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Pramanik J, Kumar A, Panchal L, Prajapati B. Countermeasures for Maintaining Cardiovascular Health in Space Missions. Curr Cardiol Rev 2023; 19:57-67. [PMID: 37005513 PMCID: PMC10518885 DOI: 10.2174/1573403x19666230330083225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/21/2023] [Accepted: 02/06/2023] [Indexed: 04/04/2023] Open
Abstract
During space exploration, the human body is subjected to altered atmospheric environments and gravity, exposure to radiation, sleep disturbance, and mental pressures; all these factors are responsible for cardiovascular diseases. Under microgravity, the physiological changes related to cardiovascular diseases are the cephalic fluid shift, dramatic reduction in central venous pressure, changes in blood rheology and endothelial function, cerebrovascular abnormalities, headaches, optic disc edema, intracranial hypertension, congestion of the jugular vein, facial swelling, and loss of taste. Generally, five countermeasures are used to maintain cardiovascular health (during and after space missions), including shielding, nutritional, medicinal, exercise, and artificial gravity. This article concludes with how to reduce space missions' impact on cardiovascular health with the help of various countermeasures.
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Affiliation(s)
- Jhilam Pramanik
- Department of Food Technology, ITM University, Gwalior, Madhya Pradesh, India
| | - Akash Kumar
- Department of Food Technology, SRM University, Sonipat, Haryana, India
| | - Lakshay Panchal
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar University, Mullana, Haryana, India
| | - Bhupendra Prajapati
- Shree S.K. Patel College of Pharmaceutical Education and Research, Ganpat University, India
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Jirak P, Mirna M, Rezar R, Motloch LJ, Lichtenauer M, Jordan J, Binneboessel S, Tank J, Limper U, Jung C. How spaceflight challenges human cardiovascular health. Eur J Prev Cardiol 2022; 29:1399-1411. [PMID: 35148376 DOI: 10.1093/eurjpc/zwac029] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/08/2022] [Accepted: 02/06/2022] [Indexed: 11/14/2022]
Abstract
The harsh environmental conditions in space, particularly weightlessness and radiation exposure, can negatively affect cardiovascular function and structure. In the future, preventive cardiology will be crucial in enabling safe space travel. Indeed, future space missions destined to the Moon and from there to Mars will create new challenges to cardiovascular health while limiting medical management. Moreover, commercial spaceflight evolves rapidly such that older persons with cardiovascular risk factors will be exposed to space conditions. This review provides an overview on studies conducted in space and in terrestrial models, particularly head-down bedrest studies. These studies showed that weightlessness elicits a fluid shift towards the head, which likely predisposes to the spaceflight-associated neuro-ocular syndrome, neck vein thrombosis, and orthostatic intolerance after return to Earth. Moreover, cardiovascular unloading produces cardiopulmonary deconditioning which may be associated with cardiac atrophy. In addition to limiting physical performance, the mechanism further worsens orthostatic tolerance after return to Earth. Finally, space conditions may directly affect vascular health, however, the clinical relevance of these findings in terms of morbidity and mortality is unknown. Targeted preventive measures, which are referred to as countermeasures in aerospace medicine, and technologies to identify vascular risks early on will be required to maintain cardiovascular performance and health during future space missions.
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Affiliation(s)
- Peter Jirak
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Moritz Mirna
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Richard Rezar
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Lukas J Motloch
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Michael Lichtenauer
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany.,Medical Faculty, University of Cologne, Germany
| | - Stephan Binneboessel
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Germany
| | - Jens Tank
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Ulrich Limper
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany.,Department of Anaesthesiology and Critical Care Medicine, Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Germany
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Merkulov YA, Pyatkov AA, Gorokhova SG, Merkulova DM, Atkov OY. [Disturbances of Autonomic Regulation of Cardiovascular System at Different Working Regimes with Night Shifts]. ACTA ACUST UNITED AC 2020; 60:62-67. [PMID: 33131476 DOI: 10.18087/cardio.2020.9.n1134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/29/2020] [Indexed: 11/18/2022]
Abstract
Aim To study temporal and spectral characteristics of heart rhythm variability (HRV) in night shift workers.Materials and methods Along with traditional risk factors, conditions of labor contribute to development of cardiovascular morbidity, including night shift work, which can be associated with disorders of the autonomic regulation detected by analysis of HRV. This study included 100 healthy men. 74 of them were engaged in shift work, including 53 men with rotating shift work, 21 men with fixed night shifts, and 26 men with day-time work. HRV was analyzed by data of 5-min electrocardiogram recording (background recording and orthostatic test).Results Night-shift workers had decreases in total power of regulation (ТР, SDNN) and in the parasympathetic branch (HF, pNN50). Rotating night-shift workers displayed significant decreases in SDNN and pNN50 and pronounced changes in the VLF / LF / HF ratio in the orthostatic test.Conclusion In work with night shifts, the type of autonomic regulation differs from the "standard" functioning of the autonomic nervous system (ANS). This study showed different effects of night work regimens on HRV indexes. With the rotating shift work, the ANS dysregulation was more profound and was evident by a significant decrease in the ANS total tone and parasympathetic activity (SDNN, pNN50) compared to night shifts with fixed working hours. The excessive weakening of the parasympathetic component in the passive orthostatic test can be considered as an early marker for ANS maladaptation.
