Acute Hypotension Research Articles

Nonsurgical management of complicated splenic rupture in infectious mononucleosis

We report on a 35-year-old man who presented to the emergency department with acute abdominal pain, postural hypotension, and tachycardia after having been diagnosed with Epstein-Barr virus infection 1 week before. Abdominal ultrasound and computed tomography revealed splenic rupture, and the patient underwent successful proximal angiographic embolization of the splenic artery. The course was complicated by painful splenic necrosis and respiratory insufficiency due to bilateral pleural effusions. Six weeks later, he additionally developed severe sepsis with Propionibacterium granulosum due to an intrasplenic infected hematoma, which required drainage. All complications were treated without surgical splenectomy, and the patient finally made a full recovery.

A severe case of haemodynamic instability during anidulafungin administration

Anidulafugin is an echinocandin used for the treatment of candida infections in non-neutropenic adults. Echinocandins show few drug-drug interactions and are usually well tolerated. We report a case of acute hypotension, bradycardia and haemodynamic instability with consecutive cardiopulmonary resuscitation during anidulafungin administration. A 41-year-old man ICU patient received anidulafungin for a suspected Candida glabrata infection. During the first administration of the drug, he developed acute haemodynamic instability with hypotension and bradycardia. The infusion was discontinued immediately and cardiopulmonary resuscitation was performed successfully. The patient regained haemodynamic stability. To the authors' knowledge, this is the first report of a life-threatening adverse event due to haemodynamic instability during anidulafungin administration. Cardiac toxicity associated with echinocandins has been described. Further studies seem to be mandatory to investigate this potential risk.

Arterial baroreflex control of sympathetic nerve activity during acute hypotension is enhanced in young normotensive black men

Although impairments in arterial baroreflex (ABR) control of heart rate have been reported in black compared to white subjects, no studies have examined the potential for racial differences in the ABR control of muscle sympathetic nerve activity (MSNA). Therefore, we tested the hypothesis that ABR control of MSNA is impaired in young black men compared to white men. In 12 non‐hypertensive men (7 black and 5 white, age 18–27 yr) ABR control of MSNA was determined using 100μg i.v. of sodium nitroprusside (NTP) followed 1 min later by 150μg of phenylephrine (PE) during supine rest (3 trials/subject). The slope of the relationship (i.e., gain) between changes in diastolic blood pressure and MSNA was determined. Overall sympathetic baroreflex gain was not different between racial groups (blacks: − 1.9±0.2 vs. whites: −2.4 ± 0.4 AU·beat·mmHg−1, p>;0.05). Similarly, sympathetic baroreflex gain for hypertension (PE phase) was also not different between groups (blacks: −1.9±0.3 vs. whites: −1.7±0.2 AU·beat·mmHg−1, p>;0.05). However, sympathetic baroreflex gain for hypotension (NTP phase) was significantly elevated in blacks (−4.0±0.3) compared to whites (−3.2±0.1 AU·beat·mmHg−1, p<0.05). In contrast to our hypothesis, these preliminary findings suggest that ABR control of MSNA is similar or enhanced in young blacks compared to their white counterparts.Supported by NIH Grant R15HL096103 (DMK) and RO1 HL093167 (PJF)

Muscle metaboreflex activation speeds the recovery of arterial blood pressure following acute hypotension in humans

It has been suggested that the arterial baroreflex and muscle metaboreflex are both activated during heavy exercise and that they interact to modulate primary cardiovascular reflex responses. This proposed interaction and its consequences are not fully understood, however. The purpose of present study was to test our hypothesis that dynamic arterial baroreflex-mediated cardiovascular responses to acute systemic hypotension in humans are augmented when the muscle metaboreflex is active and that this results in a faster recovery of arterial blood pressure. Acute hypotension was induced nonpharmacologically in 12 healthy subjects by releasing bilateral thigh cuffs after 9 min of suprasystolic resting ischemia, with and without muscle metaboreflex activation via postexercise muscle ischemia (PEMI) after 1 min of isometric handgrip exercise at 50% maximum voluntary contraction. The thigh-cuff release evoked rapid reductions in mean arterial pressure (MAP) and increases in heart rate, cardiac output (Doppler), and total vascular conductance (TVC) under control conditions and during PEMI. The reductions in MAP from baseline were greater and the increases in TVC were smaller during PEMI than control. In addition, arterial baroreflex-mediated peripheral vasoconstriction was augmented during PEMI, as evidenced by a near doubling of the rate of recovery of MAP and TVC. These results show that when the muscle metaboreflex is activated in humans, arterial baroreflex-mediated peripheral vasoconstriction elicited in response to acute hypotension is augmented, which halves the time needed for MAP recovery. Such modulation of baroreflex function would be advantageous for maintaining an elevated arterial blood pressure during activation of the muscle metaboreflex.

