Goldstein James A, Lee Daniel T, Pica Mark C, Dixon Simon R, O'Neill William W
Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Coron Artery Dis. 2005 Aug;16(5):265-74. doi: 10.1097/00019501-200508000-00002.
Occlusion and reperfusion of the acutely occluded right coronary artery may result in abrupt bradycardia and hypotension, attributed to Bezold-Jarisch cardio-inhibitory reflexes arising from the ischemic left ventricle. Given that right ventricular infarction, a result of proximal right coronary artery occlusion, predisposes to bradycardia and hypotension, we hypothesized that proximal right coronary occlusions would be more likely to result in bradycardia-hypotension compared to more distal occlusions.
In 216 patients with acute inferior myocardial infarction undergoing primary angioplasty of the right coronary artery, we retrospectively analyzed the incidence of bradyarrhythmias and hypotension during occlusion and with reperfusion.
Occlusion proximal to the right ventricular branches was identified in 151 (70%) of cases, with occlusions distal but compromising the left ventricular and atrioventricular nodal branches in 65 (30%) others. During occlusion, those with proximal occlusions were more likely to suffer hypotension (41 versus 15%, P=0.0002), advanced atrioventricular block (21 versus 3%, P=0.0008) and hypotension with bradycardia (25 versus 9%, P=0.01). Similarly, reperfusion of proximal occlusions more frequently resulted in abrupt hypotension (42 versus 19%, P=0.002), bradycardia (34 versus 14%, P=0.004) and hypotension with bradycardia (27 versus 12%, P=0.02).
These data demonstrate that during right coronary artery occlusion and with reperfusion, bradycardia and hypotension develop more commonly in patients with proximal occlusions compared with those with distal occlusions. These findings suggest that reflexes arising from the ischemic right ventricle may play a role in bradyarrhythmias and hypotension.
急性闭塞的右冠状动脉闭塞和再灌注可能导致突然的心动过缓和低血压，这归因于缺血左心室引发的贝佐尔德-雅里什心脏抑制反射。鉴于近端右冠状动脉闭塞导致的右心室梗死易引发心动过缓和低血压，我们推测与更远端的闭塞相比，近端右冠状动脉闭塞更有可能导致心动过缓-低血压。
在216例接受右冠状动脉直接血管成形术的急性下壁心肌梗死患者中，我们回顾性分析了闭塞期间及再灌注时缓慢性心律失常和低血压的发生率。
151例（70%）患者的闭塞位于右心室分支近端，另外65例（30%）患者的闭塞位于远端，但累及左心室和房室结分支。闭塞期间，近端闭塞患者更易出现低血压（41%对15%，P=0.0002）、高度房室传导阻滞（21%对3%，P=0.0008）以及伴有心动过缓的低血压（25%对9%，P=0.01）。同样，近端闭塞再灌注更常导致突然低血压（42%对19%，P=0.002）、心动过缓（34%对14%，P=0.004）以及伴有心动过缓的低血压（27%对12%，P=0.02）。
这些数据表明，在右冠状动脉闭塞及再灌注期间，与远端闭塞患者相比，近端闭塞患者更常出现心动过缓和低血压。这些发现提示，缺血右心室引发的反射可能在缓慢性心律失常和低血压中起作用。
