Advertisement

Long- and short-term exposure to microgravity significantly alters the cardiovascular system [1-9]. In this chapter, we describe the cardiovascular changes and the strategies used to manage problems in operational space medicine that arise as a consequence of those changes. Most descriptions of the effects of microgravity on the cardiovascular system have focused mainly on the physiological mechanisms that contribute to cardiovascular changes. Flight surgeons need to understand these important physiological effects on the human cardiovascular system so that they can place them within the operational context of a space mission. Crewmembers may also have subclinical cardiac abnormalities that could be exacerbated by the adaptive responses of the cardiovascular system to microgravity.

To help readers of this text understand the cardiovascular issues facing space medicine flight surgeons, this chapter uses an operational approach and considers issues that arise during each phase of a space mission, beginning with crew selection and proceeding through launch, on-orbit activities, atmospheric reentry, and postflight recovery. Both the U.S. and the Russian space programs have implemented extensive research programs to understand the alterations in cardiovascular physiology that are induced by exposure to microgravity, changes that may eventually manifest themselves in the form of impaired cardiovascular performance such as postflight orthostatic intolerance, decreased exercise capacity, or on-orbit cardiac arrhythmias [8–10]. The current literature has devoted little attention to the various clinical complications and operational problems that can arise from the deleterious effects of microgravity on the cardiovascular system [11]. The focus here is on two of the primary goals of operational space medicine: (1) to prevent the occurrence of cardiovascular illness or impaired performance in space flight and (2) to rehabilitate or treat impaired cardiovascular function in a manner that minimizes the effect on the mission while maximizing crew health and performance.

Keywords

Coronary Artery Calcium Pulmonary Capillary Wedge Pressure Space Flight Space Shuttle Lower Body Negative Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Hoffler GW, Johnson RL, Nicogossian AE, et al. Vectorcardio-graphic results from Skylab medical experiment M092: Lower body negative pressure. In: Johnston RS, Dietlein LF (eds.), Biomedical Results from Skylab. Washington, DC: US Government Printing Office; 1977:313-323. NASA SP-377.Google Scholar
  2. 2.
    Grigoriev AI, Bugrov SA, Bogomolov VV, et al. Medical results of the Mir year-long mission. Physiologist 1991; 34: S44-S48.PubMedGoogle Scholar
  3. 3.
    Nicogossian AE, Huntoon CL, Pool SL. (eds.), Space Phys-iology and Medicine. 3rd edn. Philadelphia, PA: Lea & Febiger; 1994.Google Scholar
  4. 4.
    Egorov AD, Alferova IV, Poliakova AP. Condition of cardiody-namics during prolonged exposure to weightlessness. Kosm Biol Aviakosm Med 1988; 22:19-26.PubMedGoogle Scholar
  5. 5.
    Link M. Space Medicine in Project Mercury. Washington, DC: US Government Printing Office; 1965. NASA SP-4003.Google Scholar
  6. 6.
    Johnston RS, Dietlein LF, Berry CA. (eds.), Biomedical Results of Apollo. Washington, DC: US Government Printing Office; 1975. NASA SP-386.Google Scholar
  7. 7.
    Sawin CF, Taylor GR, Smith WL. (eds.), Extended Duration Orbiter Medical Project. Final Report 1989-1995. Houston, TX: NASA-Johnson Space Center; 1999. NASA SP-1999-534.Google Scholar
  8. 8.
    Nicogossian AE, Charles JB, Bungo MW, et al. Cardiovascular function in space flight. Acta Astronaut 1991; 24:323-328.PubMedGoogle Scholar
  9. 9.
    Leach Huntoon CS, Antipov VV, Grigoriev AI. (eds.), Humans in Spaceflight. Vol. 3. Reston, VA: American Institute of Aero-nautics and Astronautics; 1996. Nicogossian AE, Mohler SR, Gazenko OG, Grigoriev AI (series eds.), Space Biology and Medicine.Google Scholar
  10. 10.
    Grigoriev AI, Egorov AD. Mechanisms of homeostasis forma-tion during prolonged exposure to weightlessness. Aviakosm Ekolog Med 1998; 32:20-26.Google Scholar
  11. 11.
    McGinnis PJ, Harris BA. The re-emergence of space medicine as a discipline. Aviat Space Environ Med 1998; 69:1107-1111.PubMedGoogle Scholar
  12. 12.
    Grigoriev AI, Bugrov SA, Bogomolov VV, et al. Main medical results of extended flights on space station Mir in 1986-1990. Acta Astronaut 1993; 29:581-585.PubMedGoogle Scholar
  13. 13.
    Booze CF, Staggs CM. A comparison of postmortem coronary atherosclerosis findings in general aviation pilot fatalities. Aviat Space Environ Med 1987; 58:297-300.PubMedGoogle Scholar
  14. 14.
    Tunstall-Pedoe H. Cardiovascular risk and risk factors in the context of aircrew certification. Eur Heart J 1992; 13(Suppl. H):16-20. 16. Cardiovascular DisordersGoogle Scholar
  15. 15.
    Oswald S, Miles R, Nixon W, et al. Review of cardiac events in USAF aviators. Aviat Space Environ Med 1996; 67:1023-1027.Google Scholar
  16. 16.
    Marenco JP, Wang PJ, Link MS, et al. Improving survival from sudden cardiac arrest: The role of the automated external defi-brillator. JAMA 2001; 285:1193-1200.PubMedGoogle Scholar
  17. 17.
    Zipes DP, Wellens HJ. Sudden cardiac death. Circulation 1998; 98:2334-3251.PubMedGoogle Scholar
  18. 18.
    Gillium RF. Sudden cardiac death in the United States 1980-1985. Circulation 1989; 79:756-765.Google Scholar
  19. 19.
    Adams MR, Celermajer DS. Detection of presymptomatic athero-sclerosis: A current perspective. Clin Sci (Lond). 1999; 97:615-624.Google Scholar
  20. 20.
    O’Rourke RA, Brundage BH, Froelicher VF, et al. American College of Cardiology/American Heart Association Expert Con-sensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. Circula-tion 2000; 102:126-154.Google Scholar
  21. 21.
    Marz W. Electron-beam computed tomography of the heart: What do we see and what is concealed? Eur J Clin Invest 2001; 31:469-470.PubMedGoogle Scholar
  22. 22.
    Janowitz WR. CT imaging of coronary artery calcium as an indi-cator of atherosclerotic disease: An overview. J Thorac Imaging 2001; 16:2-7.PubMedGoogle Scholar
  23. 23.
    Cybulsky MI, Gimbrone MA Jr. Endothelial expression of a mononuclear leukocyte adhesion molecule during atherogenesis. Science 1991; 251(4995):788-791.PubMedGoogle Scholar
  24. 24.
    Bonetti PO, Lerman LO, Lerman A. Endothelial dysfunction: A marker of atherosclerotic risk. Arterioscler Thromb Vasc Biol 2003; 23(2):168-175.PubMedGoogle Scholar
  25. 25.
    Ross R. The pathogenesis of atherosclerosis: A perspective for the 1990s. Nature 1993; 362(6423):801-809.PubMedGoogle Scholar
  26. 26.
    Ross R. Atherosclerosis—an inflammatory disease. N Engl J Med 1999; 340(2):115-126.PubMedGoogle Scholar
  27. 27.
    Falk E, Shah PK, Fuster V. Coronary plaque disruption. Circula-tion 1995; 92:657-671.Google Scholar
  28. 28.
    Wexler L, Brundage B, Crouse J, et al. Coronary artery calci-fication: Pathophysiology, epidemiology, imaging methods, and clinical implications. A statement for health professionals from the American Heart Association. Writing Group. Circulation 1996; 94:1175-1192.PubMedGoogle Scholar
  29. 29.
    Rumberger JA, Simons DB, Fitzpatrick LA, et al. Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correla-tive study. Circulation 1995; 92:2157-2162.PubMedGoogle Scholar
  30. 30.
    Falk E, Shah PK, Fuster V. Coronary plaque disruption. Circula-tion 1995; 92:657-671.Google Scholar
  31. 31.
    Wexler L, Brundage B, et al. Coronary artery calcification: Pathophysiology, epidemiology, imaging methods, and clinical implications. Circulation 1996; 94:1175-1192.PubMedGoogle Scholar
  32. 32.
    Ridker PM. Clinical application of C-reactive protein for car-diovascular disease detection and prevention. Circulation 2003; 107 (3):363-369.PubMedGoogle Scholar
  33. 33.
    Ridker PM. Connecting the role of C-reactive protein and statins in cardiovascular disease. Clin Cardiol 2003; 26(4 Suppl. 3): III39-III44.PubMedGoogle Scholar
  34. 34.
    Ridker PM. High-sensitivity C-reactive protein and cardiovascu-lar risk: Rationale for screening and primary prevention. Am J Cardiol 2003; 92(4B):17K-22K.PubMedGoogle Scholar
  35. 35.
    Ridker PM, Bassuk SS, Toth PP. C-reactive protein and risk of cardiovascular disease: Evidence and clinical application. Curr Atheroscler Rep 2003; 5(5):341-349.PubMedGoogle Scholar
  36. 36.
    Ridker PM, Rifai N, et al. Measurement of C-reactive protein for the targeting of statin therapy in the primary prevention of acute coronary events. N Engl J Med 2001; 344(26):1959-1965.PubMedGoogle Scholar
  37. 37.
    Ridker PM, Rifai N, et al. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the pre-diction of first cardiovascular events. N Engl J Med 2002; 347 (20):1557-1565.PubMedGoogle Scholar
  38. 38.
    Doyle JT, Kannel WB, McNamara PM, et al. Factors related to sudden cardiac death from coronary artery disease: Combined Albany-Framingham study. Am J Cardiol 1976; 37:1073-1078.PubMedGoogle Scholar
  39. 39.
    Shaw LJ, O’Rourke RA. The challenge of improving risk assess-ment in asymptomatic individuals: The additive prognostic value of electron beam tomography? J Am Coll Cardiol 2000; 36:1261-1264.PubMedGoogle Scholar
  40. 40.
    Lavallee PJ, Fonseca VP. Survey of USAF flight surgeons regard-ing clinical preventive services, using CHD as an indicator. Aviat Space Environ Med 1999; 70:1029-1037.PubMedGoogle Scholar
  41. 41.
    Proudfit WL, Bruschke VG, Sones FM Jr. Clinical course of patients with normal or slightly or moderately abnormal coro-nary arteriograms: 10 year follow-up of 521 patients. Circulation 1980; 62:712-717.PubMedGoogle Scholar
  42. 42.
    Radice M, Giudici V, Marinelli G. Long-term follow-up in patients with positive exercise test and angiographically nor-mal coronary arteries (syndrome X). Am J Cardiol 1995; 75: 620-621.PubMedGoogle Scholar
  43. 43.
    Lichtlen PR, Bargheer K, Wenzlaff P. Long-term prognosis of patients with anginalike chest pain and normal angiographic findings. J Am Coll Cardiol 1995; 25:1013-1018.PubMedGoogle Scholar
  44. 44.
    US Secretary of the Airforce. Medical Examination and Stan-dards. Nov. 15, 1994. Air Force Instruction 48-123.Google Scholar
  45. 45.
    Stamler J, Stamler R, Neaton JD, et al. Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy. JAMA 1999; 282:2012-2018.PubMedGoogle Scholar
  46. 46.
