Attenuation of the rise in extracellular potassium concentration during myocardial ischaemia by d.l-sotalol and d-sotalol

STUDY OBJECTIVE--The aim was to study the effects of d.l-sotalol, d-sotalol or atenolol on the rate of rise of extracellular potassium concentration [( K+]o) and the electrophysiological changes that occur during myocardial ischaemia. DESIGN--The study was performed in isolated, arterially perfused interventricular septa from rabbit. Six septa were treated with d.l-sotalol 10(-4) mol.litre-1, six with d-sotalol 10(-4) mol.litre-1, six with atenolol 10(-5) mol.litre-1, and there were seven untreated controls. At these concentrations d.l and d-sotalol are equipotent in their class III effect, though d-sotalol has only 7% of the beta blocking activity of the racemic form, and atenolol is equipotent in its beta blocking activity to d.l-sotalol. [K+]o and electrophysiological variables were compared before and during a 30 min period of global zero flow ischaemia. MEASUREMENTS AND MAIN RESULTS--Prior to ischaemia [K+]o, measured using potassium sensitive valinomycin electrodes, was similar in all the groups. [K+]o rose during ischaemia in all the groups, and at 30 min was 13.0 (SEM 0.7) mmol.litre-1 in the control group which was not different from 12.7(0.5) mmol.litre-1 in the atenolol group. In the d.l and d-sotalol groups the increases were markedly attenuated, reaching 9.2(1.0) and 8.8(0.7) mmol.litre-1 respectively. During ischaemia the class III effect of d.l and d-sotalol was lost within 6 min though the fall in maximum upstroke velocity of the action potentials (dV/dtmax) and the extent of resting membrane potential (Em) depolarisation were less in comparison to the control and atenolol groups. CONCLUSIONS--The results indicate an attenuation by sotalol of the ischaemic rise in [K+]o, with preservation of dV/dtmax and Em, despite the loss of an effect on action potential duration. This potentially antiarrhythmic effect of sotalol in ischaemic myocardium is attributable to a direct membrane effect rather than beta adrenoceptor antagonism.     

Effect of glibenclamide on extracellular potassium accumulation and the electrophysiological changes during myocardial ischaemia in the arterially perfused interventricular septum of rabbit

STUDY OBJECTIVE--The aim was to study the effects of glibenclamide on the rate of rise of extracellular potassium concentration ([K+]o) and the electrophysiological changes that occur during myocardial ischaemia. DESIGN--The study was performed in isolated, arterially perfused interventricular septa from the rabbit. Six septa were treated with glibenclamide 10(-6) mol.litre-1 and there were six untreated controls (vehicle only). [K+]o and electrophysiological variables were compared before and during a 30 min period of global zero flow ischaemia. MEASUREMENTS AND MAIN RESULTS--Prior to ischaemia, the extracellular potassium concentrations measured using potassium sensitive valinomycin electrodes were similar in the control and glibenclamide groups being 4.0 (SEM 0.1) and 4.0 (0.1) mmol.litre-1 respectively. [K+]o rose during ischaemia in both groups, and at 30 min was 13.3 (0.7) mmol.litre-1 in the control group. The increase in the glibenclamide group was less marked, reaching 9.2 (0.5) mmol.litre-1 (p less than 0.0005; unpaired t test). Glibenclamide had no electrophysiological effects prior to ischaemia. However, during ischaemia the decrease in action potential amplitude, action potential duration (APD), maximum upstroke velocity of the action potentials (dV/dtmax), and the extent of resting membrane potential (Em) depolarisation were less in the glibenclamide group than in the controls. The effective refractory period (ERP) progressively shortened over the 30 min of ischaemia in both groups, to a similar extent. When taken in conjunction with the relative changes in action potential duration the degree of post-repolarisation refractoriness (ERP-APD) that developed was less in the glibenclamide group than in the controls. CONCLUSIONS--Glibenclamide attenuated the ischaemic rise in [K+]o, with preservation of both membrane potential and action potential amplitude, duration, and upstroke velocity together with less post-repolarisation refractoriness. These effects could be potentially antiarrhythmic in acute myocardial ischaemia.     

