Hemodynamics following endoscopic thoracic sympathotomy for palmar hyperhidrosis

Erica A. Wehrwein, John E. Schmidt, Rachel L. Elvebak, Tasha L. Pike, John L.D. Atkinson, Robert D. Fealey, John H. Eisenach

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Purpose: We studied patients with palmar hyperhidrosis before and after endoscopic thoracic sympathotomy (ETS) to determine the effect of chronic sympathetic denervation on (1) forearm blood flow (FBF) response to mental stress and (2) exercise tolerance. Methods and results: Twenty-two healthy patients were evaluated before ETS, and 17 returned after surgery (11 F; 19-32 years). We measured heart rate (HR; 12 lead), blood pressure, and FBF (plethysmography, ml dl -1 min -1). Supine HR tended to decrease after ETS (69 ± 10 vs. 66 ± 6, p = 0.2). Mental stress FBF was recorded during baseline, 3-min Stroop color word test, and 2-min recovery. Mental stress responses were unaffected by ETS. However, during post-mental stress recovery period, ETS resulted in a significant elevation in FBF (2 ± 1 vs. 3 ± 1), FVC (3 ± 1 vs. 4 ± 2), and a decrease in FVR (52 ± 22 vs. 32 ± 16, p < 0.01 for all). ETS resulted in a reduction in pre-exercise seated baseline HR (94 ± 2.5 beats/min preoperatively vs. 84 ± 4.3 beats/min postoperatively, p < 0.05), maximal HR response to cycle exercise, and exercise systolic blood pressure (172 ± 5.2 mmHg pre-op vs. 158 ± 5.9 mmHg post-op, p < 0.05) but not mean or diastolic pressure. VO 2max and exercise duration determined by cycle ergometry was unchanged. Conclusions: Functional evidence of upper limb denervation is observed during the FBF recovery period from mental stress and hemodynamic alterations associated with upright cycle exercise. However, the sustained exercise capacity suggests modest clinical consequences.

Original languageEnglish (US)
Pages (from-to)3-10
Number of pages8
JournalClinical Autonomic Research
Issue number1
StatePublished - Feb 2011


  • Exercise testing
  • Hyperhidrosis
  • Mental stress
  • Sympathotomy

ASJC Scopus subject areas

  • Endocrine and Autonomic Systems
  • Clinical Neurology


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