Cardiovascular: Changes
in the Heart and Blood Vessels
That Affect Astronaut Health
and Performance
The cardiovascular system, including
the heart, lungs, veins, arteries, and
capillaries, provides the cells of the
body with oxygen and nutrients and
allows metabolic waste products
to be eliminated through the kidneys
(as urine) and the gastrointestinal tract.
All of this depends on a strong heart
to generate blood pressure and a
healthy vascular system to regulate
the pressure and distribute the blood,
as needed, throughout the body via
the blood vessels.
For our purposes, the human body
is essentially a column of fluid; the
hydrostatic forces that act on this
column, due to our upright posture
and bipedal locomotion, led to a
complex system of controls to
maintain—at a minimum—adequate
blood flow to the brain.
On Earth, with its normal gravity,
all changes in posture—such as when
lying down, sitting, or standing as
well as changes in activity levels such
as through exercising—require the
heart and vascular system to regulate
blood pressure and distribution by
adjusting the heart rate (beats per
minute), amount of blood ejected by
the heart (or stroke volume), and
constriction or dilation of the
distributing arteries. These adjustments
assure continued consciousness by
providing oxygen to the brain or
continued ability to work, with oxygen
going to the working muscles.
Removing the effects of gravity during
spaceflight and restoring gravity after a
period of adjustment to weightlessness
present significant challenges to
the cardiovascular control system.
The cardiovascular system is stressed
very differently in spaceflight, where
body fluids are shifted into the head
and upper body and changes in
posture do not require significant
responses because blood does not
drain and pool in the lower body.
Although the cardiovascular system
is profoundly affected by spaceflight,
the basic mechanisms involved are still
not well understood.
During the shuttle era, flight-related
cardiovascular research focused on
topics that could benefit the safety and
well-being of crew members while also
revealing the mechanisms underlying
the systemic adjustments to spaceflight.
NASA researchers studied the
immediate responses to the effects of
weightlessness during Space Shuttle
flights and the well-developed systemic
adjustments that followed days and
weeks of exposure. Most
such research related to the loss of
orthostatic tolerance after even brief
flights and to the development of
potentially detrimental disturbances in
cardiac rhythm during longer flights.
Scientists also evaluated the usefulness
of several interventions such as exercise,
fluid ingestion, and landing-day gravity
suits (g-suits) in protecting the
astronauts’ capacities for piloting the
Orbiter—an unpowered, 100-ton
glider—safely to a pinpoint landing,
and especially for making an unaided
evacuation from the Orbiter if it landed
at an alternate site in an emergency.
Orthostatic Intolerance:
Feeling Light-headed and Fainting
on Standing Upright
One of the most important changes
negatively impacting flight operations
and crew safety is landing day
orthostatic intolerance. Astronauts who
have orthostatic intolerance (literally,
the inability to remain standing upright)
cannot maintain adequate arterial blood
pressure and have decreased brain blood
levels when upright, and they experience
light-headedness and perhaps even
fainting. This may impair their ability
to stand up and egress the vehicle after
landing, and even to pilot the vehicle
while seated upright as apparent gravity
increases from weightlessness to 1.6
g
during atmospheric re-entry.
The orthostatic intolerance condition
is complicated and multifactorial.
Its hallmarks are increased heart rate,
decreased systolic blood pressure
and decreased stroke volume during
5 minutes of standing shortly after
landing. The decrease in blood volume
frequently observed is an important
initiating event in the etiology of
orthostatic intolerance, but it is the
subsequent effects and the
physiological responses (or lack
thereof) to those effects that may result
in orthostatic intolerance after shuttle
flights. This is highlighted by the fact
that while all shuttle crew members
who were tested had low blood volume
on landing day, only one-quarter of
them developed orthostatic intolerance
during standing or head-up tilting.
The group of astronauts that developed
orthostatic intolerance lost comparable
amounts of plasma (the watery
portion of the blood, which the body
can adjust quickly) to the group that
did not develop orthostatic intolerance.
But, the group that was not susceptible
had a more pronounced increase in
the functioning of the sympathetic
nervous system, which is important
in responding to orthostatic stress
after returning to Earth. Thus, it is not
the plasma volume loss alone that
causes light-headedness but the lack
of compensatory activation of the
sympathetic system.
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