Diastolic coronary resistance in the isolated rabbit heart during and after ischaemia: contribution of extravascular forces

Coronary blood flow is influenced by contraction of the myocardium. The contribution of extravascular forces to coronary resistance during and after a period of low pressure perfusion or hypoxia and after a period of global ischaemia was studied in experiments on rabbit hearts perfused by the Langendorff method. End diastolic flow, perfusion pressure, developed tension, and resting tension were measured. Under control conditions the relation between end diastolic flow and perfusion pressure was almost linear (r greater than 0.92). There was an initial fall in coronary resistance on initiation of hypoxia or low pressure perfusion, but subsequently coronary resistance increased concomitantly with the rise in resting tension. After 60 min total global ischaemia and 30 min reperfusion coronary resistance increased by 410(99)% and resting tension by 382(92)%. Increasing the potassium concentration of the perfusate to 19.2 mmol X litre-1 under control conditions caused the coronary resistance to increase by 336(74)%, whereas resting tension was unchanged. The increase in resistance with potassium could be reduced but not abolished by adenosine (1.87 X 10(-5) mol X litre-1), indicating that the effect was largely attributable to vasoconstriction. Increased stimulation frequency (30 Hz) raised coronary resistance by 37(10)% and resting tension by 303(53)%. Perfusion with carbonyl cyanide p-trifluoromethoxyphenylhydrazone (1 X 10(-6) mol X litre-1) increased coronary resistance by 169(27)% and resting tension by 782(11)6% and relaxed isolated epicardial coronary arteries. The effects of carbonyl cyanide p-trifluoromethoxyphenylhydrazone and increased stimulation frequency on coronary resistance were due to myocardial contracture.(ABSTRACT TRUNCATED AT 250 WORDS)     

Metabolic modulation of cardiac neurosympathetic activity in vivo: effects of potassium and adenosine

The effects of intracoronary (LAD) infusion of potassium and adenosine on changes in coronary vascular resistance and regional cardiac noradrenaline overflow during graded cardiac sympathetic stimulation were assessed in non-ischaemic myocardium in the open chest anaesthetised dog. Intracoronary potassium at three concentration (10, 25, 75 mmol.litre-1) progressively increased the potassium content of local venous effluent from 3.6 to 9.4 mmol.litre-1 and produced biphasic effects on nerve stimulated regional noradrenaline overflow. At low dose it was inhibitory (peak overflow at 20 Hz stimulation being reduced from (mean(SEM)) 10.2(2.6) to 2.9(1.8) pmol.ml-1 with 10 mmol.litre-1 potassium chloride; p less than 0.01). At high dose, overflow was potentiated to 13.3(2.7) pmol.ml-1 with 75 mmol.litre-1 potassium chloride (p less than 0.05). Noradrenaline overflow from and the potassium content of circumflex territory venous effluent was unchanged. Intracoronary adenosine at high concentration (10(-3) and 10(-2) mol.litre-1) potentiated basal noradrenaline overflow from the heart producing a small negative arteriovenous concentration difference of 0.6(0.7) and 1.0(0.6) pmol.ml-1 respectively. However, noradrenaline overflow during maximal sympathetic stimulation was inhibited from 3.8(1.4) to 0.4(0.7) pmol.ml-1 with 10(-3) mol.litre-1 adenosine and to 0.7(0.6) pmol.ml-1 with 10(-2) mol.litre-1 adenosine (p less than 0.05). The changes in blood flow and coronary vascular resistance seen with sympathetic stimulation were not modified by adenosine, despite major alteration in basal coronary vascular tone. Thus both metabolites may potentially alter local neurosympathetic activity in ischaemic myocardium and act diversely to determine noradrenaline release at the nerve terminal.     

Heart rate reduction during exercise-induced myocardial ischaemia and stunning.