    Chamberlain D. Second European Workshop in Aviation Car-diology. Attributable and absolute (polymorphic) risk in avia-tion certification: Developing the 1% rule. Eur Heart J 1999; 1: D19-D24.Google Scholar
  47. 47.
    Tunstall-Pedoe H. Risk of a coronary heart attack in the normal population and how it might be modified in flyers. Eur Heart J 1984; 5:43-50.PubMedGoogle Scholar
  48. 48.
    Frost L, Engholm G, Johnsen S, et al. Incident stroke after dis-charge from hospital with a diagnosis of atrial fibrillation. Am J Med 2000; 108:36-40.PubMedGoogle Scholar
  49. 49.
    Bennet G. Pilot incapacitation and aircraft accidents. Eur Heart J 1988; 9:21-24.Google Scholar
  50. 50.
    Chaplin JC. In perspective: The safety of aircraft, pilots and their hearts. Eur Heart J 1988; 9(Suppl. G):17-20.PubMedGoogle Scholar
  51. 51.
    Bennett G. Medical-cause accidents in commercial aviation. Eur Heart J 1992; 13:13-15.PubMedGoogle Scholar
  52. 52.
    Tunstall-Pedoe H. Acceptable cardiovascular risk in aircrew. The concept of risk. Eur Heart J 1988; 9(Suppl. G):13-15.PubMedGoogle Scholar
  53. 53.
    NASA, Space and Life Sciences Directorate. Astronaut Medical Evaluation Requirements Document. Houston, TX: Lyndon B. Johnson Space Center; 1998. JSC-24834 Rev A.Google Scholar
  54. 54.
    Smalley BW, Loecker TH, Collins TR, et al. Positive predictive value of cardiac fluoroscopy in asymptomatic U.S. Army avia-tors. Aviat Space Environ Med 2000; 71:1197-1201.PubMedGoogle Scholar
  55. 55.
    McCall NJ, Wick RL, Brawley WL, et al. A survey of blood lipid levels in airline pilot applicants. Aviat Space Environ Med 1992; 63:533-537.PubMedGoogle Scholar
  56. 56.
    Whitton RC. Medical disqualification in USAF pilots and navi-gators. Aviat Space Environ Med 1984; 55:332-336.PubMedGoogle Scholar
  57. 57.
    Van Leudsen AJ, Prendergast PR, Gray GW. Permanent ground-ing and flying restrictions in Canadian forces pilots: A ten year review. Aviat Space Environ Med 1991; 62:513-516.Google Scholar
  58. 58.
    Enos WF, Holmes RH, Beyer J. Coronary artery disease among United States soldiers killed in action in Korea. JAMA 1953; 152:1090-1093.Google Scholar
  59. 59.
    McNamara JJ, Molot MA, Stremple JF, et al. Coronary artery disease in combat casualties in Vietnam. JAMA 1972; 216:1185-1187.Google Scholar
  60. 60.
    Pettyjohn FS, McMeekin RR. Coronary artery disease and pre-ventive cardiology in aviation medicine. Aviat Space Environ Med 1975; 46(10):1299-1304.PubMedGoogle Scholar
  61. 61.
    Underwood-Ground KE. Prevalence of coronary atherosclerosis in healthy United Kingdom aviators. Aviat Space Environ Med 1981; 52:696-701.PubMedGoogle Scholar
  62. 62.
    Taneja N, Wiegmann DA. Prevalence of cardiovascular abnor-malities in pilots involved in fatal general aviation airplane acci-dents. Aviat Space Environ Med 2002; 73(10):1025-1030.PubMedGoogle Scholar
  63. 63.
    issen SE. Who is at risk for atherosclerotic disease? Lessons from intravascular ultrasound. Am J Med 2002; 112(Suppl. 8A): 27S-33S.Google Scholar
  64. 64.
    Nissen S. Coronary angiography and intravascular ultrasound. Am J Cardiol 2001; 87(4A):15A-20A.PubMedGoogle Scholar
  65. 65.
    Arva P, Wagstaff AS. Medical disqualification of 275 commer-cial pilots: Changing patterns over 20 years. Aviat Space Environ Med 2004; 75(9):791-794.Google Scholar
  66. 66.
    Van Leudsen AJ, Prendergast PR, Gray GW. Permanent ground-ing and flying restrictions in Canadian forces pilots: A ten year review. Aviat Space Environ Med 1991; 62:513-516.Google Scholar
  67. 67.
    Vlassov VV. Number of chronic conditions and professional lon-gevity of aviators. Aviat Space Environ Med 1997; 68(5):373-377.PubMedGoogle Scholar
  68. 68.
    McCrary BF, Van Syoc DL. Permanent flying disqualifications of USAF pilots and navigators (1995-1999). Aviat Space Envi-ron Med 2002; 73(11):1117-1121.Google Scholar
  69. 69.
    Whitton RC. Medical disqualification in USAF pilots and navi-gators. Aviat Space Environ Med 1984; 55(4):332-336.PubMedGoogle Scholar
  70. 70.
    Holt GW, Taylor WF, Carter ET. Airline pilot disability: The continued experience of a major US airline. Aviat Space Environ Med 1985; 56(10):939-944.PubMedGoogle Scholar
  71. 71.
    Holt GW, Taylor WF, Carter ET. Airline pilot medical disability: A comparison between three airlines with different approaches to medical monitoring. Aviat Space Environ Med 1987; 58 (8):788-791.PubMedGoogle Scholar
  72. 72.
    Richardson LA, Celio PV. The Aeromedical Implications of Supraventricular Tachycardia. Mallorca, Spain: NATO— AGARD; 1994. Human Factors and Medicine.Google Scholar
  73. 73.
    Kruyer W. Cardiac Arrhythmias: Aeromedical Implications. Galveston, TX: University of Texas Medical Branch; 2001.Google Scholar
  74. 74.
    Folarin VA, Fitzsimmons PJ, Kruyer WB. Holter monitor find-ings in asymptomatic male military aviators without structural disease. Aviat Space Environ Med 2001; 72:836-838.PubMedGoogle Scholar
  75. 75.
    Gardener RA, Kruyer WB, Pickard JS, et al. Nonsustained ven-tricular tachycardia in 193 U.S. military aviators: Long term fol-low-up. Aviat Space Environ Med 2000; 71:783-790.Google Scholar
  76. 76.
    Hamm PB, Nicogossian AE, Pool SL, et al. Design and current status of the Longitudinal Study of Astronaut Health. Aviat Space Environ Med 2000; 71:564-570.PubMedGoogle Scholar
  77. 77.
    Rowe WJ. The Apollo 15 space syndrome. Circulation 1998; 97:119-120.PubMedGoogle Scholar
  78. 78.
    Dietlein LF. Spaceflight and the telltale heart. Am J Surg 1983; 145:703-706.PubMedGoogle Scholar
  79. 79.
    Rowe WJ. To Mars before 30. Spaceflight 1998; 40:287.Google Scholar
  80. 80.
    Bungo MW, Johnson PC. Cardiovascular examinations and obser-vations of deconditioning during the Space Shuttle Orbital Flight Test program. Aviat Space Environ Med 1983; 54:1001-1004.PubMedGoogle Scholar
  81. 81.
    Rossum AC, Wood ML, Bishop SL, et al. Evaluation of cardiac rhythm disturbances during extravehicular activity. Am J Cardiol 1997; 79:1153-1155.PubMedGoogle Scholar
  82. 82.
    Hamilton DR, Mcculley PA, et al. Holter analysis of 160 EVA’s from the Shuttle and ISS. Aviat Space Environ Med 2003; 74 (4):397.Google Scholar
  83. 83.
    Egorov AD, Anashkin OD, Itsekhovskii OG, et al. Results of medical research carried out in 1985 on prolonged spaceflights (in Russian). Kosm Biol Aviakosm Med 1988; 22:4-7.Google Scholar
  84. 84.
    Charles JB, Lathers CM. Summary of lower body negative pres-sure experiments during spaceflight. J Clin Pharmacol 1994; 34:571-583.PubMedGoogle Scholar
  85. 85.
    Romanov EM, Artamonova NP, Golubchikova ZA, et al. Results of long-term electrocardiographic examinations of cosmonauts (in Russian). Kosm Biol Aviakosm Med 1987; 21:10-14.PubMedGoogle Scholar
  86. 86.
    Grigoriev AI, Bugrov SA, Bogomolov VV, et al. Review of the major medical results of the one-year flight on the Mir space sta-tion. Kosm Biol Aviakosm Med 1990; 24:3-10.Google Scholar
  87. 87.
    Gazenko OG, Shul’zhenko EB, Grigor’ev AI, et al. Medical investigations during an 8-month flight on Salyut-7/Soyuz-T (in Russian). Kosm Biol Aviakosm Med 1990; 24:9-14.Google Scholar
  88. 88.
    Newkirk D. Almanac of Soviet Manned Space Flight: A Reveal-ing Launch-by-Launch History of the Red Star in Orbit. Houston, TX: Gulf Publishing Co.; 1990.Google Scholar
  89. 89.
    Fritsch-Yelle JM, Leuenberger UA, D’Aunno DS, et al. An epi-sode of ventricular tachycardia during long-duration spaceflight. Am J Cardiol 1998; 81:1391-1392.PubMedGoogle Scholar
  90. 90.
    Dionne MV, Kruyer WB, Snyder QC Jr. Results of Holter moni-toring U.S. Air Force aircrew with ectopy in 12-lead electrocar-diograms. Aviat Space Environ Med 2000; 71:1190-1196.PubMedGoogle Scholar
  91. 91.
    Rayman RB, Hastings JD, Kruyer WB, et al. Cardiology. In: Rayman RB (ed.), Clinical Aviation Medicine. 3rd edn. New York, NY: Castle Connolly Graduate Medical Publishing, LLC; 2000; ISBN 1-883769-86-8:143-270.Google Scholar
  92. 92.
    Charles JB, Frey MA, Fritsch-Yelle JM, et al. Cardiovascular and cardiorespiratory function. In: Leach Huntoon CS, Antipov VV, Grigoriev AI (eds.), Humans in Space Flight. Vol. 3, Book 1. Reston, VA: American Institute of Aeronautics and Astronautics; 1996:63-88. Nicogossian AE, Mohler SR, Gazenko OG, Grig-oriev AI (series eds.), Space Biology and Medicine.Google Scholar
  93. 93.
    Alfrey CP, Driscoll TB, Haley WS, et al. Blood volume and hematopoiesis. In: Leach Huntoon CS, Antipov VV, Grigoriev AI (eds.), Humans in Space Flight. Vol. 3, Book 1. Reston, VA: American Institute of Aeronautics and Astronautics; 1996:105-115. Nicogossian AE, Mohler SR, Gazenko OG, Grigoriev AI (series eds.), Space Biology and Medicine.Google Scholar
  94. 94.
    Leach Huntoon CS, Cintron NM. Endocrine system and fluid and electrolyte balance. In: Leach Huntoon CS, Antipov VV, Grigoriev AI (eds.), Humans in Space Flight. Vol. 3, Book 1. Reston, VA: American Institute of Aeronautics and Astronautics; 1996:89-104. Nicogossian AE, Mohler SR, Gazenko OG, Grig-oriev AI (series eds.), Space Biology and Medicine.Google Scholar
  95. 95.
    Kumar KV, Powell MR, Waligora JM. Early stopping of aero-space medical trials: Application of sequential principles. J Clin Pharmacol 1994; 34:596-598.PubMedGoogle Scholar
  96. 96.
