Bezold-Jarisch reflex: Difference between revisions
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==Overview== | ==Overview== | ||
A cardiovascular depressor reflex involving a marked increase in [[vagal]] ([[parasympathetic]]) efferent discharge to the heart, elicited by stimulation of [[chemoreceptor]]s, primarily in the [[left ventricle]]. This causes a slowing of the heart beat ([[bradycardia]]) and dilatation of the peripheral blood vessels with resulting lowering of the [[blood pressure]]. <ref> A. von Bezold, Ludwig Hirt (1844-1907): Über die physiologischen Wirkungen des essigsauren Veratrine. Untersuchungen aus dem Physiologischen Laboratorium in Würzburg, 1867, 1: 73-122.</ref> <ref>A. Jarisch, C. Henze Über Blutdrucksenkung durch chemische Erregung depressorischer Nerven. Naunyn-Schmiedebergs Archiv für experimentelle Pathologie und Pharmakologie, 1937, 187: 706-730.</ref> <ref>A. Jarisch Vom Herzen ausgehende Kreislaufreflexe. Archiv für Kreislaufforschung 1940, 7: 260-274.</ref> | The '''Bezold–Jarisch reflex''' involves a variety of cardiovascular and neurological processes which cause [[hypopnea]] (overly shallow breathing or an abnormally low [[respiratory rate]]) and [[bradycardia]] (abnormally low resting [[heart rate]]).<ref name="pmid17567718">{{cite journal |author=Salo LM, Woods RL, Anderson CR, McAllen RM |title=Nonuniformity in the von Bezold-Jarisch reflex |journal=Am. J. Physiol. Regul. Integr. Comp. Physiol. |volume=293 |issue=2 |pages=R714–20 |year=2007 |month=August |pmid=17567718 |doi=10.1152/ajpregu.00099.2007 |url=http://ajpregu.physiology.org/cgi/pmidlookup?view=long&pmid=17567718}}</ref>. A cardiovascular depressor reflex involving a marked increase in [[vagal]] ([[parasympathetic]]) efferent discharge to the heart, elicited by stimulation of [[chemoreceptor]]s, primarily in the [[left ventricle]]. This causes a slowing of the heart beat ([[bradycardia]]) and dilatation of the peripheral blood vessels with resulting lowering of the [[blood pressure]]. <ref> A. von Bezold, Ludwig Hirt (1844-1907): Über die physiologischen Wirkungen des essigsauren Veratrine. Untersuchungen aus dem Physiologischen Laboratorium in Würzburg, 1867, 1: 73-122.</ref> <ref>A. Jarisch, C. Henze Über Blutdrucksenkung durch chemische Erregung depressorischer Nerven. Naunyn-Schmiedebergs Archiv für experimentelle Pathologie und Pharmakologie, 1937, 187: 706-730.</ref> <ref>A. Jarisch Vom Herzen ausgehende Kreislaufreflexe. Archiv für Kreislaufforschung 1940, 7: 260-274.</ref> | ||
The concept was originated by Bezold in 1867, later revised by Jarisch in 1937. | ==Historical Perspective== | ||
It is named for [[Albert von Bezold]] and [[Adolf Jarisch Junior]].<ref>{{WhoNamedIt|synd|3165}}</ref>. The concept was originated by Bezold in 1867, later revised by Jarisch in 1937. | |||
==Physiology== | |||
Prolonged upright posture results in some degree of pooling of blood in the [[lower extremities]] that can lead to diminished intracardiac volume. This phenomenon is exacerbated if the individual is [[Dehydration|dehydrate]]d. The resultant arterial hypotension is sensed in the [[carotid sinus]] [[baroreceptors]], and [[efferent nerve fiber|efferent fibers]] from these receptors trigger autonomic signals that increase cardiac rate and [[contractility]]. However, pressure receptors in the wall and [[trabeculae]] of the underfilled [[left ventricle]] may then sense stimuli, activating high-pressure [[C-fiber]] afferent nerves from these receptors. They may respond by sending signals that trigger paradoxical [[bradycardia]] and decreased contractility, resulting in additional and relatively sudden arterial [[hypotension]]. | |||