AIMS: The respective contributions of reduction in heart rate and inotropism in the beneficial effects of beta-blockade in ischaemic heart disease remains debated. The effects of selective heart rate reduction by ivabradine (If inhibitor) were compared to those of atenolol on exercise-induced ischaemia and stunning. METHODS AND RESULTS: In seven instrumented dogs, coronary stenosis was calibrated to suppress increase in coronary blood flow during a 10-min treadmill exercise. When administered before exercise, atenolol and ivabradine similarly reduced heart rate versus saline at rest and during exercise (154+/-2 and 155+/-9 vs 217+/-13 beats/min, respectively). During exercise, left ventricular wall thickening (LVWth) was reduced to 2+/-1% from 23+/-4% under saline but ivabradine limited this effect (10+/-3%) and reduced the subsequent myocardial stunning vs saline. Atenolol also limited LVWth decrease during exercise (17+/-4%) but had no effect during recovery. When administered after exercise, ivabradine attenuated stunning and this effect disappeared when heart rate reduction was corrected by atrial pacing. Atenolol administered after exercise severely depressed LVWth vs saline. CONCLUSION: Selective heart rate reduction not only provides an anti-ischaemic effect but also per se improves contractility of the stunned myocardium. Additional negative inotropism is protective against ischaemia but deleterious during stunning.     

Platelet Accumulation in the Myocardium during Acute Nonthrombotic Coronary Artery Occlusion in Dogs

The distribution of labelled autologous platelets in the myocardium was studied in open-chest dogs following a nonthrombotic coronary artery occlusion. A significant accumulation of platelets occurred in the ischaemic and borderline ischaetnic myocardium both 15 and 150 min after coronary artery occlusion, most pronounced after 150 min. The small platelet accumulation after 15-min ischaemia might be due to stasis of blood since a similar increase in labelled erythrocytes in that area was observed. The platelet trapping after 150 min most likely represents platelet aggregates. In spite of the marked increase in platelet trapping, the myocardial blood flow in the ischaemic area increased significantly from 15 to 150 min of myocardial ischaemia. It is concluded that the increased platelet trapping in the first hours following a nonthrombotic coronary artery occlusion was insufficient to impair coronary circulation.     

The anti-arrhythmic effects of myocardial ischaemia. Relation to reperfusion arrhythmias?

Ventricular tachycardia was induced in the intact non-ischaemic pig heart by intramyocardial or intracoronary infusions of noradrenaline or N6, O2'-dibutyryl-cAMP. The chemically induced tachycardia was consistently stopped within 10 to 30 s by occluding the coronary artery supplying the infusion area. This ischaemic effect was readily reversed by coronary reperfusion, with ventricular tachycardia resuming within seconds after release of the occlusion. In contrast to the immediate effect of myocardial ischaemia, it took several minutes for the tachycardia to cease after the infusion of arrhythmogenic compounds was stopped. Pacing experiments showed that the effect of myocardial ischaemia on ventricular tachycardia was probably not due to a conduction block. The anti-arrhythmic property of myocardial ischaemia was separate from its known effect of decreasing the ventricular fibrillation threshold for electrical stimulation. The increased vulnerability of the acutely ischaemic myocardium to fibrillation was apparent in experiments in which ectopic activity was induced in the non-ischaemic part of the myocardium. In these experiments ventricular fibrillation consistently ensued within 6 min following distal occlusion of the anterior descending coronary artery. By contrast, ventricular fibrillation was not precipitated by coronary artery occlusion or local infusion of arrhythmogenic compounds alone. Cyclic AMP was shown to accumulate in ischaemic myocardium. An association existed between cAMP accumulation and the intensity of early ischaemic arrhythmias as well as reperfusion arrhythmias. The highest incidence of ventricular fibrillation was found during reperfusion, at peak myocardial cAMP levels. These findings suggest: (1) Noradrenaline and dibutyryl-cAMP exert arrhythmogenic effects preferentially in the intact, non-ischaemic myocardium, the effects being attenuated in ischaemic myocardium by a paradoxical anti-arrhythmic effect of ischaemia. (2) In the acutely ischaemic heart, ventricular fibrillation may be precipitated by the emergence of ectopic activity outside the ischaemic area. (3) Arrhythmias and fibrillation occurring early after reperfusion may be caused by unmasking the effects of excitants (eg, noradrenaline or cAMP) arising during the antecedent period of ischaemia.     