Risk factors for acute kidney injury in the elderly undergoing contrast-enhanced computed tomography in the emergency department

BackgroundThere have been few studies focusing on the incidence and risk factors for elderly patients undergoing computed tomography (CT) scans with intravascular contrast medium, who develop contrast-induced nephropathy (CIN) in the emergency department (ED). Our objective was to investigate the incidence of and risk factors for, CIN in elderly patients seen in the ED, who receive intravenous contrast media for CT examination. MethodsPatients ≥65 years of age who received contrast-enhanced CT were eligible for inclusion in this retrospective analysis. CIN was defined as an increase in serum creatinine (sCr) ≥0.5 mg/dL 48 to 72 hours after intravenous contrast administration. Multiple logistic regression analysis for risk factors for CIN and Chi-square test were performed for trend analysis for CIN incidence and mortality of different risk scores. ResultsA total of 594 patients, with a mean age of 79.8 ± 6.8 years were included. The overall incidence of CIN was 8.6%. In multivariate analyses, CIN was associated with diabetes mellitus [adjusted odds ratio (OR) = 1.93; 95% confidence interval (CI) = 1.04–3.62], precontrast sCr >1.5 mg/dL (OR = 2.72; 95% CI = 1.44–5.13), and acute hypotension (OR = 3.56; 95% CI = 1.29–9.84). CIN and mortality increased with increasing risk score (p < 0.001 and p = 0.001, respectively). The all-cause in-hospital mortality rate was 13.1%, and the mortality rates for patients with and without CIN (p < 0.001) were 47.1% and 9.9%, respectively. ConclusionOur investigation confirmed diabetes mellitus, precontrast sCr >1.5 mg/dL and acute hypotension as risk factors for CIN, and also developed a simple risk score for elderly patients seen in the ED.

Spontaneous rectus sheath hematoma diagnosed by point-of-care ultrasonography

Spontaneous rectus sheath hematoma is an uncommon condition that can mimic other conditions associated with an acute abdomen. We report the case of a patient with a spontaneous rectus sheath hematoma due to a ruptured inferior epigastric artery pseudoaneurysm who presented with hypotension and severe abdominal pain and was diagnosed using emergency department point-of-care ultrasonography. Point-of-care ultrasonography has been increasingly used in the evaluation of emergency department patients with acute abdomen and hypotension to expedite the diagnosis and management of aortic aneurysm and intraperitoneal bleeding. Resuscitation and urgent surgical and interventional radiology consultations resulted in the successful embolization of a branch of the inferior epigastric artery and a good outcome.

Haemoperitoneum with hereditary haemorrhagic telangiectasia

In August, 2011, an 83-year-old woman presented to our emergency department with several days of diff use persistent abdominal pain. She also reported an episode of lower gastrointestinal bleeding with symptoms of orthostasis. She had a history of cardiac failure, pulmonary hypertension, and epistaxis of un known cause. On initial physical examination she was haemodynamically stable without signs of acute ab dom inal disease. She had oral mucocutaneous telangiectases. Gastric lavage was done, and no evidence of upper gastrointestinal bleeding was seen. Blood tests showed a haematocrit concentration reduction from 25% to 20%, and a haemoglobin of 69 g/L. She was admitted for blood transfusion and assessment. After 5 days, she developed acute abdominal pain, tachycardia (135 beats per min), and hypotension (80/40 mm Hg). Sonography of the abdomen showed a large amount of free abdominal fl uid. Multi-detector computed tomography (MDCT) of the abdomen and pelvis confi rmed intra-abdominal fl uid and also showed liver arteriovenous malformations. CT-guided paracentesis confi rmed a diagnosis of haemo peritoneum. An emergency surgical exploration of the abdominal cavity was done because of her poor clinical condition. Explor ation showed haemo peritoneum and a portal vein branch with active bleeding due to the vascular malformations (fi gure). Haemostatic suturing was done to stop bleeding, and the abdominal cavity was drained. She had an uneventful postoperative course and was discharged at postoperative day 10. At last follow-up in Lancet 2013; 381: 962

A different reason for cerebrovascular disease

Bee stings are commonly encountered worldwide. Various manifestations after a bee sting have been described. Local reactions are common. Unusually, manifestations such as vomiting, diarrhea, dyspnea, generalized edema, acute renal failure, hypotension, and collapse may occur. Rarely, vasculitis, serum sickness, neuritis, and encephalitis have been described, which generally develop days to weeks after a sting. We report a case of a 35-year-old man who developed neurologic deficit 6 hours after a bee sting, which was confirmed to be left parietooccipital infarction on magnetic resonance imaging scan. We report this case due to its rarity.

