Debra A. Kirby

Differential effects of sleep stage on coronary hemodynamic function during stenosis

We have demonstrated in a previous study that in the normal heart REM sleep induces surges in heart rate and coronary blood flow which are abolished by bilateral stellectomy. To study the effects of sleep in the stenosed coronary circulation, dogs were instrumented with Doppler flow probes and hydraulic occluders around the left circumflex coronary artery to measure coronary blood flow and to produce a 60% flow reduction. Catheters were placed in the aorta to measure mean arterial blood pressure. Electrodes were implanted via the frontal sinus to identify sleep stages. In the absence of stenosis, mean blood pressure was 95 +/- 3 mmHg, HR was 111 +/- 4 bpm, and coronary blood flow was 33 +/- 2 ml/min. During stenosis, REM induced episodic increases in heart rate which were accompanied by 38% decreases in coronary blood flow. We conclude that in the stenosed coronary circulation, REM sleep produces episodic sinus tachycardia and coronary blood flow reduction.

Diazepam administered prior to coronary artery occlusion increases latency to ventricular fibrillation

Few studies have addressed the antiarrhythmic potential of pretreatment with diazepam in acute myocardial infarction. Thus, the effect of diazepam pretreatment prior to coronary artery occlusion was examined in conscious pigs. Animals were instrumented with aortic catheters to measure arterial pressure, a pulmonary artery catheter for drug administration, and a snare around the left anterior descending coronary artery for permanent occlusion one week later. Diazepam (1 mg/kg iv bolus) or vehicle was administered 10 minutes prior to occlusion. Eight of 14 animals receiving diazepam (57%) and 13 of 22 receiving vehicle animals (59%) developed ventricular fibrillation following coronary occlusion. However, the latency to ventricular fibrillation was significantly shorter (7 +/- 1 min) in animals receiving vehicle compared to animals receiving diazepam (11 +/- 1 min). Significant increases in heart rate were seen up to 5 hours after coronary occlusion only in animals receiving vehicle. The results indicate that diazepam pretreatment can increase ventricular fibrillation latency and prevent heart rate increases following acute myocardial infarction.

Inducible monomorphic sustained ventricular tachycardia in the conscious pig

Sustained monomorphic ventricular tachycardia (VT) is of clinical importance but has not been readily modeled in conscious animals. Eleven pigs had myocardial infarction induced by pulling snares previously placed around the left anterior descending (LAD) coronary artery. Six days after occlusion, bipolar pacing catheters were inserted in the right ventricular apex for induction of VT. Testing was repeated in conscious pigs on 6 out of 8 to 19 days after infarction. Monomorphic VT was induced in each animal during each session, using three to four extrastimuli. VT was terminated by burst pacing in 74% of trials; average VT rate was 362 +/- 26 beats/min. VT was prevented in four of eight animals by procainamide and in five of eight animals by magnesium, but was not prevented by lidocaine or metoprolol. The model may be useful in the study of potentially malignant ventricular tachyarrhythmias, important prodromes for sudden death.

Decrease in repetitive extrasystole threshold during epinephrine infusion is enhanced in conscious dogs with perinephritic hypertension

Hypertension is associated with myocardial hypertrophy as well as increased adrenergic responsiveness, both of which can predispose to malignant ventricular arrhythmias. This study was designed to test the effects of subpressor doses of epinephrine (0.15 and 0.3 micrograms/kg/min x 30 min) on vulnerability to ventricular arrhythmia in normotensive and perinephritic hypertensive dogs. Two groups of 6 dogs each were chronically instrumented with aortic catheters to measure mean arterial pressure and bipolar pacing catheters in the apex of the right ventricle to measure repetitive extrasystole threshold, an index of vulnerability to ventricular fibrillation. In the normotensive dogs, the low dose of epinephrine (0.15 micrograms/kg/min IV) had no significant effects on mean arterial pressure, heart rate of repetitive extrasystole threshold. However, in the hypertensive dogs, the same dose caused a significant 39% increase in heart rate (p less than 0.05) and 41% decrease in repetitive extrasystole threshold (p less than 0.05). These findings suggest that electrophysiological vulnerability of the myocardium caused by epinephrine infusion is enhanced in the hypertensive animal.