Interaction of the effects of hypoxia, substrate depletion, acidosis and hyperkalaemia on the class III antiarrhythmic properties of sotalol

The effects of hypoxia on the actions of dl-sotalol 10(-4) mol . litre-1 were studied in rabbit papillary muscles at 32 degrees C. Superfusion for 30 min with a hypoxic solution (95% N2, 5% CO2) in the presence of 5 mmol . litre-1 glucose caused moderate shortening of control action potential duration from 208 +/- 3 to 138 +/- 9 ms (mean +/- SEM). In the presence of sotalol, hypoxia caused shortening of APD90 from 399 +/- 9 ms to 249 +/- ms, but the value after 30 min was still significantly greater than in controls (p less than 0.001). Superfusion with a hypoxic, glucose-free solution, however, caused profound shortening of APD90 in controls to 80 +/- 7 ms at 30 min. The highly significant lengthening of APD90 produced by sotalol in control conditions was abolished after 5 min hypoxia. The effects of hypoxia on the effective refractory period (ERP) paralleled those on APD90. Exposure to a hypoxic, acidotic, hyperkalaemic solution (80% N2, 20% CO2, pH 6.8; K+ 12 mmol . litre-1) produced moderate shortening of APD90 with convergence of the two groups. There was an increase in ERP, with the development of an equal degree of post-repolarisation refractoriness in the control and sotalol groups. The Class III effect of sotalol is preserved under mild but lost under severely hypoxic conditions. Using "simulated ischaemic" conditions, with controlled extracellular potassium concentrations, there was no difference in the relationship between APD90 and ERP in the control and sotalol groups.     

Exogenous substrate preference of the post-ischaemic myocardium

Myocardial exogenous substrate preference was studied under conditions of increased plasma lactate concentration before and after a severe (halving of tissue ATP concentration, sixfold increase in tissue lactate concentration) but reversible (less than 1% necrosis on reperfusion) global ischaemic stress produced by continuous hypothermic electromechanical arrest of the heart of four hours' duration by aortic cross clamping and multidose potassium cardioplegia. Fatty acid oxidation was studied using 1-14C-palmitate under steady state conditions and under similar isovolumic fixed pressure conditions with the heart at a constant rate using a left ventricular intracavitary balloon. Exogenous free fatty acid oxidation during the pre-ischaemic period with an increased lactate concentration (3.9-5.8 mmol . litre-1) was 0.62(0.21) mumol . min-1 X 100 g-1 (mean (SEM)). This represented a mean of 32% of the total carbon dioxide produced in contrast to a post-ischaemia free fatty oxidation rate of 2.67(0.87) mumol . min-1 X 100 g-1, in the presence of even further increased plasma lactate concentrations (8.47-11.17 mmol . litre-1), representing a mean of 82% of the total carbon dioxide output. These data suggest that the substrate preference of the myocardium, under conditions of increased plasma lactate concentration, shifts to greater oxidation of exogenous free fatty acids after ischaemic stress.     

Iron availability and free radical induced injury in the isolated ischaemic/reperfused rat heart.

OBJECTIVE: A proposal that injury in ischaemic/reperfused rat heart is critically dependent on the availability of free iron rather than on the efficiency of O2-. and H2O2 production was examined. METHODS: Isolated working rat hearts from 152 male Wistar rats (200-250 g weight), subjected to 20-40 min of global ischaemia and reperfused for 30 min, were perfused with 10 mumol.litre-1 Fe[III] or Fe[II] and/or 0.6 mmol.litre-1 desferrioxamine, 10 mmol.litre-1 dimethylthiourea, and 1 mmol.litre-1 allopurinol. Curves relating the recoveries of haemodynamic functions and the reperfusion lactate dehydrogenase release to the duration of the preceding ischaemic period were constructed. Morphological examination was also performed. RESULTS: In the untreated hearts, the duration of ischaemia resulting in 50% loss of cardiac output was 29 min. This time was decreased to 24 min and 20 min by Fe[III] and Fe[II], respectively, and was increased to 36 min and 37 min by desferrioxamine and dimethylthiourea, respectively. Desferrioxamine prevented the effect of Fe[III] but not that of Fe[II], whereas dimethylthiourea prevented the effect of Fe[II]. Neither the effect of Fe[III] nor that of Fe[II] was prevented by allopurinol which, however, proved to be beneficial in the untreated hearts. CONCLUSIONS: The beneficial effect of desferrioxamine and dimethylthiourea suggest that it is intensification of the Fenton reaction by iron which accounts for iron induced aggravation of the reperfusion injury. Thus we speculate that the availability of free iron, rather than O2-. and H2O2, is a limiting factor in the development of injury in an ischaemic/reperfused rat heart. What remains unclear is why allopurinol is unable to prevent iron induced changes.     