Dual inhibition of the renin–angiotensin system in high-risk diabetes and risk for stroke and other outcomes

A recent study suggested that addition of a direct renin inhibitor to either an angiotension-converting enzyme (ACE) inhibitor (ACEi) or an angiotensin receptor blocker (ARB) may increase stroke risk in people with diabetes and renal disease. We examined the effects of addition of an ACE inhibitor (ramipril) to an ARB (telmisartan) for a mean follow-up of 56 months in people with diabetes [n = 9628, mean age 66 years, baseline blood pressure 144/82 mmHg, BMI 29 kg/m², estimated glomerular filtration rate (eGFR) 73 ml/min, and urine albumin 11 mg/mmol] who participated in the ONTARGET trial, divided by those with (n = 3163) and without (n = 6465) nephropathy. We compared participants on monotherapy with either ramipril or telmisartan with those on dual therapy. SBP decreased more with dual over monotherapy (-7.1 vs. -5.3 mmHg, P < 0.0001) and the same number of strokes occurred (1.19 vs. 1.22 per 100 patient-years; hazard ratio 0.99, 95% confidence interval 0.82-1.20). Stroke rate was higher in participants with than those without diabetic nephropathy (1.5 vs. 1.0 per 100 patient-years), but effects of dual-therapy vs. monotherapy were not different in either subgroup (1.59 vs. 1.55 and 1.01 vs. 1.08 per 100 patient-years; P value for interaction = 0.60). Other cardiovascular and kidney outcomes (dialysis or doubling of serum creatinine) did not differ between dual-therapy and monotherapy in subgroups, but adverse events, namely acute dialysis, hyperkalemia and hypotension, tended to be more frequent with dual therapy, A combination of ACEi and ARB does not increase strokes or alter other major cardiovascular or renal events in patients with diabetes, irrespective of the presence of nephropathy.

Hypertensive nephrosclerosis: not enough of a good thing?

glutathione s -transferases (GSTs) are multifunctional enzymes that are perhaps best known to participate in cell detoxification by catalyzing the conjugation of reduced glutathione to a wide variety of xenobiotics that have electrophilic centers. Production of these adducts promotes cytoprotection

Subclavian artery perforation and hemothorax after right internal jugular vein catheterization

Subclavian artery perforation and hemothorax after right internal jugular vein catheterization

Perforated solitary giant true jejunal diverticulum

Jejunal diverticula are rare and usually asymptomatic. However, they may cause chronic non-specific symptoms or rarely lead to an acute presentation. Here, we report a rare case of a child presenting with a perforated congenital jejunal diverticulum. We report a case of 10-year-old female who presented with severe acute abdominal pain, repeated vomiting, hypotension, and tachycardia of 1 day duration. Chest X-ray showed free air under diaphragm and abdominal X-ray displayed dilated bowel loops. Laboratory investigations showed leukocytosis and hyperamylasemia. After intravenous (IV) fluid resuscitation, diagnostic laparoscopy was performed that detected the presence of perforated solitary giant jejunal diverticulum, about 25 cm from the duodenojejunal junction, in addition to diffuse peritonitis. We had to convert to laparotomy due to the presence of huge amount of undigested food particles. Resection of the diverticulum-bearing segment and anastomosis was done along with thorough peritoneal decontamination and washout. Solitary giant jejunal diverticulum is a rare condition which can present with chronic vague abdominal pain and altered bowel habits, and can present acutely with complications as perforation with significant morbidity.

