Hidden and unknown primary conditions affecting cardiovascular health in women that remain untreated.
I am concerned about the primary causes that we may be ignorant of that lead to cardiovascular conditions in women. Sleep apnea can cause secondary injury to the cardiovascular system, we now understand. Treat the sleep apnea and heart problems go away. The problem is the autonomic nervous system function, not the cardiovascular system.
Respiratory rate is set by the brain stem, along with the other vital signs of HR, BP, and body temperature. Yet, It is not a part of medical tradition to measure resting breathing rate or minute ventilation [RR times Tidal Volume] to learn about the state of the complex motor act of the ventilatory system. We think that some cardiovascular conditions could be prevented by looking for those people with hidden, unfelt, silent, unlooked for respiratory depression [with normal lung function]…..as we discovered with Paula.
My friend Paula found out by accident that she has a depressed respiratory rate at rest when awake. The resting respiratory rate is set by the brain stem and should ideally be set so as it can rise or fall easily depending on changing carbon dioxide levels in the blood . Her reflex for chemical stimuli causing rising PCO2 is broken. It seems to have been broken at birth, although it easily could have been broken had she been hit by a bus or car in childhood. The neck and torso have neural sensors to signal the brain stem regarding chemical stimuli and we think these have been injured. {it is only a hypothesis since no one even has heard of depressed respiratory rate at rest when awake as a possible neurological problem ….till our accidental discovery about Paula.
Paula’s resting respiratory rate is very low with normal tidal volume. She feels her breathing to be normal. It is NOT. And no one can tell, unless they count her respiratory rate for one minute with a stopwatch. No one does this. This is an entirely neglected part of the physical exam. Everyone assumes the autonomic nervous system to be working well if a person looks well or even when the person looks sick or even when the person has essential hypertension or depression…..they assume that the complex motor act of breathing is intact [if lung function is normal]. This is a neurological defect/injury; the lungs are completely healthy. We think this to be a huge omission in the practice of medicine.And perhaps especially in cardiovascular medicine.
Paula’s birth history suggests phenotypic biological adjustments due to her anoxia at birth, followed by resuscitation [hyperoxia] and blood transfusion; after which she was fine, really great. this, despite exchanging [as an adult] only 1.5 L of air per minute rather than the assumed 6-8 L. [never assume-lol] . No one can explain it, yet there it is. And it is obviously important. And we think, not as rare as we might think.
We would like someone to do more research on respiratory rate in health and in illness [including cardiovascular, neurological and neuropsychiatric illness] in unmedicated patients at the start of their illness.
Paula’s HCO3 and O2 [PULSE OXIMETRY ONLY] are normal, her routine blood tests are normal and even her cholesterol is fantastic!
So maybe she has a chronically raised PCO2 or maybe not. She is fit [cross country skis for a hobby in winter] and of course, has never had an arterial blood gas test. That is only done today when you are bedridden, critically ill and in the ICU. Which tells us nothing about ambulatory patients and effects of higher PCO2 on the cardiovascular system. I bet it increases the work of the cardiovascular system. And I am not even a doctor, only a psychologist. It is simply common sense.
Paula had one period of depression at the age of 40, and we now think that she had an episode of hypercapnia which can look like disabling depressed mood and mental status and locomotor activity.
Dr Emile Kraepelin, a century ago, measured vital signs as part of his meticulous research and he found thousands of patients like Paula with chronically depressed respiratory rates at rest when awake. They were distressed, had depressed mood and activity, and had depressed [reversible] cognitive function and were in poor physical condition. Dr Kraepelin understood that their condition was a metabolic dysfunction due to hypercapnic respiratory failure. Because he measured the vital signs. Because he measured [hidden] respiratory rates. Because he saw the effects and they were terrible. No wonder these patients looked depressed. I’m sure he was wondering why they were even alive. And the reason is that the brain stem and the autonomic nervous system can compensate, in an otherwise healthy person with healthy hearts and healthy lungs and healthy young adult bodies to compensate.
Most patients remitted spontaneously [there were no treatments then] and regained their normal baseline cognitive status and mood and locomotor activity BUT, it often took decades. they were the only patients in the asylums to do so…to get better…with time…OK sometimes 20 years…too long…but there were no supportive medical treatments or indeed treatments of any kind, back then.
This has never been studied since Kraepelin. Why? People have forgotten. It is too upsetting to think that a person like Paula has broken breathing . Paula can tell you that if she ever gets sick like that again, she would like supportive medical care and expects researchers and clinicians to learn more about people and patients like her.
In that fateful first aid class, the range of respiratory rates was very wide; from Paula’s 3 breaths per minute at rest when awake [with involuntary active exhaling-visible if you looked] to as high as 30 breaths per minute at rest when awake. the average, of course was 12.
It is not unusual for there to be conditions which make respiratory rate more fixed and less flexible to chemical stimuli, especially PCO2 which, as you know, is a normal byproduct of cell metabolism. The brain stem and rising carbon dioxide in the blood “get” each other. It is time we understood this back story too.
Our evolutionary biology must have historically, developed lots of alternative ways to deal with rising carbon dioxide in the blood when injury limits the flexibility of the autonomic and involuntary neural and motor act of breathing.
I think that broken and fixed breathing may be the basic cause [or one of them] of essential hypertension. We have simply assumed that the motor act of breathing is intact if the person does not complain or if their increased work of breathing is normal for them.
Please think about it.Everyone I have tlked to says that this is not theirr areaa of research but it is a basic thing that will lead to breakthroughs for many illnesses, especially cardiovascular issues in women.
Paula is great. She has great doctors who do not understand how she is even alive, never mind well and completely recovered from that bout of depression or whatever it was.
She has been great for decades now- no sudden death and she is 65. I have coffee with her on Zoom every morning as we work through our thoughts….
So there are a lot of questions that need further study.
Paula and I think this is how new knowledge is discovered and we hope that researchers do their part.
Precious time is being wasted…..instead of advancing scientific knowledge…..and we don’t understand why.
And it is especially important for women’s cardiovascular health.
Best Regards
Brigitte [and Paula]
Of Sound Mind 