Nisoldipine inhibits lipid peroxidation induced by coronary occlusion in pig myocardium

STUDY OBJECTIVE--The aim was to investigate the effect of the Ca++ channel blocker nisoldipine on the content of lipid peroxidation products in pig myocardium after acute coronary occlusion. DESIGN--Open chest pigs were subjected to the occlusion of the left anterior coronary artery (LAD) with or without nisoldipine. After 30 min ischaemia, myocardial samples were taken from the ischaemic area and from the non-ischaemic posterior wall of the left ventricle for determination of lipid peroxidation products. SUBJECTS--Subjects were farm pigs of either sex. In 10 pigs, the LAD was occluded without drug pretreatment; 11 pigs were infused with nisoldipine (10 micrograms.kg-1) 30 min before the LAD occlusion. Sham operated controls received no drug (n = 7) or nisoldipine (n = 9). MEASUREMENTS AND MAIN RESULTS--Myocardial samples were assayed for the content of lipid peroxidation products: malondialdehyde, conjugated double bonds, and fluorescent end products. Plasma nisoldipine concentration was measured in some experiments. Following the LAD occlusion, the content of lipid peroxidation products increased in both ischaemic and non-ischaemic myocardial regions as compared to the hearts of sham operated pigs. Pretreatment with nisoldipine completely prevented these increases. At a time of the coronary occlusion, plasma nisoldipine concentrations were within the therapeutic range. CONCLUSION--Ca++ antagonist prevents the excessive peroxidation of myocardial membrane lipids which affects the whole myocardium when there is acute local ischaemia. Prevention of myocardial damage in the non-ischaemic region may determine survival of the infarcted heart.     

Effects of regional myocardial ischaemia on coronary artery calibre in the rabbit

Microangiographic and electron microscopic studies were undertaken in isolated, perfused rabbit hearts to examine the effects of acute regional myocardial ischaemia on coronary artery calibre, vascular resistance and ultrastructure. Selective left coronary angiograms were recorded prior to, after 90 min of acute regional myocardial ischaemia induced by occlusion of the marginal left ventricular branch of the circumflex artery, and after reperfusion for 5 min. Vasodilation occurred in the proximal left anterior descending artery (9 +/- 1%, P less than 0.01) and the unoccluded part of the marginal branch (21 +/- 1%, P less than 0.001) during ischaemia which reversed on reperfusion. During reperfusion, coronary vascular resistance increased by 43 +/- 10% (P less than 0.001) despite mild vasodilation of vessels in the ischaemic zone (up to 10 +/- 1%, P less than 0.01). Failure of reperfusion occurred in vessels smaller than 30 microns in diameter (terminal arterioles) and was associated with ultrastructural damage in the ischaemic zone which was particularly prominent at the apex. These findings suggest that failure of reperfusion following 90 min of acute regional myocardial ischaemia in the rabbit is associated with damage to terminal arterioles and capillaries and that the calibre of the larger coronary vessels is maintained. Failure of reperfusion after prolonged myocardial ischaemia may occur despite arterial dilatation in the ischaemic zone.     