The Bezold–Jarisch reflex is responsible for the [[sinus bradycardia]] that commonly occurs within the first 60 minutes following an acute myocardial infarction,<ref>{{cite book|last=Goldman|first=Lee|title=Goldman: Goldman's Cecil Medicine|publisher=Saunders, an imprint of Elsevier Inc.|isbn=978-1-4377-1604-7|author2=Anderson, Jeffrey L.|edition=24th|chapter=ST SEGMENT ELEVATION ACUTE MYOCARDIAL INFARCTION AND COMPLICATIONS OF MYOCARDIAL INFARCTION|page=444}}</ref> and explains the occurrence of AV node block in the context of acute posterior or inferior myocardial infarction.<ref>{{cite book|last=Katz|first=Arnold M.|title=Physiology of the heart|year=2001|publisher=Lippincott Williams & Wilkins|location=Philadelphia [u.a.]|isbn=0-7817-1548-2|page=595|edition=3. ed.}}</ref> Bradycardia in this setting may be treated with [[atropine]]. | |||
It usually occurs in nitrate therapy and use of [[serotonin]] [[agonists]].<ref>[http://www.emedicine.com/ped/topic2188.htm eMedicine - Syncope : Article by M Silvana Horenstein, MD<!-- Bot generated title -->]</ref> The Bezold–Jarisch reflex has also been suggested as a possible cause of profound bradycardia and circulatory collapse after spinal anesthesia.<ref>Tsai T. & Greengrass R. (2007). ''Textbook of Regional Anesthesia and Acute Pain Management: Spinal Anesthesia.'' (A. Hadzic, Ed.). New York: McGraw Hill Medical.</ref> | |||
Also, it is one of the complications of interscalene brachial plexus block. | |||
[[Image:BJR.jpg|frame|left|400px|Distribution of opioid OP4 receptors involved in the regulation of cardiovascular function. Various locations of OP4 receptors as suggested by functional studies are shown. Excitatory neurons are represented by solid lines, inhibitory neurons are represented by dotted lines. Abbreviations: CVLM - caudal ventrolateral medulla; NAmb - nucleus ambiguus; NTS - nucleus tractus solitarii; PVN - paraventricular nucleus; RVLM - rostral ventrolateral medulla.<ref>[http://www.jpp.krakow.pl/journal/archive/0902/articles/01_article.html Malinowska B. Godlewski G, Schlicker E. FUNCTION OF NOCICEPTIN AND OPIOID OP4 RECEPTORS IN THE REGULATION OF THE CARDIOVASCULAR SYSTEM, 2002, Bialystok, Poland]</ref>]] | [[Image:BJR.jpg|frame|left|400px|Distribution of opioid OP4 receptors involved in the regulation of cardiovascular function. Various locations of OP4 receptors as suggested by functional studies are shown. Excitatory neurons are represented by solid lines, inhibitory neurons are represented by dotted lines. Abbreviations: CVLM - caudal ventrolateral medulla; NAmb - nucleus ambiguus; NTS - nucleus tractus solitarii; PVN - paraventricular nucleus; RVLM - rostral ventrolateral medulla.<ref>[http://www.jpp.krakow.pl/journal/archive/0902/articles/01_article.html Malinowska B. Godlewski G, Schlicker E. FUNCTION OF NOCICEPTIN AND OPIOID OP4 RECEPTORS IN THE REGULATION OF THE CARDIOVASCULAR SYSTEM, 2002, Bialystok, Poland]</ref>]] | ||
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[[Image:BJR 2.jpg|400px|left|frame|thumb]] | [[Image:BJR 2.jpg|400px|left|frame|thumb]] | ||
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==References== | |||
{{Reflist|2}} | |||
[[Category:Cardiovascular diseases]] | |||
[[Category:Reflexes]] | |||
==References== | ==References== | ||
Revision as of 14:30, 20 July 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Synonyms and keywords: Bezold's reflex; Bezold-Jarisch response; Jarisch-Bezold reflex.