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Affiliation(s)
- Yu A Merkulov
- Moscow Centre for Medical Rehabilitation, Restorative and Sports Medicine, Moscow
| | - A A Pyatkov
- Moscow Centre for Medical Rehabilitation, Restorative and Sports Medicine, Moscow
| | - S G Gorokhova
- Russian Medical Academy of Postgraduate Education, Moscow
| | - D M Merkulova
- B.M. Guekht Neurology center, «CCH «RZD-Medicine», Moscow
| | - O Yu Atkov
- Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia
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Pavlakou P, Dounousi E, Roumeliotis S, Eleftheriadis T, Liakopoulos V. Oxidative Stress and the Kidney in the Space Environment. Int J Mol Sci 2018; 19:ijms19103176. [PMID: 30326648 PMCID: PMC6214023 DOI: 10.3390/ijms19103176] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/08/2018] [Accepted: 10/12/2018] [Indexed: 12/12/2022] Open
Abstract
In space, the special conditions of hypogravity and exposure to cosmic radiation have substantial differences compared to terrestrial circumstances, and a multidimensional impact on the human body and human organ functions. Cosmic radiation provokes cellular and gene damage, and the generation of reactive oxygen species (ROS), leading to a dysregulation in the oxidants–antioxidants balance, and to the inflammatory response. Other practical factors contributing to these dysregulations in space environment include increased bone resorption, impaired anabolic response, and even difficulties in detecting oxidative stress in blood and urine samples. Enhanced oxidative stress affects mitochondrial and endothelial functions, contributes to reduced natriuresis and the development of hypertension, and may play an additive role in the formation of kidney stones. Finally, the composition of urine protein excretion is significantly altered, depicting possible tubular dysfunction.
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Affiliation(s)
- Paraskevi Pavlakou
- Department of Nephrology, Medical School, University of Ioannina, 45110 Ioannina, Greece.
| | - Evangelia Dounousi
- Department of Nephrology, Medical School, University of Ioannina, 45110 Ioannina, Greece.
| | - Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
| | - Theodoros Eleftheriadis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
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Eckberg DL, Diedrich A, Cooke WH, Biaggioni I, Buckey JC, Pawelczyk JA, Ertl AC, Cox JF, Kuusela TA, Tahvanainen KUO, Mano T, Iwase S, Baisch FJ, Levine BD, Adams-Huet B, Robertson D, Blomqvist CG. Respiratory modulation of human autonomic function: long-term neuroplasticity in space. J Physiol 2016; 594:5629-46. [PMID: 27029027 DOI: 10.1113/jp271656] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 03/14/2016] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS We studied healthy astronauts before, during and after the Neurolab Space Shuttle mission with controlled breathing and apnoea, to identify autonomic changes that might contribute to postflight orthostatic intolerance. Measurements included the electrocardiogram, finger photoplethysmographic arterial pressure, respiratory carbon dioxide levels, tidal volume and peroneal nerve muscle sympathetic activity. Arterial pressure fell and then rose in space, and drifted back to preflight levels after return to Earth. Vagal metrics changed in opposite directions: vagal baroreflex gain and two indices of vagal fluctuations rose and then fell in space, and descended to preflight levels upon return to Earth. Sympathetic burst frequencies (but not areas) were greater than preflight in space and on landing day, and astronauts' abilities to modulate both burst areas and frequencies during apnoea were sharply diminished. Spaceflight triggers long-term neuroplastic changes reflected by reciptocal sympathetic and vagal motoneurone responsiveness to breathing changes. ABSTRACT We studied six healthy astronauts five times, on Earth, in space on the first and 12th or 13th day of the 16 day Neurolab Space Shuttle mission, on landing day, and 5-6 days later. Astronauts followed a fixed protocol comprising controlled and random frequency breathing and apnoea, conceived to perturb their autonomic function and identify changes, if any, provoked by microgravity exposure. We recorded the electrocardiogram, finger photoplethysmographic arterial pressure, tidal carbon dioxide concentrations and volumes, and peroneal nerve muscle sympathetic activity on Earth (in the supine position) and in space. (Sympathetic nerve recordings were made during three sessions: preflight, late mission and landing day.) Arterial pressure changed systematically from preflight levels: pressure fell during early microgravity exposure, rose as microgravity exposure continued, and drifted back to preflight levels after return to Earth. Vagal metrics changed in opposite directions: vagal baroreflex gain and two indices of vagal fluctuations (root mean square of successive normal R-R intervals; and proportion of successive normal R-R intervals greater than 50 ms, divided by the total number of normal R-R intervals) rose significantly during early microgravity exposure, fell as microgravity exposure continued, and descended to preflight levels upon return to Earth. Sympathetic mechanisms also changed. Burst frequencies (but not areas) during fixed frequency breathing were greater than preflight in space and on landing day, but their control during apnoea was sharply altered: astronauts increased their burst frequencies from already high levels, but they could not modulate either burst areas or frequencies appropriately. Space travel provokes long-lasting sympathetic and vagal neuroplastic changes in healthy humans.
