| Heart rate in the pathophysiology of coronary blood flow and myocardial ischaemia: benefit from selective bradycardic agents. | |
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MedLine Citation:
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PMID: 18223669 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Starting out from a brief description of the determinants of coronary blood flow (perfusion, pressure, extravascular compression, autoregulation, metabolic regulation, endothelium-mediated regulation and neurohumoral regulation) the present review highlights the overwhelming importance of metabolic regulation such that coronary blood flow is increased at increased heart rate under physiological circumstances and the overwhelming importance of extravascular compression such that coronary blood flow is decreased at increased heart rate through reduction of diastolic duration in the presence of severe coronary stenoses. The review goes on to characterize the role of heart rate in the redistribution of regional myocardial blood flow between a normal coronary vascular tree with preserved autoregulation and a poststenotic vasculature with exhausted coronary reserve. When flow is normalized by heart rate, there is a consistent close relationship of regional myocardial blood flow and contractile function for each single cardiac cycle no matter whether or not there is a coronary stenosis and what the actual blood flow is. beta-Blockade improves both flow and function along this relationship. When the heart rate reduction associated with beta-blockade is prevented by pacing, alpha-adrenergic coronary vasoconstriction is unmasked and both flow and function are deteriorated. Selective heart rate reduction, however, improves both flow and function without any residual negative effect such as unmasked alpha-adrenergic coronary vasoconstriction or negative inotropic action. |
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Authors:
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G Heusch |
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Publication Detail:
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Type: Journal Article; Review Date: 2008-01-28 |
Journal Detail:
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Title: British journal of pharmacology Volume: 153 ISSN: 0007-1188 ISO Abbreviation: Br. J. Pharmacol. Publication Date: 2008 Apr |
Date Detail:
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Created Date: 2008-04-14 Completed Date: 2008-08-12 Revised Date: 2009-11-18 |
Medline Journal Info:
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Nlm Unique ID: 7502536 Medline TA: Br J Pharmacol Country: England |
Other Details:
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Languages: eng Pagination: 1589-601 Citation Subset: IM |
Affiliation:
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Institute for Pathophysiology, University of Essen Medical School, Essen, Germany. gerd.heusch@uk-essen.de |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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pharmacology Animals Anti-Arrhythmia Agents / pharmacology Benzazepines / pharmacology Coronary Circulation / drug effects* Heart Rate / drug effects* Humans Myocardial Ischemia / drug therapy*, physiopathology |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Antagonists; 0/Anti-Arrhythmia Agents; 0/Benzazepines; 155974-00-8/ivabradine |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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