    Rosenberg WM, Sackett DL. On the need for evidence-based medicine. Therapie 1996; 51:212-217.PubMedGoogle Scholar
  97. 97.
    Sackett DL, Straus S. On some clinically useful measures of the ccuracy of diagnostic tests. ACP J Club 1998; 129:A17-A19.PubMedGoogle Scholar
  98. 98.
    Muir Gray JA, Haynes RB, Sackett DL, et al. Transferring vidence from research into practice: 3. Developing evidence-based clinical policy. ACP J Club 1997; 126:A14-A16.PubMedGoogle Scholar
  99. 99.
    Gazenko OG, Grigoriev AI, Egorov AD. Physiologic effects of weightlessness on man under spaceflight conditions (in Russian). Fiziol Cheloveka 1997; 23:138-146.PubMedGoogle Scholar
  100. 100.
    Pasternak RC, Grundy SM, Levy D, et al. 27th Bethesda Conference: Matching the intensity of risk factor management with the hazard for coronary disease events. Task Force 3. Spectrum of risk factors for coronary heart disease. J Am Coll Cardiol 1996; 27:978-990.PubMedGoogle Scholar
  101. 101.
    Vaccarino V. Risk factors for cardiovascular disease: One down, many more to evaluate. Ann Intern Med 1999; 131:62-63.PubMedGoogle Scholar
  102. 102.
    Ridker PM, Stampfer MJ, Rifai N. Novel risk factors for systemic atherosclerosis. JAMA 2001; 285:2481-2485.PubMedGoogle Scholar
  103. 103.
    Eikelboom JW, Lonn E, Genest J Jr, et al. Homocysteine and cardiovascular disease: A critical review of the epidemiological evidence. Ann Intern Med 1999; 131:363-375.PubMedGoogle Scholar
  104. 104.
    Harjai KJ. Potential new cardiovascular risk factors: Left ventricular hypertrophy, homocysteine, lipoprotein(a), triglycerides, oxidative stress and fibrinogen. Ann Intern Med 1999; 131:376-386.PubMedGoogle Scholar
  105. 105.
    Lonn EM, Yusuf S. Evidence-based cardiology: Emerging approaches in preventing cardiovascular disease. BMJ 1999; 318:1337-1341.PubMedGoogle Scholar
  106. 106.
    Grundy SM. Primary prevention of coronary heart disease. Circulation 1999; 100:988-998.PubMedGoogle Scholar
  107. 107.
    The lipid research clinics coronary primary prevention trial results. II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering. JAMA 1984; 251: 365-374.Google Scholar
  108. 108.
    Navas-Nacher EL, Colangelo L, Beam C, et al. Risk factors for coronary heart disease in men 18 to 39 years of age. Ann Intern Med 2001; 134:433-439.PubMedGoogle Scholar
  109. 109.
    Wilson PW, D’Agostino RB, et al. Prediction of coronary heart disease using risk factor categories. Circulation 1998; 97 (18):1837-1847.PubMedGoogle Scholar
  110. 110.
    Grundy SM, Balady GJ, et al. Guide to primary prevention of cardiovascular diseases. A statement for healthcare profession- als from the Task Force on Risk Reduction. American Heart Association Science Advisory and Coordinating Committee. Circulation 1997; 95(9):2329-2331.PubMedGoogle Scholar
  111. 111.
    Greenland P, LaBree L, et al. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA 2004; 291(2):210-215.PubMedGoogle Scholar
  112. 112.
    Steinberg D, Gotto AM Jr. Preventing coronary artery disease by lowering cholesterol levels: Fifty years from bench to bedside. JAMA 1999; 282:2043-2050.Google Scholar
  113. 113.
    Mazurek K, Wielgosz A, Efenberg B, et al. Cardiovascular risk factors in supersonic pilots in Poland. Aviat Space Environ Med 2000; 71:1202-1205.PubMedGoogle Scholar
  114. 114.
    Stefanick ML, Mackey S, Sheehan M, et al. Effects of diet and exercise in men and postmenopausal women with low levels of HDL cholesterol and high levels of LDL cholesterol. N Engl J Med 1998; 339:12-20.PubMedGoogle Scholar
  115. 115.
    Locke J. Cardiovascular Risk Assessment and Mitigation Program. Unpublished NASA document, JSC Flight Medicine Clinic. Houston, TX: NASA-Johnson Space Center; 2000.Google Scholar
  116. 116.
    Ansell BJ, Watson KE, Fogelman AM. An evidence-based assessment of the NCEP Adult Treatment Panel II guidelines. National Cholesterol Education Program. JAMA 1999; 282:2051-2057.PubMedGoogle Scholar
  117. 117.
    Lauer MS, Fontanarosa PB. Updated guidelines for cholesterol management. JAMA 2001; 285:2508-2509.PubMedGoogle Scholar
  118. 118.
    Gotto AM Jr. Lipid lowering therapy for the primary prevention of coronary heart disease. J Am Coll Cardiol 1000; 33:2078-2082.Google Scholar
  119. 119.
    Knopp RH. Drug treatment of lipid disorders. N Engl J Med 1999; 341:489-511.Google Scholar
  120. 120.
    Khan MA, Amroliwalla FK. Lipid lowering therapy and military aviators. Aviat Space Environ Med 1996; 67:867-871.PubMedGoogle Scholar
  121. 121.
    The lipid research clinics coronary primary prevention trial results. I. Reduction in incidence of coronary heart disease. JAMA 1984; 251:351-364.Google Scholar
  122. 122.
    Byington RP, Jukema JW, Salonen JT, et al. Reduction in cardiovascular events during pravastatin therapy. Pooled analysis of clinical events of the Pravastatin Atherosclerosis Intervention Program. Circulation 1995; 92:2419-2425.PubMedGoogle Scholar
  123. 123.
    O’Rourke RA, Brundage BH, Froelicher VF, et al. American College of Cardiology/American Heart Association Expert Consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. J Am Coll Cardiol 2000; 36:326-340.PubMedGoogle Scholar
  124. 124.
    Arad Y, Spadaro LA, Goodman K, et al. Prediction of coronary events with electron beam computed tomography. J Am Coll Cardiol 2000; 36:1253-1260.PubMedGoogle Scholar
  125. 125.
    Beck LH, Kumar SP. Update in preventive medicine. Ann Intern Med 1999; 131:681-687.PubMedGoogle Scholar
  126. 126.
    Stamler JS, Daviglus ML, Garside DB, et al. Relationship of baseline serum cholesterol levels in 3 large cohorts of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity. JAMA 2000; 284:311-318.PubMedGoogle Scholar
  127. 127.
    Ridker PM, Rifai N, et al. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 2002; 347(20):1557-1565.PubMedGoogle Scholar
  128. 128.
    Pearson TA, Mensah GA, et al. Markers of inflammation and cardiovascular disease: Application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003; 107(3):499-511.PubMedGoogle Scholar
  129. 129.
    Willerson JT, Ridker PM. Inflammation as a cardiovascular risk factor. Circulation 2004; 109(21 Suppl. 1):II2-II10.PubMedGoogle Scholar
  130. 130.
    Braunwald E. Shattuck lecture—cardiovascular medicine at the turn of the millennium: Triumphs, concerns, and opportunities. N Engl J Med 1997; 337(19):1360-1369.Google Scholar
  131. 131.
    Albert CM, Ma J, et al. Prospective study of C-reactive protein, homocysteine, and plasma lipid levels as predictors of sudden cardiac death. Circulation 2002; 105(22):2595-2599.PubMedGoogle Scholar
  132. 132.
    Ridker PM, Rifai N, et al. Measurement of C-reactive protein for the targeting of statin therapy in the primary prevention of acute coronary events. N Engl J Med 2001; 344(26):1959-1965.PubMedGoogle Scholar
  133. 133.
    Hamilton DR, Mcculley PA, et al. Analysis of periodic fitness exercise ECG’s on the ISS. Aviat Space Environ Med 2003; 74 (4):397.Google Scholar
  134. 134.
    Dower GE. EASI 12-Lead Electrocardiography. Point Roberts, Washington, DC: Totemite Inc.; 1996.Google Scholar
  135. 135.
    Dower GE, Machado HB. XYZ data interpreted by a 12-lead computer program using the derived electrocardiogram. J Electrocardiol 1979; 12(3):249-261.PubMedGoogle Scholar
  136. 136.
    Dower GE, Yakush A, et al. Deriving the 12-lead electrocardiogram from four (EASI) electrodes. J Electrocardiol 1988; 21 (Suppl.):S182-S187.PubMedGoogle Scholar
  137. 137.
    Drew BJ, Adams MG, et al. Value of a derived 12-lead ECG for detecting transient myocardial ischemia. J Electrocardiol 1995; 28 (Suppl.):211.PubMedGoogle Scholar
  138. 138.
    Drew BJ, Koops RR, et al. Derived 12-lead ECG. Comparison with the standard ECG during myocardial ischemia and its potential application for continuous ST-segment monitoring. J Electrocardiol 1994; 27 (Suppl.):249-255.PubMedGoogle Scholar
  139. 139.
    Edenbrandt L, Pahlm O. Vectorcardiogram synthesized from a 12-lead ECG: superiority of the inverse Dower matrix. J Electrocardiol 1988; 21(4):361-367.PubMedGoogle Scholar
  140. 140.
    Feild DQ, Feldman CL, Horacek BM. Improved EASI coefficients: Their derivation, values, and performance. J Electrocardiol 2002; 35 (Suppl.):23-33.PubMedGoogle Scholar
  141. 141.
    Feldman CL, MacCallum G, Hartley LH. Comparison of the standard ECG with the EASI cardiogram for ischemia detection during exercise monitoring. Computers in Cardiology. Piscataway, NJ: IEEE Computer Society Press; 1997:343-345.Google Scholar
  142. 142.
    Horacek BM, Warren JW, et al. Statistical and deterministic approaches to designing transformations of electrocardiographic leads. J Electrocardiol 2002; 35 (Suppl.):41-52.PubMedGoogle Scholar
  143. 143.
    Rautaharju PM, Zhou SH, et al. Comparability of 12-lead ECGs derived from EASI leads with standard 12-lead ECGS in the classification of acute myocardial ischemia and old myocardial infarction. J Electrocardiol 2002; 35 (Suppl.):35-39.PubMedGoogle Scholar
  144. 144.
    Welinder A, Sornmo L, et al. Comparison of signal quality between EASI and Mason-Likar 12-lead electrocardiograms during physical activity. Am J Crit Care 2004; 13(3):228-234.PubMedGoogle Scholar
  145. 145.
    Hamilton DR, Wear M, Murray J. Longitudinal study of treadmill tests of active and inactive NASA astronauts. Aviat Space Environ Med 2002; 73(3):303.Google Scholar
  146. 146.
    Levine BD, Zuckerman JH, Pawelczyk JA. Cardiac atrophy after bed-rest deconditioning. Circulation 1997; 96:517-525.PubMedGoogle Scholar
  147. 147.
    Chen G, Redberg RF. Noninvasive diagnostic testing of coronary artery disease in women. Cardiol Rev 2000; 8:354-360.PubMedGoogle Scholar
  148. 148.
    Dehn MM, Bruce RA. Longitudinal variations in maximal oxygen uptake with age and activity. J Appl Physiol 1972; 33:805-812.PubMedGoogle Scholar
  149. 149.
    Sox HC Jr, Garber AM, Littenberg B. The resting electrocardiogram as a screening test: A clinical analysis. Ann Intern Med 1989; 111:486-502.Google Scholar
  150. 150.