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Affiliation(s)
- Dwain L Eckberg
- Departments of Medicine and Physiology, Hunter Holmes McGuire Department of Veterans Affairs Medical Center, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
| | - André Diedrich
- Department of Medicine, Division of Clinical Pharmacology, Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - William H Cooke
- Department of Kinesiology, Health, and Nutrition, University of Texas at San Antonio, San Antonio, TX, USA
| | - Italo Biaggioni
- Department of Medicine, Division of Clinical Pharmacology, Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Jay C Buckey
- Dartmouth Hitchcock Medical Centre, Lebanon, NH, USA
| | - James A Pawelczyk
- Department of Physiology, Pennsylvania State University, University Park and Hershey, PA, USA
| | - Andrew C Ertl
- Department of Medicine, Division of Clinical Pharmacology, Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - James F Cox
- Departments of Medicine and Physiology, Hunter Holmes McGuire Department of Veterans Affairs Medical Center, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Tom A Kuusela
- Department of Physics, Turku University, Turku, Finland
| | - Kari U O Tahvanainen
- Department of Clinical Physiology and Nuclear Medicine, South Karelia Central Hospital, Lappeenranta, Finland
| | - Tadaaki Mano
- Gifu University of Medical Science, 795-1 Nagamine Ichihiraga, Seki, Gifu, 501-3892, Japan
| | - Satoshi Iwase
- Department of Physiology, Aichi Medical University, Aichi, Japan
| | | | - Benjamin D Levine
- Department of Medicine, University of Texas Southwestern Medical Centre at Dallas, Dallas, TX, USA.,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian, Hospital, Dallas, TX, USA
| | | | - David Robertson
- Department of Medicine, Division of Clinical Pharmacology, Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - C Gunnar Blomqvist
- Department of Medicine, University of Texas Southwestern Medical Centre at Dallas, Dallas, TX, USA
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Xu D, Shoemaker JK, Blaber AP, Arbeille P, Fraser K, Hughson RL. Reduced heart rate variability during sleep in long-duration spaceflight. Am J Physiol Regul Integr Comp Physiol 2013; 305:R164-70. [PMID: 23637139 DOI: 10.1152/ajpregu.00423.2012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Limited data are available to describe the regulation of heart rate (HR) during sleep in spaceflight. Sleep provides a stable supine baseline during preflight Earth recordings for comparison of heart rate variability (HRV) over a wide range of frequencies using both linear, complexity, and fractal indicators. The current study investigated the effect of long-duration spaceflight on HR and HRV during sleep in seven astronauts aboard the International Space Station up to 6 mo. Measurements included electrocardiographic waveforms from Holter monitors and simultaneous movement records from accelerometers before, during, and after the flights. HR was unchanged inflight and elevated postflight [59.6 ± 8.9 beats per minute (bpm) compared with preflight 53.3 ± 7.3 bpm; P < 0.01]. Compared with preflight data, HRV indicators from both time domain and power spectral analysis methods were diminished inflight from ultralow to high frequencies and partially recovered to preflight levels after landing. During inflight and at postflight, complexity and fractal properties of HR were not different from preflight properties. Slow fluctuations (<0.04 Hz) in HR presented moderate correlations with movements during sleep, partially accounting for the reduction in HRV. In summary, substantial reduction in HRV was observed with linear, but not with complexity and fractal, methods of analysis. These results suggest that periodic elements that influence regulation of HR through reflex mechanisms are altered during sleep in spaceflight but that underlying system complexity and fractal dynamics were not altered.