The effect of coronary artery occlusion and reperfusion on the activities of triglyceride lipase and glycerol 3-phosphate acyl transferase in the isolated perfused rat heart

Glycerol 3-phosphate acyltransferase (GPAT) and Triglyceride lipase (TGL) were measured in homogenates from non-ischaemic and ischaemic tissue from the isolated perfused rat heart. Ischaemia was produced by occlusion of the left descending coronary artery for 10 min. Compared to activities measured in tissue from normally perfused hearts, GPAT activity measured in tissue from the ischaemic area was considerably reduced. TGL activity in the ischaemic area was markedly increased compared to activity measured in normally perfused hearts. No change was seen in GPAT or TGL activity measured in tissue from the non-ischaemic area. The change in activities produced by ischaemia were prevented by pre-perfusion with the cardio-selective beta-antagonist Atenolol. Reperfusion of the ischaemic area resulted in TGL activity returning to the value measured in tissue from normally perfused hearts. However, GPAT activity, after 1 min of reperfusion, fell to a value lower than after 10 min ischaemia. The reperfusion-induced fall in GPAT activity was prevented by pre-perfusion with the alpha 1 antagonist Doxasozin. Pre-perfusion of the alpha 2 antagonist Yohimbine resulted in a prolongation of the increased TGL activity in the ischaemic area during reperfusion. All changes in enzyme activities were prevented by injection of 6 OH-dopamine 24 h before hearts were removed. These changes in enzyme activities show that during ischaemia there is an increased beta-adrenergic drive. On reperfusion the beta-adrenergic drive is removed but an alpha 1 adrenergic drive becomes apparent.     

Two different metabolic responses to ischaemia: inherent variability or artefact?

Guinea pig hearts, perfused with (5-3H) glucose (8 mmol . litre-1) and subjected to 30 min of reduced (6%) coronary flow, exhibited two distinctly different metabolic and electrophysiological responses to ischaemia. In 22 of the 50 hearts studied (Group 1) glucose utilisation declined during ischaemia from 2.5 +/- 0.2 to 1.3 +/- 0.2 mumol . litre-1 . g-1 dry wt. In these hearts, endogenous substrates such as glucogen and triglyceride were mobilised and, although input into glycolysis may have been initially increased through accelerated glycogenolysis, estimated glycolytic flux (1.7 +/- 0.1 mumol hexose . min-1 . g-1 dry wt) remained limited. Instead, there was a large accumulation of the intermediates of glycolysis, an increase in the content of AMP and cAMP and a particularly marked decline in creatine phosphate levels. With subsequent reperfusion, these hearts all fibrillated. In contrast, in the other 28 hearts (Group 2) glucose utilisation (5.1 +/- 0.4 mumol . min-1 . g-1 dry wt) and estimated glycolytic flux (4.1 +/- 0.01 mumol hexose . min-1 . g-1 dry wt) were increased during ischaemia. In these preparations, relatively little glycogen and triglyceride were utilised, and there was less accumulation of glycolytic intermediates. Further, lower levels of AMP and cAMP were observed and creatine phosphate: creatine ratios were better maintained. These hearts did not fibrillate during reperfusion. Thus the variable susceptibility of the myocardium to ischaemic damage, as evidenced by the random incidence of ventricular fibrillation during reperfusion, may have been related to two distinctly different metabolic responses to restricted perfusion.     

The influence of acute myocardial ischaemia on the class III antiarrhythmic action of sotalol

The effects of acute myocardial ischaemia on the Class III antiarrhythmic properties of dl-sotalol 10(-4) mol . litre-1 were studied in the isolated arterially perfused interventricular septum of the rabbit heart. Before ischaemia, sotalol increased mean action potential duration (APD90) from 267 +/- 6 to 406 +/- 19 ms (p less than 0.001 mean +/- SEM, n = 7 septa), and mean effective refractory period (ERP) from 222 +/- 7 to 291 +/- 10 ms. During 30 min zero flow global ischaemia, mean APD90 in the control group fell from 264 +/- 7 to 128 +/- 13 ms (n = 7). APD90 fell more rapidly in the sotalol group, so that the initial difference between the sotalol and control groups was abolished after 24 min ischaemia. In the sotalol group, ERP shortened rapidly during ischaemia, and was significantly less than in the control group after 30 min. These changes were associated with the development of substantial post-repolarisation refractoriness in the control but not in the sotalol group. There was a greater fall in action potential upstroke velocity in the controls than in the sotalol group. The results indicate that the Class III effect of sotalol gradually disappears during ischaemia. The effects on post-repolarisation refractoriness and upstroke velocity are compatible with the hypothesis that sotalol slows the rate of rise of extracellular potassium concentration in acute ischaemia. This is a potentially antiarrhythmic property.     

