Bezold Jarisch Reflex- New Interest, Old Phenomenon

Arya, Sanjeev; Belwal, Shantanu; Uniyal, Bhupesh; Tiwari, Bhuwan Chandra; Sharma, Preeti

doi:10.11648/j.ajim.20200801.15

Cited by 7 publications

(19 citation statements)

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“…As a response, sympathetic activity is inhibited, while parasympathetic activity increases resulting in bradycardia and vasodilation. This reflex, known as Bezold-Jarisch reflex, can also be elicited in pathological situations such as myocardial ischemia by activation of both ventricular mechanoreceptors and chemoreceptors [ 2 , 50 ]. Moreover, a reduced energy state of the hypoxic myocardium due to compromised mitochondrial respiration and ATP synthesis [ 3 , 19 ] might count for the depression of LV inotropic and lusitropic functions.…”

Section: Discussionmentioning

confidence: 99%

Left ventricular depression and pulmonary edema in rats after short-term normobaric hypoxia: effects of adrenergic blockade and reduced fluid load

Appelt

Gabriel

Bölter

et al. 2021

Pflugers Arch - Eur J Physiol

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Acute normobaric hypoxia may induce pulmonary injury with edema (PE) and inflammation. Hypoxia is accompanied by sympathetic activation. As both acute hypoxia and high plasma catecholamine levels may elicit PE, we had originally expected that adrenergic blockade may attenuate the severity of hypoxic pulmonary injury. In particular, we investigated whether administration of drugs with reduced fluid load would be beneficial with respect to both cardiocirculatory and pulmonary functions in acute hypoxia. Rats were exposed to normobaric hypoxia (10% O2) over 1.5 or 6 h and received 0.9% NaCl or adrenergic blockers either as infusion (1 ml/h, increased fluid load) or injection (0.5 ml, reduced fluid load). Control animals were kept in normoxia and received infusions or injections of 0.9% NaCl. After 6 h of hypoxia, LV inotropic function was maintained with NaCl injection but decreased significantly with NaCl infusion. Adrenergic blockade induced a similar LV depression when fluid load was low, but did not further deteriorate LV depression after 6 h of infusion. Reduced fluid load also attenuated pulmonary injury after 6 h of hypoxia. This might be due to an effective fluid drainage into the pleural space. Adrenergic blockade could not prevent PE. In general, increased fluid load and impaired LV inotropic function promote the development of PE in acute hypoxia. The main physiologic conclusion from this study is that fluid reduction under hypoxic conditions has a protective effect on cardiopulmonary function. Consequently, appropriate fluid management has particular importance to subjects in hypoxic conditions.

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Section: Discussionmentioning

confidence: 99%

Left ventricular depression and pulmonary edema in rats after short-term normobaric hypoxia: effects of adrenergic blockade and reduced fluid load

Appelt

Gabriel

Bölter

et al. 2021

Pflugers Arch - Eur J Physiol

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“…Although clinical features suggest vasovagal-like syncope, it is essential to rule out cardiac syncope before the diagnosis is confirmed. Further investigation and follow-up are essential in such cases (15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

Congenital Anomalous Origin of Coronary Artery Disease in Children With Syncope: A Case Series