    Joy M, Trump DW. Significance of minor ST segment and T wave changes in the resting electrocardiogram of asymptomatic subjects. Br Heart J 1981; 45:48-55.PubMedGoogle Scholar
  151. 151.
    Barrett PA, Peter CT, Swan HJ, et al. The frequency and prognostic significance of electrocardiographic abnormalities in clinically normal individuals. Prog Cardiovasc Dis 1981; 23:299-319.PubMedGoogle Scholar
  152. 152.
    Borer JS, Brensike JF, Redwood DR, et al. Limitations of the electrocardiographic response to exercise in predicting coronary-artery disease. N Engl J Med 1975; 293:367-371.PubMedGoogle Scholar
  153. 153.
    Schlant RC, Blomqvist CG, Brandenburg RO, et al. Guidelines for exercise testing. A report of the Joint American College of Cardiology/American Heart Association Task Force on Assess ment of Cardiovascular Procedures (Subcommittee on Exercise Testing). Circulation 1986; 74:653A-667A.PubMedGoogle Scholar
  154. 154.
    MacIntyre NR, Kunkler JR, Mitchell RE, et al. Eight-year fol-low-up of exercise electrocardiograms in healthy middle-aged aviators. Aviat Space Environ Med 1981; 52:256-259.PubMedGoogle Scholar
  155. 155.
    Allen WH, Aronow WS, Goodman P, et al. Five-year follow-up of maximal exercise stress test in asymptomatic men and women. Circulation 1980; 62:522-527.PubMedGoogle Scholar
  156. 156.
    Schmermund A, Baumgart D, Sack S, et al. Assessment of coronary calcification by electron-beam computed tomography in symptomatic patients with normal, abnormal or equivocal exercise stress test. Eur Heart J 2000; 21:1674-1682.PubMedGoogle Scholar
  157. 157.
    Shavelle DM, Budoff MJ, LaMont DH, et al. Exercise testing and electron beam computed tomography in the evaluation of coronary artery disease. J Am Coll Cardiol 2000; 36:32-38.PubMedGoogle Scholar
  158. 158.
    Gibbons RJ, Balady GJ, Beasley JW, et al. ACC/AHA guidelines for exercise testing: Executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). Circulation 1997; 96:345-354.PubMedGoogle Scholar
  159. 159.
    Schwartz RS, Jackson WG, Celio PV, et al. Accuracy of exercise 201Tl myocardial scintigraphy in asymptomatic young men. Circulation 1993; 87:165-172.PubMedGoogle Scholar
  160. 160.
    Fleg JL, Gerstenblith G, Zonderman AB, et al. Prevalence and prognostic significance of exercise induced silent myocardial ischemia detected by thallium scintigraphy and electrocardiography in asymptomatic volunteers. Circulation 1990; 81:428-436.PubMedGoogle Scholar
  161. 161.
    Fitzsimmons P, Palm-Leis A, Thompson W, et al. Comparison of noninvasive cardiac testing in 759 military aviators; angiographic correlation and clinical follow-up. Presented at the 72nd annual meeting of the Aerospace Medicine Association, Reno, NV; May 2001.Google Scholar
  162. 162.
    Loecker TH, Schwartz RS, Cotta CW, et al. Fluoroscopic coronary artery calcification and associated coronary disease in asymptomatic young men. J Am Coll Cardiol 1991; 19:1167-1172.CrossRefGoogle Scholar
  163. 163.
    Barnett S, Fitzsimmons P, Thompson W, et al. The natural history of minimal and significant coronary artery disease in 575 asymptomatic male military aviators. Presented at the 72nd annual meeting of the Aerospace Medicine Association, Reno, NV; May 2001.Google Scholar
  164. 164.
    Leding C, Fitzsimmons P, Kruyer W. Coronary artery disease and aerospace medicine: Summary, applications and future directions. Presented at the 72nd annual meeting of the Aerospace Medicine Association, Reno, NV; May 2001.Google Scholar
  165. 165.
    Zarr S, Gee M, Fitzsimmons P, et al. Angiographic and clinical follow-up of military aviators with minimal coronary artery disease and serial coronary angiography. Presented at the 72nd annual meeting of the Aerospace Medicine Association, Reno, NV; May 2001.Google Scholar
  166. 166.
    Gee MR, Kruyer WB. Progression of minimal coronary artery disease in USAF aviators followed with serial cardiac catheterizations. Aviat Space Environ Med 2000; 71:312, (Abstract).Google Scholar
  167. 167.
    Schmermund A, Baumgart D, Gorge G, et al. Coronary artery calcium in acute coronary syndrome: A comparative study of electron-beam computed tomography, coronary angiography, and intracoronary ultrasound in survivors of acute myocardial infarction and unstable angina. Circulation 1997; 96:1461-1469.PubMedGoogle Scholar
  168. 168.
    Budoff MJ, Georgiou D, Brody A, et al. Ultrafast computed tomography as a diagnostic modality in the detection of coronary-artery disease: A multicenter study. Circulation 1996; 93:898-904.PubMedGoogle Scholar
  169. 169.
    Wong ND, Hsu JC, Detrano RC, et al. Coronary artery calcium evaluation by electron beam computed tomography and its relation to new cardiovascular events. Am J Cardiol 2000; 86:495-498.PubMedGoogle Scholar
  170. 170.
    Agaston AS, Janowitz WR, Kaplan G, et al. Ultrafast computed tomography-detected coronary calcium reflects the angiographic extent of coronary arterial atherosclerosis. Am J Cardiol 1994; 74:1272-1274.Google Scholar
  171. 171.
    Aldrich RF, Brensike JF, Battaglini JW, et al. Coronary calcification in the detection of coronary artery disease and comparison with electrocardiographic exercise testing. Results from the National Heart, Lung and Blood Institute’s Type II Coronary Intervention Study. Circulation 1979; 5:1113-1134.Google Scholar
  172. 172.
    O’Malley PG, Taylor AJ, Gibbons RV, et al. Rationale and design of the Prospective Army Coronary Calcium (PACC) study: Utility of electron beam computed tomography as a screening test for coronary artery disease and as an intervention for risk factor modification among young, asymptomatic, active-duty United States Army personnel. Am Heart J 1999; 137:932-941.PubMedGoogle Scholar
  173. 173.
    Watkins SP, Andrews TC. Guidelines for Interpretation of electron beam computed tomography calcium scores from the Dallas Heart Disease Prevention Project. Am J Cardiol 2001; 87:1387-1388.PubMedGoogle Scholar
  174. 174.
    Nallamothu BK, Saint S, Bielak LF, et al. Electron-beam computed tomography in the diagnosis of coronary artery disease: A meta-analysis. Arch Intern Med 2001; 161:833-838.PubMedGoogle Scholar
  175. 175.
    Teng W, Wong ND, Abrahamson D, et al. Relation of electron beam computed tomography screening for coronary calcium to cardiovascular risk and disease: A review. Coron Artery Dis 1996; 7:383-389.PubMedGoogle Scholar
  176. 176.
    Bild DE, Folsom AR, Lowe LP, et al. Prevalence and correlates of coronary calcification in black and white young adults: The Coronary Artery Risk Development in Young Adults (CARDIA) study. Arterioscler Thromb Vasc Biol 2001; 21:852-857.PubMedGoogle Scholar
  177. 177.
    Rumberger JA, Schwartz RS, Simons DB, et al. Relation of coronary calcium determined by electron beam computed tomography and lumen narrowing determined by autopsy. Am J Cardiol 1994; 73:1169-1173.PubMedGoogle Scholar
  178. 178.
    Rumberger JA, Sheedy PF 2nd, Breen JF, et al. Electron beam computed tomography and coronary artery disease: Scanning for coronary artery calcification. Mayo Clin Proc 1996; 71:369-377.PubMedGoogle Scholar
  179. 179.
    Rumberger JA, Sheedy PF 3rd, Breen JF, et al. Coronary calcium, as determined by electron beam computed tomography, and coronary disease on arteriogram. Effect of patient’s sex on diagnosis. Circulation 1995; 91:1363-1367.PubMedGoogle Scholar
  180. 180.
    Feuerstein IM, Brazaitis MP, Zoltick JM, et al. Electron beam computed tomography screening of the coronary arteries: Experience with 3,263 patients at Walter Reed Army Medical enter. Mil Med 2001; 166:432-442.PubMedGoogle Scholar
  181. 181.
    O’Malley PG, Taylor AJ, Jackson JL, et al. Prognostic value of coronary electron-beam computed tomography for coronary heart disease events in asymptomatic populations. Am J Cardiol 2000; 85:945-948.PubMedGoogle Scholar
  182. 182.
    Raggi P. Coronary calcium on electron beam tomography imaging as a surrogate marker of coronary artery disease. Am J Cardiol 2001; 87:27-34.Google Scholar
  183. 183.
    Taylor AJ, Feuerstein I, Wong H, et al. Do conventional risk factors predict subclinical coronary artery disease? Results from the Prospective Army Coronary Calcium Project. Am Heart J 2001; 141:463-468.PubMedGoogle Scholar
  184. 184.
    Secci A, Wong N, Tang W, et al. Electron beam computed tomographic coronary calcium as a predictor of coronary events: Comparison of two protocols. Circulation 1997; 96:1122-1129.PubMedGoogle Scholar
  185. 185.
    Arad Y, Spadaro LA, Goodman K, et al. Predictive value of electron beam computed tomography of the coronary arteries. Circulation 1996; 93:1951-1953.PubMedGoogle Scholar
  186. 186.
    Hoff JA, Chomka EV, Krainik AJ, et al. Age and gender distributions of coronary artery calcium detected by electron beam tomography in 35,246 adults. Am J Cardiol 2001; 87:1335-1339.PubMedGoogle Scholar
  187. 187.
    Raggi P, Cooil B, Callister TQ. Use of electron beam tomography data to develop models for prediction of hard coronary events. Am Heart J 2001; 141:375-82.PubMedGoogle Scholar
  188. 188.
    Guerci AD, Arad Y. Electron beam computed tomography for the diagnosis and prognosis of coronary artery disease. Circulation 2001; 103:E87-E87.PubMedGoogle Scholar
  189. 189.
    Achenbach S, Moshage W, Ropers D, et al. Value of electron-beam computed tomography for the noninvasive detection of high-grade coronary-artery stenoses and occlusions. N Engl J Med 1998; 339:1964-1971.PubMedGoogle Scholar
  190. 190.
    Mitchell TL, Pippin JJ, Devers SM, et al. Age- and sex-based nomograms from coronary artery calcium scores as determined by electron beam computed tomography. Am J Cardiol 2001; 87:453-456, A6.Google Scholar
  191. 191.
    Achenbach S, Ropers D, Mohlenkamp S, et al. Variability of repeated coronary artery calcium measurements by electron beam tomography. Am J Cardiol 2001; 87:210-213, A8.Google Scholar
  192. 192.
    Fleischmann KE, Hunink MG, Kuntz KM, et al. Exercise echocardiography over exercise SPECT? A meta-analysis of diagnostic test performance. JAMA 1998; 280:913-920.PubMedGoogle Scholar
  193. 193.
    Crouse JR, Craven TE, Hagaman AP, et al. Association of coronary disease with segment-specific intimal-medial thickening of the extracranial carotid artery. Circulation 1995; 92:1141-1147.PubMedGoogle Scholar
  194. 194.