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Affiliation(s)
- D Xu
- Schlegel-University of Waterloo Research Institute for Aging, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Zhang LF. Region-specific vascular remodeling and its prevention by artificial gravity in weightless environment. Eur J Appl Physiol 2013; 113:2873-95. [DOI: 10.1007/s00421-013-2597-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 01/20/2013] [Indexed: 10/27/2022]
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Rowe WJ. Potential renovascular hypertension, space missions, and the role of magnesium. Int J Nephrol Renovasc Dis 2009; 2:51-7. [PMID: 21694921 PMCID: PMC3108762 DOI: 10.2147/ijnrd.s8249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Indexed: 11/23/2022] Open
Abstract
Space flight (SF) and dust inhalation in habitats cause hypertension whereas in SF (alone) there is no consistent hypertension but reduced diurnal blood pressure (BP) variation instead. Current pharmaceutical subcutaneous delivery systems are inadequate and there is impairment in the absorption, metabolism, excretion, and deterioration of some pharmaceuticals. Data obtained from the National Aeronautics and Space Administration through the Freedom of Information Act shows that Irwin returned from his 12-day Apollo 15 mission in 1971 and was administered a bicycle stress test. With just three minutes of exercise, his BP was >275/125 mm Hg (heart rate of only 130 beats per minute). There was no acute renal insult. Irwin’s apparent spontaneous remission is suggested to be related to the increase of a protective vasodilator, and his atrial natriuretic peptide (ANP) reduced with SF because of reduced plasma volume. With invariable malabsorption and loss of bone/muscle storage sites, there are significant (P < 0.0001) reductions of magnesium (Mg) required for ANP synthesis and release. Reductions of Mg and ANP can trigger pronounced angiotensin (200%), endothelin, and catecholamine elevations (clearly shown in recent years) and vicious cycles between the latter and Mg deficits. There is proteinuria, elevated creatinine, and reduced renal concentrating ability with the potential for progressive inflammatory and oxidative stress-induced renal disease and hypertension with vicious cycles. After SF, animals show myocardial endothelial injuries and increased vascular resistance of extremities in humans. Even without dust, hypertension might eventually develop from renovascular hypertension during very long missions. Without sufficient endothelial protection from pharmaceuticals, a comprehensive gene research program should begin now.
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Affiliation(s)
- William J Rowe
- Former Assistant Clinical Professor of Medicine, Medical University of Ohio at Toledo, Keswick, VA, USA
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Moffitt JA, Grippo AJ, Beltz TG, Johnson AK. Hindlimb unloading elicits anhedonia and sympathovagal imbalance. J Appl Physiol (1985) 2008; 105:1049-59. [PMID: 18635876 DOI: 10.1152/japplphysiol.90535.2008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The hindlimb-unloaded (HU) rat model elicits cardiovascular deconditioning and simulates the physiological adaptations to microgravity or prolonged bed rest in humans. Although psychological deficits have been documented following bed rest and spaceflight in humans, few studies have explored the psychological effects of cardiovascular deconditioning in animal models. Given the bidirectional link established between cardiac autonomic imbalance and psychological depression in both humans and in animal models, we hypothesized that hindlimb unloading would elicit an alteration in sympathovagal tone and behavioral indexes of psychological depression. Male, Sprague-Dawley rats confined to 14 days of HU displayed anhedonia (a core feature of human depression) compared with casted control (CC) animals evidenced by reduced sucrose preference (CC: 81 +/- 2.9% baseline vs. HU: 58 +/- 4.5% baseline) and reduced (rightward shift) operant responding for rewarding electrical brain stimulation (CC: 4.4 +/- 0.3 muA vs. 7.3 +/- 1.0 muA). Cardiac autonomic blockade revealed elevated sympathetic [CC: -54 +/- 14.1 change in (Delta) beats/min vs. HU: -118 +/- 7.6 Delta beats/min] and reduced parasympathetic (CC: 45 +/- 11.8 Delta beats/min vs. HU: 8 +/- 7.3 Delta beats/min) cardiac tone in HU rats. Heart rate variability was reduced (CC: 10 +/- 1.4 ms vs. HU: 7 +/- 0.7 ms), and spectral analysis of blood pressure indicated loss of total, low-, and high-frequency power, consistent with attenuated baroreflex function. These data indicate that cardiovascular deconditioning results in sympathovagal imbalance and behavioral signs consistent with psychological depression. These findings further elucidate the pathophysiological link between cardiovascular diseases and affective disorders.
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Affiliation(s)
- Julia A Moffitt
- Department of Psychology, The University of Iowa, Iowa City, IA 52242-1407, USA.
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