et al. 2022

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ObjectiveThis study is aimed to analyze the characteristics of congenital anomalous origin of coronary artery in pediatric patients with syncope.MethodsA total of eight patients were retrospectively analyzed from August 2018 to August 2020 who were admitted to the Peking University First Hospital with the complaint of syncope and were diagnosed with congenital coronary artery disease.ResultsIn total, eight patients were included in the study with a median age of 12.5 ± 2.7 (8–16) years. In total, four of them were males, and four were females. Six of the eight patients were diagnosed with right anomalous coronary artery from the opposite sinus (R-ACAOS), while two patients were diagnosed with left anomalous coronary artery from the opposite sinus (L-ACAOS). The most frequent inducement was exercise, and the commonest prodromes were dizziness and blurred vision. Serum cardiac markers and exercise electrocardiography test (EET) were normal in seven of the patients. The majority of cases had abnormal electrocardiograms (ECGs), but only two of them manifested elevated/depressed ST-T segments. In total, seven patients had positive head-up tilt test (HUT). Echocardiography and coronary artery computed tomography angiography (CTA) were performed to aid the diagnosis. Coronary unroofing procedures were conducted in four patients, and none of them reported syncope after the surgery. The other four patients received routine medical treatment for vasovagal-like syncope. In total, two patients out of them became asymptomatic, and in the other two patients, episodes of syncope were reduced, but they still required medical treatment.ConclusionCongenital coronary artery anomalies in children with syncope need prompt attention. Though ECG and echocardiography are the common methods for investigating cardiac syncope, they have limited ability to find coronary artery anomalies. When coronary artery anomalies are suspected, coronary CTA should be considered.

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“…No supportive data exists as to whether cardio-inhibitory receptors or bezold jarisch reflex is solely responsible for the event. 11 Cardiac accelerator fibres T1-T4 blockade modifies autonomic nervous system cardiac input leading to unopposed parasympathetic activity (at Sino-atrial and atrioventricular node) may manifest as bradycardia and asystole and the "reverse" Bainbridge reflex explains decreases in heart rate noticed under condition of decreased venous return e.g., in intra-thecal block. 12,13 In another study it was backed to practice a rationale for cardio-vascular changes (bradycardia and hypotension) following intrathecal block by treating bradycardia immediately with anticholinergic agent, if hypotension persists it is managed by appropriate vasopressors.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Atropine to Blunt Unopposed Vagal Activity in Prevention of Hypotension in Parturients Undergoing Spinal Caesarean Section

Maqbool¹,

Ashfaq²

2022

J. Bahria Uni. Med. Dent. Coll.

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Objective: To determine efficacy of prophylactic atropine to blunt un-opposed vagal activity in prevention of hypotension associated with caesarean spinal block in first 15 minutes. Study Design & Setting: Randomized controlled interventional study (purposive sampling method) done at Islam Teaching Hospital, Sialkot from 03-3-2021 to 11-8-2021 Methodology: Chairman Ethics Review Board, Islam Medical College, Sialkot vide letter No.2021-04/A, dated 03-3-2021, consented for study. G-power statistics v3.1.9.2, employing chi-square goodness of fit test value of 11.07, total sample was 144 bunched into two prophylactic treatment groups by using computer generated numbers (group-A, Inj. atropine 0.5mg and group-B, Inj. Placebo (control) planned for elective caesarean spinal delivery. Primary study variable being hemodynamic stability (pulse, blood pressure) in first 15 minutes after placing block. Independent-Samples Kruskal-Wallis Test used to compare systolic blood pressures between groups for association. Chi- square hypothesis test, was done with P-value <0.05 considered as statistically significant. SPSS analysis was done with v.21 Results: In Atropine group-A, there was rather a 11% increase in mean heart rate at 15 minutes mark (statistically significant) than the mean baseline value while in group-B (placebo)similar values parameter showed a 4.7% decline in mean heart rate value. In group-A, mean systolic blood pressure value declined only by 12.2% at 15 minutes mark from baseline value whereas in group-B, a decline of 13.2% was noted. Conclusion: Prophylactic bolus of atropine against un-opposed vagal activity provided stable hemodynamic values in cesarean spinal delivery.

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Bezold Jarisch Reflex- New Interest, Old Phenomenon

Cited by 7 publications

References 0 publications

Left ventricular depression and pulmonary edema in rats after short-term normobaric hypoxia: effects of adrenergic blockade and reduced fluid load

Left ventricular depression and pulmonary edema in rats after short-term normobaric hypoxia: effects of adrenergic blockade and reduced fluid load

Congenital Anomalous Origin of Coronary Artery Disease in Children With Syncope: A Case Series

Efficacy of Atropine to Blunt Unopposed Vagal Activity in Prevention of Hypotension in Parturients Undergoing Spinal Caesarean Section

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