    Hodis HN, Mack WJ, LaBree L, et al. The role of carotid arterial intima-media thickness in predicting clinical coronary events. Ann Intern Med 1998; 128:262-269.PubMedGoogle Scholar
  195. 195.
    NASA. Crew Escape Systems. Unpublished NASA document. Houston, TX: NASA-Johnson Space Center; 1996. Space Flight Operations Contract Document SFOC-FL0236.Google Scholar
  196. 196.
    Buckey JC, Gaffney AF, Lane LD, et al. Central venous pressure in space. J Appl Physiol 1996; 81:19-25.PubMedGoogle Scholar
  197. 197.
    Gotshall RW, Yumikura S, Aten LA. Effect of prelaunch position on the cardiovascular response to standing. Aviat Space Environ Med 1991; 62:1132-1136.PubMedGoogle Scholar
  198. 198.
    Kirkpatrick AW, Campbell MR, Novinkov O, et al. Blunt trauma and operative care in microgravity: A review of microgravity physiology and surgical investigations with implications for critical care and operative treatment in space. J Am Coll Surg 1997; 184:441-453.PubMedGoogle Scholar
  199. 199.
    Lee SMC, Bishop PA, Schneider SM, et al. Simulated shuttle egress: Comparison of two space shuttle protective garments. Aviat Space Environ Med 2001; 72:110-114.PubMedGoogle Scholar
  200. 200.
    Lee SMC, Bishop PA, Schneider SM, et al. Simulated shuttle egress: Role of helmet visor position during approach and landing. Aviat Space Environ Med 2001; 72:484-489.PubMedGoogle Scholar
  201. 201.
    NASA National Space Transportation System. Space Shuttle Operational Flight Rules. Houston, TX: NASA-Johnson Space Center; 1996;12820: A: Section 13, Aeromedical; PCN 10; Aug. 3, 2000.Google Scholar
  202. 202.
    Mitchell JH, Victor RG. Neural control of the cardiovascular system insights from muscle sympathetic nerve recordings in humans. Med Sci Sports Exerc 1996; 28:S60-S69.PubMedGoogle Scholar
  203. 203.
    Eckberg DL, Fritsch JM. Human autonomic responses to actual and simulated weightlessness. J Clin Pharmacol 1991; 31:951-955.PubMedGoogle Scholar
  204. 204.
    Pollack AA, Wood EH. Venous pressure changes in the saphenous vein at the ankle in man during exercise and changes in posture. J Appl Physiol 1949; 1.Google Scholar
  205. 205.
    Blomqvist CG, Stone HL. Cardiovascular adjustments to gravitational stress. In: Shepard JT, Abboud FM (eds.), Handbook of Physiology, section 2 (the Cardiovascular System), Vol. III. Bethesda, MD: American Physiological Society; 1983: 1025-1063.Google Scholar
  206. 206.
    Thornton WE, Hoffler GW, Rummel JA. Anthropometric changes and fluid shifts. In: Johnston RS, Dietlein LF (eds.), Biomedical Results from Skylab. Washington, DC: US Government Printing Office; 1977:330-338. NASA SP-377.Google Scholar
  207. 207.
    Thornton WE, Hedge V, Coleman E, et al. Changes in leg volumes during microgravity simulation. Aviat Space Environ Med 1992; 63:789-794.PubMedGoogle Scholar
  208. 208.
    Simanonok KE, Bernauer E. Blood volume reduction counteracts fluid shifts in water immersion. Aviat Space Environ Med 1993; 64:139-145.PubMedGoogle Scholar
  209. 209.
    Buckey JC, Lane LD, Gaffney FA, et al. Orthostatic intolerance after spaceflight. J Appl Physiol 1996; 81:7-18.PubMedGoogle Scholar
  210. 210.
    Davis JR, Jennings RT, Beck BG. Comparison of treatment strategies for space motion sickness. Acta Astronaut 1993; 29:587-591.PubMedGoogle Scholar
  211. 211.
    Davis JR, Vanderploeg JM, Santy PA, et al. Space motion sickness during 24 flights of the Space Shuttle. Aviat Space Environ Med 1988; 59:1185-1189.PubMedGoogle Scholar
  212. 212.
    Graybiel A, Lackner JR. Space motion sickness: Skylab revisited. Aviat Space Environ Med 1980; 51:814-822.Google Scholar
  213. 213.
    Simanonok KE, Charles JB. Space sickness and fluid shifts: A hypothesis. J Clin Pharmacol 1994; 34:652-663.PubMedGoogle Scholar
  214. 214.
    Engle E, Lott A. Man In Flight: Biomedical Achievements in Space Flight. Annapolis, MD: Leeward Publications; 1979.Google Scholar
  215. 215.
    Busby DE. Cardiovascular adaptations to weightlessness. In: Space Clinical Medicine. Dordrecht, Holland: Reidel Publishing Company; 1968.Google Scholar
  216. 216.
    Charles JB, Lathers CM. Cardiovascular adaptation to spaceflight. J Clin Pharmacol 1991; 31:1010-1023.PubMedGoogle Scholar
  217. 217.
    Moore PT, Thornton WE. Space Shuttle inflight and postflight fluid shifts measured by leg volume changes. Aviat Space Environ Med 1987; 58:A91-A96.PubMedGoogle Scholar
  218. 218.
    Leach CS, Alexander WC, Johnson PC. Endocrine, electrolyte, and fluid volume changes associated with Apollo missions. In: Johnston RS, Dietlein LF, Berry CA (eds.), Biomedical Results of Apollo. Washington, DC: NASA; 1975:163-184. NASA SP-368.Google Scholar
  219. 219.
    Thornton WE, Ord J. Physiological mass measurements in Skylab. In: Johnston RS, Dietlein LF (eds.), Biomedical Results from Skylab. Washington, DC: US Government Printing Office; 1977:175-182. NASA SP-377.Google Scholar
  220. 220.
    Grigoriev AI, Popova IA, Ushakov AS. Metabolic and hormonal status of crewmembers in short-term spaceflights. Aviat Space Environ Med 1987; 58(Suppl. 9):A121-A125.PubMedGoogle Scholar
  221. 221.
    Schoeller DA, van Santen E, Peterson DW, et al. Total body water measurement in humans with 18O and 2H labeled water. Am J Clin Nutr 1980; 33:2686-2693.PubMedGoogle Scholar
  222. 222.
    Leach CS, Alfrey CP, Suki WN, et al. Regulation of body fluid compartments during short-term spaceflight. J Appl Physiol 1996; 81:105-116.PubMedGoogle Scholar
  223. 223.
    Convertino VA. Clinical aspects of the control of plasma volume at microgravity and during return to one gravity. Med Sci Sports Exerc 1996; 28:S45-S52.PubMedGoogle Scholar
  224. 224.
    Hargens AR. Critical discussion of the research issues in body fluids metabolism and control of intravascular volume. Med Sci Sports Exerc 1996; 28:S56-S59.PubMedGoogle Scholar
  225. 225.
    Alfrey CP, Rice L, Udden MM, et al. Neocytolysis: Physiological down-regulator of red-cell mass. Lancet 1997; 349:1389-1390.PubMedGoogle Scholar
  226. 226.
    Alfrey CP, Udden MM, Huntoon CL, et al. Destruction of newly released red blood cells in spaceflight. Med Sci Sports Exerc 1996; 28:S42-S44.PubMedGoogle Scholar
  227. 227.
    Alfrey CP, Udden MM, Leach-Huntoon C, et al. Control of red blood cell mass in spaceflight. J Appl Physiol 1996; 81:98-104.PubMedGoogle Scholar
  228. 228.
    Udden MM, Driscoll TB, Gibson LA, et al. Blood volume and erythropoiesis in the rat during spaceflight. Aviat Space Environ Med 1995; 66:557-561.PubMedGoogle Scholar
  229. 229.
    Udden MM, Driscoll TB, Pickett MH, et al. Decreased production of red blood cells in human subjects exposed to microgravity. J Lab Clin Med 1995; 125:442-449.PubMedGoogle Scholar
  230. 230.
    Kimzey SL, Ritzmann SE, Mengel CE, et al. Skylab experiment results: Hematology studies. Acta Astronaut 1975; 2:141-154.PubMedGoogle Scholar
  231. 231.
    Fischer CL, Johnson PC, Berry CA. Red blood cell mass and plasma volume changes in manned spaceflight. JAMA 1967; 200:579-583.PubMedGoogle Scholar
  232. 232.
    Buckey JC, Goble RL, Blomquvist CG. A new device for continuous ambulatory central venous pressure measurement. Med Instrum 1987; 21:238-243.PubMedGoogle Scholar
  233. 233.
    Foldager N, Andersen TA, Jessen FB, et al. Central venous pressure in humans during microgravity. J Appl Physiol 1996; 81:408-412.PubMedGoogle Scholar
  234. 234.
    Kirsch KA, Rocker L, Gauer OH, et al. Venous pressure in man during weightlessness. Science 1984; 225:218-219.PubMedGoogle Scholar
  235. 235.
    Videbaek R, Norsk P. Atrial distention in humans during microgravity induced by parabolic flight. J Appl Physiol 1997; 83:1862-1866.PubMedGoogle Scholar
  236. 236.
    Nixon JV, Murray RG, Byrant C, et al. Early cardiovascular adaptation to simulated zero gravity. J Appl Physiol 1979; 46:541-548.PubMedGoogle Scholar
  237. 237.
    Gaffney FA, Nixon JV, Karlsson ES, et al. Cardiovascular deconditioning produced by 20 hours of bedrest with head-down tilt (−5 degrees) in middle-aged healthy men. Am J Cardiol 1985; 56:635-638.Google Scholar
  238. 238.
    Norsk P. Gravitational stress and volume regulation. Clin Physiol 1992; 12:505-526.PubMedGoogle Scholar
  239. 239.
    Norsk P, Foldager N, Bonde-Pertersen F, et al. Central venous pressure in humans during short periods of weightlessness. J Appl Physiol 1987; 63:2433-2437.PubMedGoogle Scholar
  240. 240.
    Gerzer R, Heer M, Drummer C. Body fluid metabolism at actual and simulated microgravity. Med Sci Sports Exerc 1996; 28:S32-S35.PubMedGoogle Scholar
  241. 241.
    Lathers CM, Charles JB. Comparison of cardiovascular function during the early hours of bed rest and spaceflight. J Clin Pharmacol 1994; 34:489-499.PubMedGoogle Scholar
  242. 242.
    Prisk GK, Fine JM, Elliot AR, et al. Effect of 6° head-down tilt on cardiopulmonary function: Comparison with microgravity. Aviat Space Environ Med 2002; 73:8-16.PubMedGoogle Scholar
  243. 243.
    White RJ, Blomqvist CG. Central venous pressure and cardiac function during spaceflight. J Appl Physiol 1889; 85:738-746.Google Scholar
  244. 244.
    Hamilton DR, Dani RS, Semlacher RA, et al. Right atrial and right ventricular transmural pressure in the human and dog: Effects of the pericardium. Circulation 1994; 90:2492-2500.PubMedGoogle Scholar
  245. 245.
    Tyberg JV, Smith ER. Ventricular diastole and the role of the pericardium. Herz 1990; 15:354-361.PubMedGoogle Scholar
  246. 246.
    Tyberg JV, Keon WJ, Sonnenblick EH, et al. Mechanics of ventricular diastole. Cardiovasc Res 1970; 4:423-428.PubMedGoogle Scholar
  247. 247.
