Comparison of the acute hemodynamic effects of intravenous celiprolol and propranolol in patients with suspected coronary disease.

The acute hemodynamic effects of intravenously administered celiprolol and propranolol were compared in 18 patients, 12 with coronary obstruction in the presence or absence of reduced LV function and six with no significant cardiac disease. The study was performed using a single blind, randomized design with celiprolol (0.07 and 0.14 mg/kg) and propranolol (0.07 mg/kg) in six patients per treatment group. The hemodynamic parameters obtained via right and left heart catheterization were measured at baseline and at 5 and 10 min after drug infusion (1.0 mg/min). Propranolol produced a significant fall in left ventricular Vmax, left ventricular dP/dt and cardiac output. In contrast, celiprolol either caused no change or significantly increased these parameters. These results indicate that celiprolol has an acute hemodynamic profile which differs significantly from that of propranolol.

Coronary reperfusion and Bezold-Jarisch reflex (bradycardia and hypotension).

This study reports the occurrence of bradycardia and hypotension (Bezold-Jarisch reflex) induced by myocardial reperfusion. Among 92 patients undergoing interventional catheterization for intracoronary thrombolysis in an early phase of acute myocardial infarction, left anterior descending, right coronary, and left circumflex (LC) arteries were identified as the "infarct vessel" in 44, 41, and 7 cases, respectively. The Bezold-Jarisch reflex occurred in 15 of 23 patients (65%) after right coronary recanalization and in 1 of 34 patients after left anterior descending recanalization. The reflex also was observed in 4 (22%) of 18 patients with nonoccluded or nonrecanalized right coronary arteries. The average time from onset of symptoms to right recanalization was significantly shorter (p less than 0.01) among patients in whom the reflex did not develop. Atropine, postural changes, or temporary pacing, or all 3, were generally sufficient to control symptoms. The findings of this study are substantially parallel to those reported by others and confirm that reperfusion of the inferoposterior myocardium is capable of stimulating a cardioinhibitory reflex. Follow-up data available in 15 patients with occluded and recanalized right coronary arteries indicate that the occurrence of the Bezold-Jarisch reflex after reperfusion is not a reliable predictor of myocardial salvage.