may be due to a greater load in the circulation as the blood vol. in these is definitely elevated. On tilting, the cardiac output fell about 4 times as much as in normals. The avg. acceleration of pulse rate on tilting was twice normal. After removal of the venous reservoir, the varicosities, the cardiac indices and acceleration of pulse rate returned toward normal, the blood pressures were lower and the patients experienced relief of symptoms.