Overview
The Bezold–Jarisch reflex involves a variety of cardiovascular and neurological processes which cause hypopnea (overly shallow breathing or an abnormally low respiratory rate) and bradycardia (abnormally low resting heart rate).[1]. A cardiovascular depressor reflex involving a marked increase in vagal (parasympathetic) efferent discharge to the heart, elicited by stimulation of chemoreceptors, primarily in the left ventricle. This causes a slowing of the heart beat (bradycardia) and dilatation of the peripheral blood vessels with resulting lowering of the blood pressure. [2] [3] [4]
Historical Perspective
It is named for Albert von Bezold and Adolf Jarisch Junior.[5]. The concept was originated by Bezold in 1867, later revised by Jarisch in 1937.
Physiology
Prolonged upright posture results in some degree of pooling of blood in the lower extremities that can lead to diminished intracardiac volume. This phenomenon is exacerbated if the individual is dehydrated. The resultant arterial hypotension is sensed in the carotid sinus baroreceptors, and efferent fibers from these receptors trigger autonomic signals that increase cardiac rate and contractility. However, pressure receptors in the wall and trabeculae of the underfilled left ventricle may then sense stimuli, activating high-pressure C-fiber afferent nerves from these receptors. They may respond by sending signals that trigger paradoxical bradycardia and decreased contractility, resulting in additional and relatively sudden arterial hypotension.
The Bezold–Jarisch reflex is responsible for the sinus bradycardia that commonly occurs within the first 60 minutes following an acute myocardial infarction,[6] and explains the occurrence of AV node block in the context of acute posterior or inferior myocardial infarction.[7] Bradycardia in this setting may be treated with atropine.
It usually occurs in nitrate therapy and use of serotonin agonists.[8] The Bezold–Jarisch reflex has also been suggested as a possible cause of profound bradycardia and circulatory collapse after spinal anesthesia.[9] Also, it is one of the complications of interscalene brachial plexus block.
References
- ↑ Salo LM, Woods RL, Anderson CR, McAllen RM (2007). "Nonuniformity in the von Bezold-Jarisch reflex". Am. J. Physiol. Regul. Integr. Comp. Physiol. 293 (2): R714–20. doi:10.1152/ajpregu.00099.2007. PMID 17567718. Unknown parameter
|month=ignored (help) - ↑ A. von Bezold, Ludwig Hirt (1844-1907): Über die physiologischen Wirkungen des essigsauren Veratrine. Untersuchungen aus dem Physiologischen Laboratorium in Würzburg, 1867, 1: 73-122.
- ↑ A. Jarisch, C. Henze Über Blutdrucksenkung durch chemische Erregung depressorischer Nerven. Naunyn-Schmiedebergs Archiv für experimentelle Pathologie und Pharmakologie, 1937, 187: 706-730.
- ↑ A. Jarisch Vom Herzen ausgehende Kreislaufreflexe. Archiv für Kreislaufforschung 1940, 7: 260-274.
- ↑ Template:WhoNamedIt
- ↑ Goldman, Lee; Anderson, Jeffrey L. "ST SEGMENT ELEVATION ACUTE MYOCARDIAL INFARCTION AND COMPLICATIONS OF MYOCARDIAL INFARCTION". Goldman: Goldman's Cecil Medicine (24th ed.). Saunders, an imprint of Elsevier Inc. p. 444. ISBN 978-1-4377-1604-7.
- ↑ Katz, Arnold M. (2001). Physiology of the heart (3. ed. ed.). Philadelphia [u.a.]: Lippincott Williams & Wilkins. p. 595. ISBN 0-7817-1548-2.
- ↑ eMedicine - Syncope : Article by M Silvana Horenstein, MD
- ↑ Tsai T. & Greengrass R. (2007). Textbook of Regional Anesthesia and Acute Pain Management: Spinal Anesthesia. (A. Hadzic, Ed.). New York: McGraw Hill Medical.
- ↑ Malinowska B. Godlewski G, Schlicker E. FUNCTION OF NOCICEPTIN AND OPIOID OP4 RECEPTORS IN THE REGULATION OF THE CARDIOVASCULAR SYSTEM, 2002, Bialystok, Poland
References
Additional Reading
- Hurst's the Heart, Fuster V, 12th ed. 2008, ISBN 978-0-07-149928-6
- Willerson JT, Cardiovascular Medicine, 3rd ed., 2007, ISBN 978-1-84628-188-4