Epinephrine and phenylephrine pretreatments for preventing postreperfusion syndrome during adult liver transplantation

Acute hypotension after reperfusion of the liver graft occurs frequently during liver transplantation. A randomized, prospective trial was performed to test the effects of epinephrine and phenylephrine pretreatments for attenuating postreperfusion syndrome (PRS). Ninety-three adult liver recipients were randomly allocated to receive an intravenous bolus of 10 μg of epinephrine, 100 μg of phenylephrine, or normal saline (the control group) at the time of graft reperfusion. The occurrence of PRS, the use of vasoactive drugs, and the postoperative courses were compared. The epinephrine and phenylephrine groups showed PRS less frequently (39% and 48%) than the control group (77%, P = 0.006) as well as higher mean arterial pressures (MAPs) immediately after reperfusion (P < 0.05). An overshoot of MAP was observed in one-third of the pretreated patients with minimal heart rate changes. Only 2 patients in each pretreatment group showed an increase in MAP that was greater than 20% of the baseline value. The intraoperative epinephrine and dopamine requirements were significantly lower in both pretreatment groups. Perioperative laboratory data, postoperative stays, and in-hospital mortality rates were similar for the 3 groups. In conclusion, pretreatment with 10 μg of epinephrine or 100 μg of phenylephrine significantly reduces the occurrence of PRS and vasopressor requirements without immediate or delayed adverse effects in adult liver transplantation.

Tyrosine Hydroxylase Phosphorylation in Catecholaminergic Brain Regions: A Marker of Activation following Acute Hypotension and Glucoprivation

The expression of c-Fos defines brain regions activated by the stressors hypotension and glucoprivation however, whether this identifies all brain sites involved is unknown. Furthermore, the neurochemicals that delineate these regions, or are utilized in them when responding to these stressors remain undefined. Conscious rats were subjected to hypotension, glucoprivation or vehicle for 30, 60 or 120 min and changes in the phosphorylation of serine residues 19, 31 and 40 in the biosynthetic enzyme, tyrosine hydroxylase (TH), the activity of TH and/or, the expression of c-Fos were determined, in up to ten brain regions simultaneously that contain catecholaminergic cell bodies and/or terminals: A1, A2, caudal C1, rostral C1, A6, A8/9, A10, nucleus accumbens, dorsal striatum and medial prefrontal cortex. Glucoprivation evoked phosphorylation changes in A1, caudal C1, rostral C1 and nucleus accumbens whereas hypotension evoked changes A1, caudal C1, rostral C1, A6, A8/9, A10 and medial prefrontal cortex 30 min post stimulus whereas few changes were evident at 60 min. Although increases in pSer19, indicative of depolarization, were seen in sites where c-Fos was evoked, phosphorylation changes were a sensitive measure of activation in A8/9 and A10 regions that did not express c-Fos and in the prefrontal cortex that contains only catecholaminergic terminals. Specific patterns of serine residue phosphorylation were detected, dependent upon the stimulus and brain region, suggesting activation of distinct signaling cascades. Hypotension evoked a reduction in phosphorylation in A1 suggestive of reduced kinase activity. TH activity was increased, indicating synthesis of TH, in regions where pSer31 alone was increased (prefrontal cortex) or in conjunction with pSer40 (caudal C1). Thus, changes in phosphorylation of serine residues in TH provide a highly sensitive measure of activity, cellular signaling and catecholamine utilization in catecholaminergic brain regions, in the short term, in response to hypotension and glucoprivation.

Acute renal failure in Weil's disease

Leptospirosis is an emerging worldwide zoonotic disease. Renal involvement is common; it may vary from sub-clinical course with mild proteinuria and urinary sediment changes to severe renal failure. Leptospirosis-induced acute kidney injury is usually non oliguric and hypokalaemic. Renal impairment is mainly characterized by an association of interstitial and tubular damages. The most severe form of Leptospirosis, characterized by jaundice, acute kidney injury and haemorrhagic diathesis, is referred as Weil's disease. We describe a Weil's disease case with oliguric and hypokalaemic acute renal failure, hypotension, jaundice and lung haemorrhage. We performed haemodialysis treatment, steroid and antibiotic therapy with complete recovery of renal function.

Risk factors for mortality in patients with acute kidney injury and hypotension treated with continuous veno-venous hemodiafiltration