    Tyberg JV, Belenkie I, Manyari DE, et al. Ventricular interaction and venous capacitance modulate left ventricular preload. Can J Cardiol 1996; 12:1058-1064.PubMedGoogle Scholar
  248. 248.
    Sandler H. Things may not be the way they seem. Aviat Space Environ Med 1993; 64:247-248.PubMedGoogle Scholar
  249. 249.
    Smith ER, Smiseth OA, Kingma I, et al. Mechanism of action of nitrates. Role of changes in venous capacitance and in left ventricular diastolic pressure-volume relation. Am J Med 1984; 76:14-21.PubMedGoogle Scholar
  250. 250.
    Smiseth OA, Kingma I, Refsum H, et al. The pericardium hypothesis: A mechanism of acute shifts of the left ventricular diastolic pressure-volume relation. Clin Physiol 1985; 5:403-415.PubMedGoogle Scholar
  251. 251.
    Kingma I, Smiseth OA, Belenkie I, et al. A mechanism for the nitroglycerin-induced downward shift of the left ventricular diastolic pressure-diameter relation. Am J Cardiol 1986; 57:673-677.PubMedGoogle Scholar
  252. 252.
    Gauer OH, Henry JP. Circulatory basis of fluid volume control. Physiol Rev 1963; 43:423-481.PubMedGoogle Scholar
  253. 253.
    Gibbons Kroeker CA, Shrive NG, Tyberg JV. Pericardiummediated equalization of left and right ventricular outputs. Circulation, in press.Google Scholar
  254. 254.
    Kirkpatrick AW, Dulchavsky SA, Boulanger BR, et al. Extraterrestrial resuscitation of hemorrhagic shock: Fluids. J Trauma 2001; 50:162-168.PubMedGoogle Scholar
  255. 255.
    Fritsch-Yelle JM, Charles JB, Jones MM, et al. Microgravity decreases heart rate and arterial pressure in humans. J Appl Physiol 1996; 80:910-914.PubMedGoogle Scholar
  256. 256.
    Gundel A, Drescher J, Spatenko YA, et al. Changes in basal heart rate in spaceflights up to 438 days. Aviat Space Environ Med 2002; 73:17-21.PubMedGoogle Scholar
  257. 257.
    Prisk GK, Guy HJ, Elliott AR, et al. Pulmonary diffusion capacity, capillary blood volume and cardiac output during sustained microgravity. J Appl Physiol 1993; 75:15-26.PubMedGoogle Scholar
  258. 258.
    Dower GE. EASI 12-Lead Electrocardiography. Point Roberts, Washington, DC: Totemite Inc.; 1996.Google Scholar
  259. 259.
    Dower GE, Machado HB. XYZ Data interpreted by a 12-lead computer program using the derived electrocardiogram. J Electrocardiol 1979; 12:249-261.PubMedGoogle Scholar
  260. 260.
    Dower GE, Yakush A, Nazzal SB, et al. Deriving the 12-lead electrocardiogram from four (EASI) electrodes. J Electrocardiol 1988; 21:S182-S187.PubMedGoogle Scholar
  261. 261.
    Drew BJ, Pelter MM, Wung SF, et al. Accuracy of the EASI 12-lead electrocardiogram compared to the standard 12-lead electrocardiogram for the diagnosing multiple cardiac abnormalities. J Electrocardiol 1999; 32:38-47.PubMedGoogle Scholar
  262. 262.
    Drew BJ, Adams MG, Pelter MM, et al. ST segment monitoring with a derived 12-lead electrocardiogram is superior to routine cardiac care unit monitoring. Am J Crit Care 1996; 5:198-206.PubMedGoogle Scholar
  263. 263.
    Drew BJ, Adams MG, Pelter MM, et al. Comparison of standard and derived 12-lead electrocardiograms for diagnosis of coronary angioplasty-induced myocardial ischemia. Am J Cardiol 1997; 79:639-644.PubMedGoogle Scholar
  264. 264.
    Drew BJ, Adams MG, Wung SF, et al. Value of a derived 12-lead ECG for detecting transient myocardial ischemia. J Electrocardiol 1995; 28:211.PubMedGoogle Scholar
  265. 265.
    Drew BJ, Koops RR, Adams MG, et al. Derived 12-lead ECG. comparison with the standard ECG during myocardial ischemia and its potential application for continuous ST-segment monitoring. J Electrocardiol 1994; 27:S249-S255.Google Scholar
  266. 266.
    Drew BJ, Pelter MM, Adams MG, et al. 12-Lead ST-segment monitoring vs single-lead maximum ST-segment monitoring for detecting ongoing ischemia in patients with unstable coronary syndromes. Am J Crit Care 1998; 7:355-363.PubMedGoogle Scholar
  267. 267.
    Drew BJ, Tisdale LA. ST Segment monitoring for coronary artery reocclusion following thrombolytic therapy and coronary angioplasty: Identification of optimal bedside monitoring leads. Am J Crit Care 1993; 2:280-292.Google Scholar
  268. 268.
    Tisdale LA, Drew BJ. ST segment monitoring for myocardial ischemia. AACN Clin Issues Crit Care Nurs 1993; 4:34-43.PubMedGoogle Scholar
  269. 269.
    Lind A, Leithead CS, McNicol GW. Cardiovascular changes during syncope induced by tilting men in the heat. J Appl Physiol 1976; 25:268-276.Google Scholar
  270. 270.
    Crandall CG, Zhang R, Levine BD. Effect of whole body heating on dynamic baroreflex regulation of heart rate in humans. Am J Physiol Heart Circ Physiol 2000; 279:H2486-H2492.PubMedGoogle Scholar
  271. 271.
    Fortney SM, Mikhaylov V, Lee SMC, et al. Body temperature and thermoregulation after 115-day spaceflight. Aviat Space Environ Med 1998; 69:137-141.PubMedGoogle Scholar
  272. 272.
    Lee SMC, Williams WJ, Greenleaf JE, et al. Exercise thermo-regulation after 13-day bed rest. Med Sci Sports Exerc 1999; 31:S309.Google Scholar
  273. 273.
    Gazenko OG, Genin AM, Egorov AD. Summary of medical investigations in the USSR manned space missions. Acta Astronaut 1981; 8:907-917.PubMedGoogle Scholar
  274. 274.
    Fritsch-Yelle JM, Charles JB, Jones MM, et al. Spaceflight alters autonomic regulation of arterial pressure in humans. J Appl Physiol 1994; 77:1776-1783.PubMedGoogle Scholar
  275. 275.
    Smith ML. Mechanisms of vasovagal syncope: Relevance to postflight orthostatic intolerance. J Clin Pharmacol 1994; 43:460-465.Google Scholar
  276. 276.
    Schraeder PL, Lathers CM, Charles JB. The spectrum of syncope. J Clin Pharmacol 1994; 34:454-459.PubMedGoogle Scholar
  277. 277.
    Davrath LR, Gotshall RW, Tucker A, et al. The heart is not necessarily empty at syncope. Aviat Space Environ Med 1999; 70:213-219.PubMedGoogle Scholar
  278. 278.
    Schraeder PL, Pontzer R, Engel TR. A case of being scared to death. Arch Intern Med 1983; 143:1793-1794.PubMedGoogle Scholar
  279. 279.
    Bondar RL, Kassam MS, Stein F, et al. Simultaneous cerebrovascular and cardiovascular responses during presyncope. Stroke 1995; 26:1794-1800.PubMedGoogle Scholar
  280. 280.
    Levine BD, Giller CA, Lane LD, et al. Cerebral versus systemic hemodynamics during graded orthostatic stress in humans. Circulation 1994; 90:298-306.PubMedGoogle Scholar
  281. 281.
    Zhang R, Zuckerman JH, Pawelczyk JA, et al. Effects of head-down-tilt bed rest on cerebral hemodynamics during orthostatic stress. J Appl Physiol 1997; 83:2139-2145.PubMedGoogle Scholar
  282. 282.
    Lathers CM, Charles JB. Use of lower body negative pressure to counter symptoms of orthostatic intolerance in patients, bed rest subjects, and astronauts. J Clin Pharmacol 1993; 33:1071-1085.PubMedGoogle Scholar
  283. 283.
    Fritsch JM, Charles JB, Bennett BB, et al. Short-duration spaceflight impairs human carotid baraoreceptor-cardiac reflex response. J Appl Physiol 1992; 73:664-671.PubMedGoogle Scholar
  284. 284.
    Pool SL, Charles JB, Beck B. Physiologic deconditioning sub-sequent to short duration spaceflight. Presented at the 9th International “Man in Space” Symposium, International Academy of Astronautics, Cologne, Germany; June 20, 1991.Google Scholar
  285. 285.
    Fritsch-Yelle JM, Whitson PA, Bondar RL, et al. Subnormal norepinephrine release relates to presyncope in astronauts after spaceflight. J Appl Physiol 1996; 81:2134-2141.PubMedGoogle Scholar
  286. 286.
    Waters WW, Ziegler MG, Meck JV. Postspaceflight orthostatic hypotension occurs mostly in women and is predicted by low vascular resistance. J Appl Physiol 2002; 92:586-594.PubMedGoogle Scholar
  287. 287.
    Leach CS, Inners D, Charles JB. Changes in total body water during spaceflight. J Clin Pharmacol 1991; 31:1001-1006.PubMedGoogle Scholar
  288. 288.
    Cooke WH, Ames JE, Crossman AA, et al. Nine months in space: Effects on human autonomic cardiovascular function. J Appl Physiol 2000; 89:1039-1045.PubMedGoogle Scholar
  289. 289.
    Sprenkle JM, Eckberg DL, Goble RL, et al. Device for the rapid quantification of human carotid baroreceptor-cardiac reflex responses. J Appl Physiol 1986; 60:727-732.PubMedGoogle Scholar
  290. 290.
    Sopher SM, Smith ML, Eckberg DL, et al. Autonomic pathology in heart failure: Carotid baroreceptor-cardiac reflex. Am J Physiol 1990; 259:H689-H696.PubMedGoogle Scholar
  291. 291.
    Convertino VA, Adams WC, Shea JD, et al. Impairment of carotid-cardiac vagal baroreflex in wheelchair-dependent quadriplegics. Am J Physiol 1991; 260:R576-R580.PubMedGoogle Scholar
  292. 292.
    Thompson CA, Ludwig DA, Convertino VA. Carotid baro-receptor influence on forearm vascular resistance during low level lower body negative pressure. Aviat Space Environ Med 1991; 62:930-933.PubMedGoogle Scholar
  293. 293.
    Ludwig DA, Convertino VA. A statistical note in the redundancy of nine standard baroreflex parameters. Aviat Space Environ Med 1991; 62:172-175.PubMedGoogle Scholar
  294. 294.
    Pannier B, Slama M, Guerin SA, et al. Further study on the carotid baroreflex system in the cardiovascular deconditioning induced by head down tilt. Aviat Space Environ Med 1998; 69:904-910.PubMedGoogle Scholar
  295. 295.
    Convertino VA, Doerr DF, Eckberg DL, et al. Head-down bed rest impairs vagal baroreflex responses and provokes orthostatic hypotension. J Appl Physiol 1990; 68:1458-1464.PubMedGoogle Scholar
  296. 296.
    Greenleaf JE, Bernauer EM, Juhos LT, et al. Effects of exercise on fluid exchange and body composition in man during 14-day bed rest. J Appl Physiol 1977; 43:126-132.PubMedGoogle Scholar
  297. 297.