Depressant effects of fast sodium channel blockade on the electrical activity of ischaemic canine ventricle: mediation by the sympathetic nervous system

In this study we examined the possibility that local anaesthetic agents such as tetrodotoxin may exacerbate electrical changes during acute myocardial ischaemia by inhibiting fast sodium channels, both in cardiac cells and in sympathetic nerve terminals. Bipolar electrograms were recorded during serial 2 to 5 min occlusions of the left anterior descending coronary artery in open-chest, anaesthetised dogs. Tetrodotoxin (1 or 2 micrograms X kg-1 iv) given prior to occlusion did not affect activation times or electrograms in normal myocardium but exacerbated activation delay and loss of electrogram amplitude during ischaemia. Bilateral stellectomy reversed the effects of tetrodotoxin during ischaemia. Tetrodotoxin (1 microgram X kg-1 iv) reduced changes in heart rate and mean arterial blood pressure produced by stellate ganglia stimulation. Intracoronary infusion of tetrodotoxin (10(-5) mol X litre-1) during normal perfusion lengthened mean effective ventricular refractory periods and propranolol (0.5 mg X kg-1 iv) or bilateral stellectomy prevented this effect. Thus, tetrodotoxin appeared to increase ventricular refractoriness and exacerbate ischaemia-induced activation delay by inhibiting sympathetic nerve activity. Other agents with local anaesthetic properties may have similar effects.     

Diastolic coronary resistance after ischaemia in the isolated rabbit heart: effect of nifedipine

The effect of nifedipine on tension, coronary flow and perfusion pressure was studied in the Langendorff rabbit heart after 15 and 60 min global ischaemia. Nifedipine (1.44 X 10(-8) M) added to the perfusate before 15 min ischaemia prevented the increase of diastolic coronary resistance which occurred on reperfusion in the absence of the drug. The recovery of force of contraction was unaltered. There was no change in the increase in resistance on reperfusion if nifedipine (1.44 X 10(-8) M) was given at the time of reperfusion after 15 min ischaemia. Ventricular fibrillation on reperfusion was prevented if nifedipine was added before 15 min of ischaemia. After a more prolonged period of ischaemia (60 min) the rise of resting tension on reperfusion was not prevented by giving nifedipine (1.44 X 10(-8) M or 1.44 X 10(-7) M) before ischaemia, although the rise during ischaemia was delayed. Both concentrations of nifedipine reduced the increase in diastolic coronary resistance which occurred on reperfusion. These results suggest that nifedipine, in a concentration close to the therapeutic range, increases coronary reperfusion after global ischaemia. This represents one mechanism by which nifedipine can have a beneficial effect on the ischaemic myocardium.     

Hypoxic preconditioning of ischaemic canine myocardium.

OBJECTIVE: The aim was to test whether a brief period of non-ischaemic hypoxia can precondition myocardium. METHODS: 60 anaesthetised adult mongrel dogs of either sex underwent 60 min occlusion of the left anterior descending coronary artery, followed by 5 h reperfusion. In treated groups, hearts were either preconditioned with 5 min coronary perfusion with hypoxic blood [O2 content 9.2(SEM 0.6) ml.litre-1] or 5 min occlusion followed by a 10 min reperfusion period prior to 60 min occlusion. The effect of these treatments on myocardial infarct size and regional contractile function was assessed. RESULTS: Infarct size, determined by tetrazolium staining, as a percentage of anatomical area at risk was markedly decreased in hypoxia preconditioned hearts, at 7.2(1.8)% v 22.4(4.6)% in controls (p < 0.01), but did not differ from ischaemia preconditioned hearts [4.6(1.7)%; p < 0.01 v control]. Anatomical area at risk, expressed as a percentage of left ventricular mass, and collateral blood flow to the inner two thirds of the ischaemic wall did not differ among the groups. Regional contractile function was depressed following ischaemic preconditioning but not following hypoxic preconditioning. During reperfusion following 60 min occlusion, marked paradoxical systolic lengthening was evident in ischaemia preconditioned and control hearts but not in hypoxia preconditioned myocardium. CONCLUSIONS: Five minutes of hypoxic and ischaemic preconditioning were equipotent in preventing infarction, whereas ischaemic preconditioning caused a greater decrement in postischaemic contractile function.     

