Abstract
Background
The Bezold-Jarisch reflex is a depressor reflex of the heart due to the preferential
distribution of vagal nerves in the inferior wall of the left ventricle. We report
a case of Stanford type A acute aortic dissection, in which coronary spastic angina
caused the Bezold-Jarisch reflex in the acute phase.
Case Report
A 53-year-old man presented with left chest pain and cold sweating. An electrocardiogram
was normal and the high-sensitivity cardiac troponin T level was negative. A diagnosis
of Stanford type A acute aortic dissection was made based on computed tomography (CT);
there was no evidence of ischemic heart disease on coronary CT angiogram obtained
simultaneously. While waiting for emergency surgical repair, chest pain worsened,
followed by bradycardia and hypotension, along with ST-segment elevations in the inferior
leads, all of which were resolved by conservative treatment. During surgery, no evidence
to suggest an extension of the dissection to the ostium of the right coronary artery
was observed.
Why Should an Emergency Physician Be Aware of This?
The present case highlights the importance of recognizing the Bezold-Jarisch reflex
because this depressor reflex may require different management than other conditions.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Uber die physiologischen wirkungen des essigsauren veratrins.Untersuchungen Physiol Lab Wurzburg. 1867; 1: 75-156
- Die kreislauf des veratrins.Arch Exp Pathol Pharmacol. 1939; 193: 347-354
- Die afferenten bahnen des veratrine effektes in den herznerven.Arch Exp Pathol Pharmacol. 1939; 193: 355-371
- The Bezold-Jarisch reflex revisited: clinical implications of inhibitory reflexes originating in the heart.J Am Coll Cardiol. 1983; 1: 90-102
- Autonomic disturbance at onset of acute myocardial infarction.Br Med J. 1972; 3: 89-92
- Role of cardiac vagal C-fibers in cardiovascular control.Rev Physiol Biochem Pharmacol. 1979; 86: 1-94
- Listening to heart rate for myocardial ischemic site.J Med Cases. 2011; 2: 169-171
- Sinus node deceleration during exercise as a marker of significant narrowing of the right coronary artery.Am J Cardiol. 1993; 71: 371-373
- Reflexly evoked coactivation of cardiac vagal and sympathetic motor outflows: observations and functional implications.Clin Exp Pharmacol Physiol. 2006; 33: 1245-1250
- Enhanced vagal modulation and exercise induced ischaemia of the inferoposterior myocardium.Heart. 2006; 92: 325-330
- Vagal enhancement as evidence of residual ischemia after inferior myocardial infarction.Pacing Clin Electrophysiol. 2009; 32: 52-58
- Proximal aortic dissection with coronary malperfusion: presentation, management, and outcome.J Thorac Cardiovasc Surg. 2001; 121: 552-560
- Coronary spasm due to type A aortic dissection complicated by hemopericardium: a case report of another possible cause of coronary malperfusion.Intern Med. 2010; 49: 829-831
- The Bezold-Jarisch reflex in a patient with coronary spastic angina.Ann Noninvasive Electrocardiol. 2020; 26: e12759
Article info
Publication history
Published online: September 21, 2020
Accepted:
August 2,
2020
Received in revised form:
August 1,
2020
Received:
July 1,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