    Pannier BM, Lacolley PJ, Gharib C, et al. Twenty-four hours of bed rest with head down tilt: Venous and arterial changes on limbs. Am J Physiol 1991; 260:H1043-H1050.PubMedGoogle Scholar
  298. 298.
    Tripathi A, Mack G, Nadel ER. Peripheral vascular reflexes elicited during lower body negative pressure. Aviat Space Environ Med 1989; 60:1187-1193.PubMedGoogle Scholar
  299. 299.
    Zoller RP, Mark AL, Abboud FM, et al. The role of low pressure baroreceptors in reflex vasoconstrictor responses in man. J Clin Invest 1972; 51:2967-2972.PubMedGoogle Scholar
  300. 300.
    Zhang L-F, Ma Z-B, Mao Q-W. Peripheral effector mechanism hypothesis of postflight cardiovascular dysfunction. Aviat Space Environ Med 2001; 72:567-575.PubMedGoogle Scholar
  301. 301.
    Zucker IH, Wang W. Modulation of baroreflex and baroreceptor function in experimental heart failure. Basic Res Cardiol 1991; 86:133-148.PubMedGoogle Scholar
  302. 302.
    Convertino VA. Carotid-cardiac baroreflex: Relation with orthostatic hypotension following simulated microgravity and implications for developing of countermeasures. Acta Astronaut 1991; 23:9-17.PubMedGoogle Scholar
  303. 303.
    Hyatt KH, West DA. Reversal of bedrest induced orthostatic intolerance by lower body negative pressure and saline. Aviat Space Environ Med 1977; 48:120-124.PubMedGoogle Scholar
  304. 304.
    Convertino VA. Effects of exercise and inactivity on intravascular volume and cardiovascular control mechanisms. Acta Astronaut 1992; 27:123-129.PubMedGoogle Scholar
  305. 305.
    Convertino VA, Montgomery LD, Greenleaf JE. Cardiovascular responses during orthostasis: Effect of an increase in VO2max. Aviat Space Environ Med 1984; 55:702-708.Google Scholar
  306. 306.
    Hinghofer-Salkay HG, Noskov VB, Rossler A, et al. Endocrine status and LBNP- induced hormone changes during a 438-day spaceflight: A case study. Aviat Space Environ Med 1999; 70:1-5.Google Scholar
  307. 307.
    Whitson PA, Charles JB, Williams WJ, et al. Changes in sympathoadrenal response to standing in humans after spaceflight. J Appl Physiol 1995; 79:428-433.PubMedGoogle Scholar
  308. 308.
    Piwinski SAE, Jankovic J, McElligott MA. A comparison of post space-flight orthostatic intolerance to vasovagal syncope and autonomic failure and the potential use of the alpha agonist midorine for these conditions. J Clin Pharmacol 1994; 34:466-471.PubMedGoogle Scholar
  309. 309.
    Ramsdell CD, Mullen TJ, Sundby GH, et al. Midodrine prevents orthostatic intolerance associated with simulated space-flight. J Appl Physiol 2001; 90:2245-2248.PubMedGoogle Scholar
  310. 310.
    Buckey JC, Peshock RM, Blomqvist CG. Deep venous contribution to hydrostatic blood volume change in the human leg. Am J Cardiol 1988; 62:449-453.PubMedGoogle Scholar
  311. 311.
    Thornton WE, Hoffler GW. Hemodynamic studies of the leg under weightlessness. In: Johnston RS, Dietlein LF (eds.), Biomedical Results from Skylab. Washington, DC: US Government Printing Office; 1977:324-329. NASA SP-377.Google Scholar
  312. 312.
    Rummel JA, Michel EL, Berry CA. Physiological response to exercise after spaceflight. Aerospace Med 1973; 44:235-238.PubMedGoogle Scholar
  313. 313.
    Atkov OY, Bednenko VS, Fomina GA. Ultrasound techniques in space medicine. Aviat Space Environ Med 1987; 58:A69-A73.PubMedGoogle Scholar
  314. 314.
    Georgiyevskiy VS, Lapshina NA, Andriyako LY, et al. Circulation in exercising crew members of the first main expedition aboard Salyut-6. Kosm Biol Aviakosm Med 1980; 14:15-18.Google Scholar
  315. 315.
    Vorobyov EI, Gazenko OG, Genin AM, et al. Main medical results of Salyut-6 manned spaceflights. Aviat Space Environ Med 1983; 54:S31-S40.PubMedGoogle Scholar
  316. 316.
    Perhonen MA, Zuckerman JH, Levine BD. Deterioration of left ventricular chamber performance after bed rest. Circulation 2001; 103:1851-1857.PubMedGoogle Scholar
  317. 317.
    Lee SM, Moore AD, Fritsch-Yelle JM, et al. Inflight exercise affects stand test responses after spaceflight. Med Sci Sports Exerc 1999; 31:1755-1762.PubMedGoogle Scholar
  318. 318.
    Engelke KA, Doerr DF, Convertino VA. Application of acute maximal exercise to protect othorstatic tolerance after simulated microgravity. J Appl Physiol 1996; 40:R837-R847.Google Scholar
  319. 319.
    Rowell LB, Detry JMR, Blackmon JR, et al. Importance of the splanchnic vascular bed in human blood pressure regulation. J Appl Physiol 1972; 32:213-220.PubMedGoogle Scholar
  320. 320.
    Greenleaf JE, Vernikos J, Wade CE, et al. Effect of leg exercise on vascular volumes during 30 days of 6 (degree) head-down bed rest. J Appl Physiol 1992; 72:1887-1894.PubMedGoogle Scholar
  321. 321.
    Convertino VA, Doerr DF, Flores JF, et al. Leg size and muscle functions associated with leg compliance. J Appl Physiol 1988; 64:1017-1021.PubMedGoogle Scholar
  322. 322.
    Green HJ, Thomson JA, Ball ME, et al. Alterations in blood volume following short-term supramaximal exercise. J Appl Physiol 1984; 56:145-149.PubMedGoogle Scholar
  323. 323.
    Siconolfi SF, Charles JB, Moore AD, et al. Comparing the effects of two in-flight aerobic exercise protocols on standing heart rates and VO2peak before and after spaceflight. J Clin Pharmacol 1994; 34:590-595.PubMedGoogle Scholar
  324. 324.
    Pawelczyk JA, Kenny WL, Kenney P. Cardiovascular response to head-up tilt after an endurance exercise program. Aviat Space Environ Med 1988; 59:107-112.PubMedGoogle Scholar
  325. 325.
    Lathers CM, Charles CB. Orthostatic hypotension in patient, bed rest subjects, and astronauts. J Clin Pharmacol 1994; 34:403-417.PubMedGoogle Scholar
  326. 326.
    Tietze KJ, Putcha L. Factors affecting drug bioavailability in space. J Clin Pharmacol 1994; 34:671-676.PubMedGoogle Scholar
  327. 327.
    Srinivasan SR, Bourne DWA, Putcha L. Application of physiologically based pharmacokinetic models for assessing drug disposition in space. J Clin Pharmacol 1994; 34:692-698.PubMedGoogle Scholar
  328. 328.
    Whitson PA, Pietrzyk RA, Sams CF. Urine volume and its effects on renal stone risk in astronauts. Aviat Space Environ Med 2001; 72:368-372.PubMedGoogle Scholar
  329. 329.
    Hoyer JR, Pietrzyk RA, Liu H, et al. Effects of microgravity on urinary osteopontin. J Am Soc Nephrol 1999; 10:S389-S393.PubMedGoogle Scholar
  330. 330.
    Whitson PA, Pietrzyk RA, Pak CYC, et al. Alterations in renal stone risk factors after spaceflight. J Urol 1993; 150:803-807.PubMedGoogle Scholar
  331. 331.
    Pak CYC, Sakhaee K, Crowther C, et al. Evidence justifying a high fluid intake in treatment of nephrolithiasis. Ann Intern Med 1980; 93:36-39.PubMedGoogle Scholar
  332. 332.
    Medical Operations Branch. Space and Life Sciences Directorate. ISS Medical Operations Data and Communications Concepts and Requirements. Houston, TX: NASA-Johnson Space Center; 2000 JSC 28289.Google Scholar
  333. 333.
    Johnson PC. Fluid volume changes induced by spaceflight. Acta Astronaut 1969; 6:1335-1341.Google Scholar
  334. 334.
    Greenleaf JE, van Beaumont W, Bernauer EM, et al. Effects of rehydration on +Gz tolerance after 14 days of bedrest. Aerospace Med 1973; 44:715-722.PubMedGoogle Scholar
  335. 335.
    Greenleaf JE, Jackson CGR, Geelen G, et al. Plasma volume expansion with oral fluids in hypohydrated med at rest and during exercise. Aviat Space Environ Med 1998; 69:837-844.PubMedGoogle Scholar
  336. 336.
    Bungo MW, Charles JB, Johnson PC. Cardiovascular deconditioning during spaceflight and the use of saline as a countermeasure to orthostatic intolerance. Aviat Space Environ Med 1985; 56:985-990.PubMedGoogle Scholar
  337. 337.
    Frey MB, Riddle J, Charles JB, Bungo MW. Blood and urine responses to ingesting fluids of various salt and glucose concentrations. J Clin Pharmacol 1991; 31:880-887.PubMedGoogle Scholar
  338. 338.
    Nicogossian AE, Pool SL, Sawin CF. Status and efficacy of countermeasures to physiological deconditioning from space-flight. Acta Astronaut 1995; 37:393-398.Google Scholar
  339. 339.
    Burton RR, Krutz RW. G-tolerance and protection with anti-G suit concepts. Aviat Space Environ Med 1975; 46:119-124.Google Scholar
  340. 340.
    Convertino VA, Reister CA. Effect of G-suit protection on carotid-cardiac baroreflex function. Aviat Space Environ Med 2000; 71:31-36.PubMedGoogle Scholar
  341. 341.
    Krutz RW, Sawin CF, Stegmann BJ, et al. Preinflation before acceleration on tolerance to simulated space shuttle reentry G profiles in dehydrated subjects. J Clin Pharmacol 1994; 34:480-483.PubMedGoogle Scholar
  342. 342.
    Tripp LD, Jennings TJ, Seaworth JF, et al. Long-duration +Gz acceleration on cardiac volumes determined by two dimensional echocardiography. J Clin Pharmacol 1994; 34:484-488.PubMedGoogle Scholar
  343. 343.
    Güell A, Braal L, Gharib C. Cardiovascular deconditioning during weightlessness simulation and the use of lower body negative pressure as a countermeasure to orthostatic intolerance. Aviakosm Ekolog Med 1990; 33:S31-S33.Google Scholar
  344. 344.
    Egorov A, Anashkin O, Itsehovsky O, et al. Results of medical investigations obtained during a 125-day flight on Salyut-7/Mir Orbital Stations. Physiologist 1988; 31:S-1-S-3.Google Scholar
  345. 345.
    Gazenko OG, Shulzhenko EB, Turchaninova VF, et al. Central and regional hemodynamics in prolonged spaceflights. Acta Astronaut 1988; 17:173-179.PubMedGoogle Scholar
  346. 346.
    Watenpaugh DE, Ballard RE, Breit GA, et al. Self generated lower body negative pressure. Aviat Space Environ Med 1999; 70:522-526.PubMedGoogle Scholar
  347. 347.
    National Space Transportation System. ISS Generic Operational Flight Rules. Houston, TX: NASA-Johnson Space Center; 2000; 12820: B: Section 13, Aeromedical.Google Scholar
  348. 348.