Abolition of clonidine's effects on ventricular refractoriness by naloxone in the conscious dog

The interaction between opiate and adrenergic receptors on cardiac electrophysiologic function in the conscious dog was addressed in our study. We examined the effects of opiate receptor blockade with naloxone on clonidine-induced changes in refractoriness of the cardiac ventricle. Nine dogs were chronically instrumented for recording mean arterial blood pressure, administration of drugs and for measurement of effective refractory period of the ventricle. Clonidine (10 micrograms/kg, i.v.) significantly (p less than 0.05) decreased heart rate to 72 +/- 5 beats/minute from 108 +/- 8 beats/minute; mean arterial pressure decreased significantly (p less than 0.05) to 83 +/- 3 mmHg from 91 +/- 4 mmHg. Ventricular refractoriness was increased significantly (p less than 0.05) at current levels of 7 and 10 mA and pacing rates 180 and 200 beats/minute. Naloxone (3-10 mg/kg, i.v.) abolished clonidines effects on heart rate, mean arterial pressure and ventricular refractoriness. We conclude that ventricular refractoriness may be regulated in part by interactions between central adrenergic and opioidergic systems.

Epinephrine-induced decrease in repetitive extrasystole threshold is reversed by tyrosine in conscious dogs

Previous studies indicate that availability of L-tyrosine, the precursor for catecholaminergic neurotransmitters, reduced psychological and physiological effects of stressful situations including hypotension, cold and behavioral stress. The current study examined the effect of L-tyrosine administration on cardiac vulnerability to arrhythmia induced by an infusion of epinephrine in conscious dogs. Heart rate, mean arterial pressure and cardiac electrophysiologic parameters, i.e., effective refractory period and repetitive extrasystole threshold, were measured during infusion of epinephrine (0.3 micrograms/kg/min x 30 min), before and after L-tyrosine (B mg/kg iv bolus). Epinephrine administration significantly increased heart rate by 39% (p less than 0.05), and decreased repetitive extrasystole threshold by 33% (p less than 0.05). Mean arterial pressure and effective refractory period were unchanged. Following L-tyrosine, repetitive extrasystole threshold was restored to baseline levels. Tyrosine may thus ameliorate stress-induced increases in ventricular vulnerability to arrhythmias in conscious animals.

Transient coronary stenosis associated with arrhythmia and ischemia 24 hours after reperfusion

We examined the electrophysiologic sequelae of transient reductions in coronary blood flow (CBF) in conscious dogs. Animals were instrumented to measure arterial pressure, heart rate, repetitive extrasystole threshold (RET), and CBF before coronary stenosis, during 90 minutes of a 50% reduction in CBF, and at 1, 24, 48, and 72 hours after reperfusion. RET was decreased at 24 and 48 hours but returned to baseline by 72 hours after reperfusion. Frequent ventricular ectopic activity (VEA), absent during the control period, was noted during stenosis and at 1, 24, and 48 hours after reperfusion. beta-Adrenergic blockade (metoprolol) normalized the decreased RET at 24 hours. Addition of alpha 1-adrenergic blockade (prazosin) abolished VEA. Endocardial blood flow in the posterior papillary muscle of the left ventricle was reduced by 52 +/- 9% during stenosis, was similar to baseline levels by 1 hour after reperfusion, and decreased by 39 +/- 5% at 24 hours. We conclude that episodes of modest coronary artery stenosis may be followed by electrophysiologic changes indicative of increased vulnerability to malignant ventricular arrhythmias.

Decreases in repetitive extrasystole threshold in the conscious pig with myocardial infarct were reversed by tyrosine

Reports indicate that the administration of tyrosine, the precursor amino acid for catecholaminergic neurotransmitters, may be beneficial under conditions of physiologic stress. We studied the effects of tyrosine on vulnerability to ventricular arrhythmia in conscious pigs with healing myocardial infarcts, and sham operated (intact) pigs. Mean arterial pressure and heart rate were measured via chronically implanted aortic catheters. The repetitive extrasystole threshold (defined as the energy in milliamperes (ma) needed to cause a spontaneous ventricular beat following a premature beat induced by an electrical impulse), was measured via a bipolar pacing catheter placed during instrumentation surgery in the apex of the right ventricle. One week after infarct, the myocardial infarct group was studied before and ninety minutes after the administration of tyrosine (8 mg/kg iv). Before tyrosine, the myocardial infarct group had a significantly lower repetitive extrasystole threshold (12 +/- 1 ma) compared to the intact group (19 +/- 2 ma). Ninety minutes after tyrosine, the repetitive extrasystole threshold in the myocardial infarct group was 17 +/- 1 ma. The availability of tyrosine did not alter the repetitive extrasystole threshold in the intact group. Thus, vulnerability to ventricular arrhythmia was enhanced in pigs with recent myocardial infarction. Tyrosine, which can be nutritionally manipulated, may reduce myocardial vulnerability to arrhythmia after infarct.