Key result
Inferior or posterior ischemia is linked to ~4-fold higher rates of bradycardia and hypotension versus anterior ischemia.
Why the study?
Although arrhythmias from myocardial ischemia are a recognized cause of sudden death, the potential influence of cardiogenic reflexes originating in ischemic areas had received less attention.
Observational (n=12)
Transient transmural myocardial ischemia triggers distinct reflex hemodynamic responses depending on the anatomic location of ischemia—predominantly bradycardia and hypotension in posterior/inferior ischemia versus hypertension and tachycardia in anterior ischemia—which may influence sudden cardiac death.
Site-specific reflexes may influence acute hemodynamic management in spasm; leaves open their role in ischemia-related sudden death.
Although arrhythmias caused by myocardial ischemia are a well recognized cause of sudden death, the potential influence of cardiogenic reflexes originating in areas of ischemia has received less attention. In this study, 12 patients with well documented single vessel coronary artery spasm, with a total of 2,240 episodes of transient transmural ischemia, are described. Continuous electrocardiographic and hemodynamic recordings were analyzed to determine possible relations between the anatomic area of ischemia and patterns of change in blood pressure and heart rate. Of seven patients with ischemia of the posterior or inferior left ventricular wall, six had associated bradycardia and hypotension, an apparent Bezold-Jarisch response. Only one of five patients with anterior ischemia had a similar response. A hypertensive, tachycardiac response resembling the James reflex was seen in two of the patients with anterior ischemia, with an increase in blood pressure of 36/22 +/- 12/6 mm Hg and an increase in heart rate of 8 +/- 3 beats/min. This increase began before the onset of chest pain and was seen even in asymptomatic episodes. These reflexly mediated hemodynamic responses may modulate the direct effects of myocardial ischemia and could play a role in sudden cardiac death.
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Robertson et al. (1985) conducted an observational in Single vessel coronary artery spasm with transient transmural ischemia (n=12). Posterior or inferior left ventricular wall ischemia vs. Anterior left ventricular wall ischemia was evaluated on Associated bradycardia and hypotension (Bezold-Jarisch response). Posterior/inferior myocardial ischemia provoked bradycardia and hypotension in 6 of 7 patients (85.7%) versus 1 of 5 patients (20.0%) with anterior ischemia.
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