    Convertino VA, Cooke WH, Lurie KG. Inspiratory resistance as a potential treatment for orthostatic intolerance and hemorrhagic shock. Aviat Space Environ Med 2005 Apr.; 76(4): 319-325.PubMedGoogle Scholar
  349. 349.
    Convertino VA, Ratliff DA, et al. Effects of inspiratory impedance on hemodynamic responses to a squat-stand test in human volunteers: Implications for treatment of orthostatic hypotension. Eur J Appl Physiol 2005; 94:392-399.PubMedGoogle Scholar
  350. 350.
    Convertino VA, Ratliff DA, et al. Hemodynamics associated with breathing through an inspiratory impedance threshold device in human volunteers. Crit Care Med 2004; 32(9 Suppl): S381-S386.PubMedGoogle Scholar
  351. 351.
    Billica RD, Simmons SC, Mathes KL, et al. Perception of medical risk of spaceflight. Aviat Space Environ Med 1996; 67:467-473.PubMedGoogle Scholar
  352. 352.
    Committee on Space Biology and Medicine Space Studies Board, National Research Council. (A Strategy for Space Biology and Medical Science.) Washington, DC: National Academy Press; 1987.Google Scholar
  353. 353.
    Task Group on Life Sciences, Space Studies Board, National Research Council. Space Science in the Twenty-First Century, Imperatives for the Decades 1995 to 2015.Washington, DC: National Academy Press; 1988.Google Scholar
  354. 354.
    Goldberg RJ, Samad MA, Yazebski J, et al. Temporal trends in cardiogenic shock complicating acute myocardial infarction. N Engl J Med 1999; 340:1162-1168.PubMedGoogle Scholar
  355. 355.
    Hasdai JS, Califf RM, Thompson TD, et al. Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction. J Am Coll Cardiol 2000; 35:136-143.PubMedGoogle Scholar
  356. 356.
    Hochman JS, Buller CE, Sleeper LA, et al. Cardiogenic shock complicating acute myocardial infarction: Etiology, management and outcome: A report from the SHOCK Trial registry. J Am Coll Cardiol 2000; 36:1063-1070.PubMedGoogle Scholar
  357. 357.
    Mant J, Fitzmaurice D, Murray E, et al. Long term anticoagulation or antiplatelet treatment. inclusion criteria determine results of review. BMJ 2001; 323:233-234; discussion 235-236.PubMedGoogle Scholar
  358. 358.
    Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. (Second International Study of Infarct Survival) Collaborative Group. Lancet 1988; 12:3A-13A.Google Scholar
  359. 359.
    French JK, Hyde TA, Patel H, et al. Survival 12 years after randomization to streptokinase: The influence of thrombolysis in myocardial infarction flow at three to four weeks. J Am Coll Cardiol 1999; 34:62-69.PubMedGoogle Scholar
  360. 360.
    Collins R, Peto R, Baigent C, et al. Aspirin, heparin, and fibrinolytic therapy in suspected acute myocardial infarction. N Engl J Med 1997; 336:847-860.PubMedGoogle Scholar
  361. 361.
    An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. The GUSTO investigators. N Engl J Med 1993; 329:673-682.Google Scholar
  362. 362.
    Indications for ACE inhibitors in the early treatment of acute myocardial infarction: Systematic overview of individual data from 100,000 patients in randomized trials. ACE Inhibitor Myocardial Infarction Collaborative Group. Circulation 1998; 97:2202-2012.Google Scholar
  363. 363.
    Domanski MJ, Exner DV, Borkowf CB, et al. Effect of angiotensin converting enzyme inhibition on sudden cardiac death in patients following acute myocardial infarction. A meta-analysis of randomized clinical trials. J Am Coll Cardiol 1999; 33: 598-604.PubMedGoogle Scholar
  364. 364.
    Latini R, Tognoni G, Maggioni AP, et al. Clinical effects of early angiotensin-converting enzyme inhibitor treatment for acute myocardial infarction are similar in the presence and absence of aspirin: Systematic overview of individual data from 96,712 randomized patients. Angiotensin-Converting Enzyme Inhibitor Myocardial Infarction Collaborative Group. J Am Coll Cardiol 2000; 35:1801-1907.PubMedGoogle Scholar
  365. 365.
    Weaver WD, Simes RJ, Betriu A, et al. Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: A quantitative review. JAMA 1997; 278:2093-2098.PubMedGoogle Scholar
  366. 366.
    Cucherat M, Bonnefoy E, Tremeau G. Primary angioplasty versus intravenous thrombolysis for acute myocardial infarction. Cochrane Database Syst Rev 2000; 2:CD001560.PubMedGoogle Scholar
  367. 367.
    Freemantle N, Cleland J, Young P, et al. Beta blockade after myocardial infarction: Systematic review and meta regression analysis. BMJ 1999; 318:1730-1737.PubMedGoogle Scholar
  368. 368.
    Cohen M, Blaber R, Demers C, et al. The Essence Trial: Efficacy and safety of subcutaneous enoxaparin in unstable angina and non-Q-wave MI: A double-blind, randomized, parallelgroup, multicenter study comparing enoxaparin and intravenous unfractionated heparin: Methods and design. J Thromb Thrombolysis 1997; 4:271-274.PubMedGoogle Scholar
  369. 369.
    Cohen M, Demers C, Gurfinkel EP, et al. Low-molecular-weight heparins in non-st-segment elevation ischemia: The ESSENCE Trial. Efficacy and safety of subcutaneous enoxaparin versus intravenous unfractionated heparin, in non-Q-wave coronary events. Am J Cardiol 1998; 82:19L-24L.PubMedGoogle Scholar
  370. 370.
    Cohen M, Demers C, Gurfinkel EP, et al. A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease. Efficacy and safety of sub-cutaneous enoxaparin in non-Q-wave coronary events study group. N Engl J Med 1997; 337:447-452.PubMedGoogle Scholar
  371. 371.
    Goodman SG, Cohen M, Bigonzi F, et al. Randomized trial of low molecular weight heparin (enoxaparin) versus unfractionated heparin for unstable coronary artery disease: One-year results of the ESSENCE study. Efficacy and safety of subcutaneous enoxaparin in non-Q-wave coronary events. J Am Coll Cardiol 2000; 36:693-698.PubMedGoogle Scholar
  372. 372.
    Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes. The PURSUIT Trial Investigators. Platelet glycoprotein IIb/IIIa in unstable angina: Receptor suppression using integrilin therapy. N Engl J Med 1998; 339:436-443.Google Scholar
  373. 373.
    Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-Q-wave myocardial infarction. Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) Study Investigators. N Engl J Med 1998; 338:1488-1497.Google Scholar
  374. 374.
    Beck G, Pettys R, Smith L. After Action Report. Evaluation of Endotracheal Intubation Methods in Microgravity. Unpublished report, NASA-Johnson Space Center, Houston, TX; 2001 May.Google Scholar
  375. 375.
    Keller C, Brimacombe J, Giampalmo M, et al. Airway management during spaceflight: A comparison of four airway devices in simulated microgravity. Anesthesiology 2000; 92:1237-1241.PubMedGoogle Scholar
  376. 376.
    Bishop MJ, Michalowski P, Hussey JD, et al. Recertification of respiratory therapist’s intubation skills one year after initial training: An analysis of skill retention and retraining. Respir Care 2001; 46:234-237.PubMedGoogle Scholar
  377. 377.
    LeJeune FE. Laryngeal problems in space. Aviat Space Environ Med 1978; 49:1347-1349.PubMedGoogle Scholar
  378. 378.
    Bradley JS, Billows GL, Olinger ML, et al. Prehospital oral endotracheal intubation by rural basic emergency medical technicians. Ann Emerg Med 1998; 32:26-32.PubMedGoogle Scholar
  379. 379.
    Li J, Murphy-Lavoie H, Bugas C, et al. Complications of emergency intubation with and without paralysis. Am J Emerg Med 1999; 17:141-143.PubMedGoogle Scholar
  380. 380.
    Sayre MR, Sakles JC, Mistler AF, et al. Field Trial of endotracheal intubation by basic EMTs. Ann Emerg Med 1999; 31:228-233.Google Scholar
  381. 381.
    Raymondos K, Panning B, Leuwer M, et al. Absorption and hemodynamic effects of airway administration of adrenaline in patients with severe cardiac disease. Ann Intern Med 2000; 132:800-813.PubMedGoogle Scholar
  382. 382.
    Cannon CP, Gibson CM, Lambrew CT, et al. Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction. JAMA 2000; 382:2941-2947.Google Scholar
  383. 383.
    Pomerantz M, Baumgartner R, Lauridson J, et al. Transthoracic electrical impedance for the early detection of pulmonary edema. Surgery 1969; 66:260-268.PubMedGoogle Scholar
  384. 384.
    Ebert TJ, Smith JJ, Barney JA. The use of thoracic impedance for determining thoracic blood volume changes in man. Aviat Space Environ Med 1986; 57:49-53.PubMedGoogle Scholar
  385. 385.
    Gotshall RW, Davrath LR. Bioelectric impedance as an index of thoracic fluid. Aviat Space Environ Med 1999; 70:58-61.PubMedGoogle Scholar
  386. 386.
    Frey MA. Space research activities during missions of the past. Med Sci Sports Exerc 1996; 28:S3-S8.PubMedGoogle Scholar
  387. 387.
    Hamilton DR, Gloss D. Cases in space medicine. Aviat Space Environ Med 2004; 75(3):288-292.PubMedGoogle Scholar
  388. 388.
    Lauer MS. Primary angioplasty—time is of the essence. JAMA 2000; 283:2988-2989.PubMedGoogle Scholar
  389. 389.
    Williams DR, Bashshur RL, Pool SA, et al. A strategic vision for telemedicine and medical informatics in spaceflight. Telemed J E Health 2000; 6:441-448.PubMedGoogle Scholar
  390. 390.
    Morrison LJ, Verbeek PR, McDonald AC, et al. Mortality and prehospital thrombolysis for acute myocardial infarction. JAMA 2000; 283:2686-2692.PubMedGoogle Scholar
  391. 391.
    Hochman JS, Sleeper LA, White HD, et al. One-year survival following early revascularization for cardiogenic shock. JAMA 2001; 285:190-192.PubMedGoogle Scholar
  392. 392.
    Go AS, Hylek EM, Phillips KA, et al. Implications of stroke risk criteria on the anticoagulation decision in nonvalvular atrial fibrillation: The Anticoaguation and Risk Factors in the Atrial Fibrillation (Atria) Study. Circulation 2000; 102:11-13.PubMedGoogle Scholar
  393. 393.
    Solomon SD, Glynn RJ, Greaves S, et al. Recovery of ventricular function after myocardial infarction in the reperfusion era: The healing and early afterloading reducing therapy study. Ann Intern Med 2001; 134:451-458.PubMedGoogle Scholar
  394. 394.
    Stenestrand U, Wallentin L. Early statin treatment following acute myocardial infarction and 1-year survival. JAMA 2001; 285:430-436.PubMedGoogle Scholar
  395. 395.
    Davis JR. Medical issues for a mission to Mars. Aviat Space Environ Med 1999; 70:162-168.PubMedGoogle Scholar
  396. 396.
    Barratt M. Medical support for the International Space Station. Aviat Space Environ Med 1998; 70:155-161.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Douglas R. Hamilton
    • 1
  1. 1.Wyle LaboratoriesHoustonUSA

Personalised recommendations