Postischaemic metabolic and functional recovery of rat heart after transient reperfusion with various low Ca2+ concentrations.

OBJECTIVE: The effects of transient low Ca2+ reperfusion after ischaemia on metabolic and functional recovery were studied in isolated rat hearts. METHODS: 31P nuclear magnetic resonance (NMR) was used to monitor creatine phosphate, ATP, intracellular inorganic phosphate (Pi), and intracellular pH during control perfusion (15 min), total ischaemia (30 min), and reperfusion (30 min). During early reperfusion (0-10 min) perfusate [Ca2+] amounted to 1.3 (control group), 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, or 0.7 mmol.litre-1. During late reperfusion (10-30 min) perfusate [Ca2+] was 1.3 mmol.litre-1. Isolated rat hearts were used and perfused according to Langendorff. RESULTS: Recovery of creatine phosphate during early reperfusion was partly abolished during late reperfusion in the 0.1-0.4 mmol.litre-1 groups (p < 0.01). In the 0.1 mmol.litre-1 group creatine phosphate content after 30 min reperfusion was lower (p < 0.05) than in the control group. Recovery of ATP during early reperfusion in the 0.3 mmol.litre-1 group was better than in the control group (p < 0.01). After 30 min reperfusion ATP recovery was better in the 0.3 mmol.litre-1 group (p < 0.01) and worse in the 0.1 mmol.litre-1 group (p = 0.05) than in the control group. Decline of Pi during early reperfusion was more pronounced in the 0.2 and 0.3 mmol.litre-1 groups (p < 0.01) and in the 0.5 and 0.6 mmol.litre-1 groups (p < 0.05) than in the control group. In the 0.3 and 0.4 mmol.litre-1 groups, Pi after 30 min reperfusion was higher (p < 0.05) than after 10 min reperfusion. After 30 min reperfusion left ventricular developed pressure, measured with an intraventricular balloon, was lower in the 0.1 mmol.litre-1 group (p < 0.01) than in the control group. CONCLUSIONS: The data show that under the experimental conditions used successive postischaemic reperfusion with 0.1 and 1.3 mmol.litre-1 Ca2+ resulted in poorer metabolic and functional recovery of the hearts than continuous reperfusion with 1.3 mmol.litre-1 Ca2+. Postischaemic reperfusion with 0.1 mmol.litre-1 Ca2+ may predispose the heart to a mild calcium paradox. Successive reperfusion with 0.3 and 1.3 mmol.litre-1 Ca2+ was optimal in terms of ATP recovery but did not result in an increased recovery of left ventricular developed pressure.     

Acute myocardial ischaemia in the anaesthetised pig: local catecholamine release and its relation to ventricular fibrillation

Summary In anaesthetised open-chest pigs, sequential myocardial samples were obtained before and after occlusion of the distal half of the LAD. These samples were analysed histofluorimetrically to determine the density of catecholamine containing neurones in each sample (quantified morphometrically), and radioenzymatically for total tissue noradrenaline content. Following coronary artery occlusion, 75% of the animals (24 out of 32) died in ventricular fibrillation in the first 30 min, the other 25% (8/32) survived the first 60 min of myocardial ischaemia. Coronary artery occlusion led to a significant reduction in the density of fluorescing fibres in the ischaemic myocardium of animals which fibrillated (from 1.25±0.2% to 0.67±0.10% at 15 min) whereas in the survivors there was no significant change in fluorescing area during the course of the experiment. Animals which fibrillated had a significant reduction in tissue noradrenaline concentration of the ischaemic myocardium (from an initial concentration of 612±72 to 402±64 ng/g ww) within the first 5 min of ischaemia. It is concluded that in this model of myocardial ischaemia, the development of ventricular fibrillation in the early phase seems to be related to the release of noradrenaline from the sympathetic neurones after the onset of myocardial ischaemia.Supported by Deutsche Forschungsgemeinschaft Hi 137/8-1