BackgroundContinuous veno-venous hemodiafiltration (CVVHDF) is a preferred treatment modality in hemodynamically unstable acute kidney injury (AKI) patients, because it has advantages over intermittent dialysis in terms of hemodynamic stability. However, this patient group still shows a significantly high mortality rate. To aid in the management of these high-risk patients, we evaluated the risk factors for mortality in CVVHDF-treated hypotensive AKI patients. MethodsWe studied 67 patients with AKI and hypotension who were treated with CVVHDF from February 2008 to August 2010. We reviewed patient characteristics and laboratory parameters to evaluate the risk factors for 90-day mortality. ResultsOf the 67 enrolled patients (male:female=42:25; mean age=69±14 years), 18 (27%) survived until 90 days after the initiation of CVVHDF. There was no significant difference in survival rates according to the etiology of AKI [hypovolemic shock 2/10 (20%), cardiogenic shock 4/20 (20%), septic shock 12/37 (32%)]. Univariate analysis did show significant differences between survivors and non-survivors in the frequency of ventilator use (44% vs. 76%, respectively; P=0.02), APACHE II score (29±7 vs. 34±7, respectively; P=0.01), SOFA score (11±4 vs. 13±4, respectively; P=0.03), blood pH (7.3±0.1 vs. 7.2±0.1, respectively; P=0.03), and rate of urine output <500mL for 12hours (50% vs. 80%, respectively; P=0.03). A multivariate Cox proportional hazards model showed that a urine output<500mL for 12hours was the only significant risk factor for 90-day mortality following CVVHDF treatment (odds ratio=2.1, confidence interval=1.01–4.4, P=0.048). ConclusionA urine output<500mL for 12hours before the initiation of CVVHDF is an independent risk factor for 90-day mortality in hypotensive AKI patients treated with CVVHDF.

Acute Liver Failure Due to Herpes Simplex Virus in an Immunocompetent Patient

Purpose: A 48-year-old male with a history of sleep apnea and nephrolithiasis presented to an outside hospital with hepatitis, acute renal failure, hypotension, and pancytopenia. Five days earlier, he developed nausea, vomiting, night sweats, diarrhea, headache, intermittent fever, and chills. The patient did not use tobacco, alcohol, or illicit drugs. On transfer to our hospital on day 8 of his illness, he was febrile, tachypneic, tachycardic, and encephalopathic, but responsive. No icterus or asterixis was present. His abdomen was unremarkable. Petechia were present but no herpetic lesions. AST and ALT peaked at 9438 and 8230, respectively. Intial bilirubin and INR were normal. INR worsened, and bilirubin peaked at 4. He had hepatic steatosis and splenomegaly by CT. Hepatitis serologies, EBV, CMV, ANA, RF, anti-michochondrial antibodies, anti-smooth muscle antibodies, HIV, and HSV I/II IgM were negative. Blood, urine, and stool cultures were negative. The patient was intubated, started on hemodialysis for ARF, and begun on broad-spectrum antibiotics and doxycycline for possible rickettsial infection. However, over the course of the next 48 hours, the patient's condition deteriorated rapidly. He was taken for liver transplant but arrested and was not able to be resuscitated. Liver pathology showed herpes simplex hepatitis with massive hepatic necrosis with less than 10% viable hepatic parenchyma. Discussion: HSV hepatitis is a rare cause of acute liver failure (ALF) but occurs in immunocompromised and immunocompetent patients at a rate of 0.4%-1.4% of cases of ALF. The diagnosis is usually made post-mortem due to a lack of characteristic features and awareness. Common features of HSV hepatitis include fever, leucopenia, thrombocytopenia, elevated transaminases, encephalopathy, coagulopathy, and the absence of herpetic lesions or icterus. Both primary and secondary HSV-1 and HSV-2 infections are potential causes of hepatitis, and measurement of HSV IgM is often not helpful, as was the case in this patient. HSV PCR may be a more reliable method of diagnosis, as this has been found to be uniformly high in patients with HSV ALF. If HSV hepatitis is suspected, acyclovir should be started and transjugular biopsy should be undertaken to confirm diagnosis. Some recommend that all patients with ALF of unknown etiology be started on empiric acyclovir until a cause is determined. Liver transplant may be an option, although morbidity and mortality remain high post-transplant. A difficult diagnosis to make, clinicians should maintain a high index of suspicion for HSV infection in all cases of ALF even in immunocompetent patients and in the absence of herpetic lesions.

Efficacy and safety of adoptive immunotherapy using anti-CD19 chimeric antigen receptor transduced T-cells: a systematic review of phase I clinical trials

There remain some key questions regarding the adoptive infusion of chimeric antigen receptor (CAR) transduced T-cells in the clinical setting. This article systematically reviews the phase I clinical trials using CARs targeting CD19 in B-lineage malignancies. Twenty-nine patients were enrolled and the 6-month progression free survival for this cohort was 50.0 ± 9.9%. Univariate analysis showed that patients benefited from lymphodepletion before CAR+T-cell infusion and the administration of interleukin-2 (IL-2). Longer-term persistence (≥ 4 weeks) and stronger expansion of CAR+ T-cells in the blood and higher peak serum interferon-γ (IFN-γ) level (≥ 200 pg/mL) were also related to superior outcome. Regarding treatment-related adverse events, the most prominent toxicities were fever, rigors, chills, acute renal failure, hypotension and capillary leak syndrome. In conclusion, anti-CD19 CAR+ T-cells have shown some benefits in patients with B-lineage malignancies and are well tolerated in most patients. Preconditioning and cytokine supplement are required to improve the clinical outcome.

