Wednesday, July 31, 2019

Inferior wall MI and Bezold-Jarisch reflex

Hello everyone!

Acute myocardial infarction (AMI), especially of the inferior left ventricular wall, is often associated with transient hypotension and sinus bradycardia.

Ever wondered... Why?


Let's talk about the Bezold-Jarisch reflex (BJR) first! BJR is characterized by sudden bradycardia associated with hypotension, decreased inotropy, and coronary vasodilation.

Evidence suggests a possible role for BJR components  in AMI because - The distribution of the cardioinhibitory C fiber afferent receptors in the myocardium correlates well the coronary anatomy affected during myocardial ischemia with the concentration of cardiac inhibitory receptors greatest in the inferior and posterior walls of the heart, locations corresponding to the anatomic territory where myocardial ischemia is associated with hypotension and bradycardia.

What stimulates the BJR?

The stimulus for reflex triggering during myocardial ischemia is not known, but there is some evidence for molecules generated during ischemia and reperfusion, such as oxygen-derived free radicals and prostaglandins. There is also evidence that the stimulus may be mechanical secondary to the aneurysmal bulging of myocardium that occurs during transmural ischemia.

The purpose of this response during myocardial ischemia is unclear.

I found this interesting to know :)

That's all!

-IkaN

Source: https://anesthesiology.pubs.asahq.org/article.aspx?articleid=1943118

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