Coronary responses to cold air inhalation following afferent and efferent blockade

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Abstract

Cardiac ischemia and angina pectoris are commonly experienced during exertion in a cold environment. In the current study we tested the hypotheses that oropharyngeal afferent blockade (i.e., local anesthesia of the upper airway with lidocaine) as well as systemic β-adrenergic receptor blockade (i.e., intravenous propranolol) would improve the balance between myocardial oxygen supply and demand in response to the combined stimulus of cold air inhalation (-15 to -30°C) and isometric handgrip exercise (Cold + Grip). Young healthy subjects underwent Cold + Grip following lidocaine, propranolol, and control (no drug). Heart rate, blood pressure, and coronary blood flow velocity (CBV, from Doppler echocardiography) were continuously measured. Rate-pressure product (RPP) was calculated, and changes from baseline were compared between treatments. The change in RPP at the end of Cold + Grip was not different between lidocaine (2,441± 376) and control conditions (3,159± 626); CBV responses were also not different between treatments. With propranolol, heart rate (8± 1 vs. 14± 3 beats/min) and RPP responses to Cold + Grip were significantly attenuated. However, at peak exercise propranolol also resulted in a smaller CBV (1.4± 0.8 vs. 5.3± 1.4 cm/s, P < 0.035), such that the relationship between coronary flow and cardiac metabolism was impaired under propranolol (0.43± 0.37 vs. 2.1± 0.63 arbitrary units). These data suggest that cold air breathing and isometric exercise significantly influence efferent control of coronary blood flow. Additionally, β-adrenergic vasodilation may play a significant role in coronary regulation during exercise.

Original languageEnglish (US)
JournalAmerican Journal of Physiology - Heart and Circulatory Physiology
Volume307
Issue number2
DOIs
StatePublished - Jul 15 2014

Fingerprint

Inhalation
Air
Propranolol
Hand Strength
Lidocaine
Exercise
Pressure
Heart Rate
Breathing Exercises
Blood Flow Velocity
Doppler Echocardiography
Drug and Narcotic Control
Angina Pectoris
Local Anesthesia
Vasodilation
Adrenergic Agents
Adrenergic Receptors
Healthy Volunteers
Ischemia
Oxygen

All Science Journal Classification (ASJC) codes

  • Physiology
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Coronary responses to cold air inhalation following afferent and efferent blockade",
abstract = "Cardiac ischemia and angina pectoris are commonly experienced during exertion in a cold environment. In the current study we tested the hypotheses that oropharyngeal afferent blockade (i.e., local anesthesia of the upper airway with lidocaine) as well as systemic β-adrenergic receptor blockade (i.e., intravenous propranolol) would improve the balance between myocardial oxygen supply and demand in response to the combined stimulus of cold air inhalation (-15 to -30°C) and isometric handgrip exercise (Cold + Grip). Young healthy subjects underwent Cold + Grip following lidocaine, propranolol, and control (no drug). Heart rate, blood pressure, and coronary blood flow velocity (CBV, from Doppler echocardiography) were continuously measured. Rate-pressure product (RPP) was calculated, and changes from baseline were compared between treatments. The change in RPP at the end of Cold + Grip was not different between lidocaine (2,441± 376) and control conditions (3,159± 626); CBV responses were also not different between treatments. With propranolol, heart rate (8± 1 vs. 14± 3 beats/min) and RPP responses to Cold + Grip were significantly attenuated. However, at peak exercise propranolol also resulted in a smaller CBV (1.4± 0.8 vs. 5.3± 1.4 cm/s, P < 0.035), such that the relationship between coronary flow and cardiac metabolism was impaired under propranolol (0.43± 0.37 vs. 2.1± 0.63 arbitrary units). These data suggest that cold air breathing and isometric exercise significantly influence efferent control of coronary blood flow. Additionally, β-adrenergic vasodilation may play a significant role in coronary regulation during exercise.",
author = "Matthew Muller and Zhaohui Gao and Patrick McQuillan and Urs Leuenberger and Lawrence Sinoway",
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AU - Muller, Matthew

AU - Gao, Zhaohui

AU - McQuillan, Patrick

AU - Leuenberger, Urs

AU - Sinoway, Lawrence

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N2 - Cardiac ischemia and angina pectoris are commonly experienced during exertion in a cold environment. In the current study we tested the hypotheses that oropharyngeal afferent blockade (i.e., local anesthesia of the upper airway with lidocaine) as well as systemic β-adrenergic receptor blockade (i.e., intravenous propranolol) would improve the balance between myocardial oxygen supply and demand in response to the combined stimulus of cold air inhalation (-15 to -30°C) and isometric handgrip exercise (Cold + Grip). Young healthy subjects underwent Cold + Grip following lidocaine, propranolol, and control (no drug). Heart rate, blood pressure, and coronary blood flow velocity (CBV, from Doppler echocardiography) were continuously measured. Rate-pressure product (RPP) was calculated, and changes from baseline were compared between treatments. The change in RPP at the end of Cold + Grip was not different between lidocaine (2,441± 376) and control conditions (3,159± 626); CBV responses were also not different between treatments. With propranolol, heart rate (8± 1 vs. 14± 3 beats/min) and RPP responses to Cold + Grip were significantly attenuated. However, at peak exercise propranolol also resulted in a smaller CBV (1.4± 0.8 vs. 5.3± 1.4 cm/s, P < 0.035), such that the relationship between coronary flow and cardiac metabolism was impaired under propranolol (0.43± 0.37 vs. 2.1± 0.63 arbitrary units). These data suggest that cold air breathing and isometric exercise significantly influence efferent control of coronary blood flow. Additionally, β-adrenergic vasodilation may play a significant role in coronary regulation during exercise.

AB - Cardiac ischemia and angina pectoris are commonly experienced during exertion in a cold environment. In the current study we tested the hypotheses that oropharyngeal afferent blockade (i.e., local anesthesia of the upper airway with lidocaine) as well as systemic β-adrenergic receptor blockade (i.e., intravenous propranolol) would improve the balance between myocardial oxygen supply and demand in response to the combined stimulus of cold air inhalation (-15 to -30°C) and isometric handgrip exercise (Cold + Grip). Young healthy subjects underwent Cold + Grip following lidocaine, propranolol, and control (no drug). Heart rate, blood pressure, and coronary blood flow velocity (CBV, from Doppler echocardiography) were continuously measured. Rate-pressure product (RPP) was calculated, and changes from baseline were compared between treatments. The change in RPP at the end of Cold + Grip was not different between lidocaine (2,441± 376) and control conditions (3,159± 626); CBV responses were also not different between treatments. With propranolol, heart rate (8± 1 vs. 14± 3 beats/min) and RPP responses to Cold + Grip were significantly attenuated. However, at peak exercise propranolol also resulted in a smaller CBV (1.4± 0.8 vs. 5.3± 1.4 cm/s, P < 0.035), such that the relationship between coronary flow and cardiac metabolism was impaired under propranolol (0.43± 0.37 vs. 2.1± 0.63 arbitrary units). These data suggest that cold air breathing and isometric exercise significantly influence efferent control of coronary blood flow. Additionally, β-adrenergic vasodilation may play a significant role in coronary regulation during exercise.

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