Low blood pressure

The link between high maternal blood pressure and poor pregnancy outcome is well established. Similarly the causal relationship between acute maternal hypotension and acute fetal distress is well recognised. The link between poor pregnancy outcome and persistent maternal hypotension is less well known. McClure Brown [1] was the first to report an increase in perinatal mortality in the presence of persistent maternal hypotension. In a prospective trial involving more than 7,000 primigravid women conducted in the 1960s he noticed a “curious” association between low initial (first visit) systolic and diastolic blood pressure and increased risk of stillbirth. Nearly 20 years later Friedman and Neff [2] also found a similar level of risk in a population based study of more than 38,000 women who presented with persistently low (over 4 visits) diastolic hypotension and poor pregnancy outcome. A number of German studies conducted in the 1980s also variously reported findings suggesting a relationship between maternal hypotension and poor pregnancy outcome such as FGR and stillbirth. For example, a retrospective study comparing hypotensive pregnant women with their normotensive peers found there was an increased risk of preterm birth, IUGR and complications such as meconium stained liquor and post partum hemorrhage in the hypotensive group [3]. There were seven stillbirths in total in their study, four in the hypotensive and three in the normotensive groups, but the study was underpowered to detect any statistically significant difference on this rare outcome. Zhang and Klebanoff [4] further investigated the “paradox” of hypotension. Using the same data bank as Friedman and Neff they found the lower the baseline the higher the risk of poor pregnancy outcome. They suggested that the mechanism for this finding may be poor placental perfusion in the hypotensive group, also implicated in several of the German studies. In another large population based study Steer et al [5] described higher risk of low birth weight and increased risk of perinatal mortality in their hypotensive group. Although Chen [6] pointed out that this finding may be due to failure to take into account gestational length, in a case-control study matched for gestational age [7] still found an association between hypotension and stillbirth. It is problematic that previously reported studies have defined maternal hypotension differently. However, Warland [7] attempted to address this by including all previously used definitions as well as mean arterial pressure (MAP). Diastolic hypotension and low MAP seemed more “dangerous” than systolic hypotension and this supports findings from earlier German studies which suggest that the casual mechanism for hypotension on poor pregnancy outcome is poor placental perfusion. In summary, there is a small body of research which has consistently demonstrated the negative effect of persistent maternal hypotension on poor pregnancy outcome including stillbirth. These studies have been conducted using a range of approaches including prospective cohort, retrospective case-control and population based data bank analysis. Many questions remain unanswered, including the definition of hypotension, the level at which hypotension becomes problematic, and how best to manage maternal hypotension in pregnancy.

Feasibility of conjunctival hemodynamic measurements in rabbits: reproducibility, validity, and response to acute hypotension.

To evaluate the feasibility of conjunctival hemodynamic measurements based on assessment of reproducibility, validity, and response to acute hypotension. Image sequences of the conjunctival microvasculature of rabbits were captured using a slit lamp biomicroscope under a steady-state condition, after topical administration of phenylephrine, and after intravenous administration of esmolol. Venous hemodynamic parameters (diameter, blood velocity, blood flow, and wall shear stress) were derived. Conjunctival venous diameters ranged from 9 to 34 μm and blood velocities ranged from 0.08 to 0.95 mm/s. Coefficients of variation of venous diameter and blood velocity measurements were, on average, 6% and 14%, respectively. Automated and manual measurements of venous diameter and velocity were highly correlated (R = 0.97; p < 0.001; n = 16). With phenylephrine administration, diameter and velocity were reduced by 21% and 69%, respectively. Following esmolol administration, blood pressure was reduced with a concomitant decrease in velocity, followed by recovery to baseline. Venous blood velocity, flow, and WSS were correlated with blood pressure (R ≥ 0.52; p ≤ 0.01). The feasibility of quantifying alterations in microvascular hemodynamics in the bulbar conjunctiva was established. The method is of potential value in evaluating microcirculatory hemodynamics related to cardiovascular function.