American Journal of Internal Medicine

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Bezold Jarisch Reflex- New Interest, Old Phenomenon

Received: Dec. 13, 2019    Accepted: Jan. 06, 2020    Published: Jan. 16, 2020
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Abstract

Bezold Jarisch reflex (BJR) is an eponym for a triad of responses namely: bradycardia, hypotension and vasodilation that develops upon stimulation of intracardiac mechanoreceptors and is mediated by vagal afferent nerve fibers. Though it was first reported in 1867 it remains a topic of discussion due to its implications in various clinical scenarios. The reflex can be stimulated either by mechanical or chemical stimulators. Often considered a physiologic response, if identified by the clinician at earlier phase, can avoid cardiac complication, it also acts as a prognostic indicator in various diseases. This review focuses on the physiology of the BJR and its possible physiologic role in several clinical situations. We used evidence obtained from a computerized literature of medical databases search using PubMed/Medline/NIH (all articles till October 2019). The search was carried out with MeSH phrase “Bezold Jarisch reflex” and articles were limited to English language only. The relevant published reports, abstracts and human studies with clinical cases to determine the clinical implications of BJR were considered for the review. It has been concluded that BJR is a physiologic response that can occur in number of clinical scenarios. Therefore, simultaneous occurrence of bradycardia and hypotension should alert clinicians to the possibility of BJR.

DOI 10.11648/j.ajim.20200801.15
Published in American Journal of Internal Medicine ( Volume 8, Issue 1, January 2020 )
Page(s) 24-29
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Bezold Jarisch Reflex, C-fibers, Chemoreceptors, Myocardial Receptors

References
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[2] Kim YH, Kim DJ, Kim WY. Bezold–Jarisch reflex caused by postural change. J Anesth 2015; 29 (1): 158.
[3] Aviado DM, Aviado DG. The Bezold-Jarisch reflex. A historical perspective of cardiopulmonary reflexes. Ann N Y Acad Sci. 2001; 940: 48-58.
[4] Heringer OA, Cassaro KOD, Mateus, NC et al. Relationship between male hormonal status, Bezold-Jarisch reflex function and ACE activity (cardiac and plasmatic). Can J PhysiolPharmacol. 2016; 94 (2): 231-6.
[5] Kashihara K. Roles of arterial baroreceptor reflex during Bezold-Jarisch Reflex. CurrCardiol Rev. 2009; 5 (4): 263-7.
[6] Campagna JA, Carter C. Clinical relevance of the Bezold–Jarisch reflex. Anesthesiology. 2003; 98 (5): 1250–60.
[7] Shah S, Waxman S. Two cases of Bezold-Jarisch reflex induced by intra-arterial nitroglycerin in critical left main coronary artery stenosis. Tex Heart Inst J. 2013; 40 (4): 484-6.
[8] Thames MD, Klopfenstein HS, Abboud FM, Mark AL and Walker JL. Preferential distribution of inhibitory cardiac receptors with vagal afferents to the inferoposterior wall of the left ventricle activated during coronary occlusion in the dog. Circ Res. 1978; 43 (4): 512-9.
[9] Mark AL. The Bezold-Jarischreflex revisited: clinical implications of inhibitory reflexes originating in the heart. J Am CollCardiol. 1983; 1 (1): 90-102.
[10] Bilgi K, Kamath S, Sultana N. BezoldJarisch reflex and acute cardiovascular collapse during craniotomy. Indian J Anaesth. 2017; 61 (2): 176-7.
[11] Pires JG, Silva SR, Ramage AG, Futuro-Neto HA. Evidence that 5-HT3 receptors in the nucleus tractussolitarius and other brainstem areas modulate the vagal bradycardia evoked by activation of the von Bezold-Jarisch reflex in the anesthetized rat. Brain Res. 1998; 791 (1-2): 229-34.
[12] Parent ME, Lepage S. A heart stopping case of theBezold-Jarischreflex. Case Rep Cardiol. 2015; 2015: 359401. http://dx.doi.org/10.1155/2015/359401.
[13] Conde Ruiz C, Junot S. Successful cardiopulmonary resuscitation in a sevoflurane anesthetized horse that suffered cardiac arrest at recovery. Front Vet Sci. 2018; 5: 138. doi: 10.3389/fvets.2018.00138.
[14] Kinsella SM, Tuckey JP. Perioperative bradycardia and asystole: relationship to vasovagal syncope and the BezoldJarisch reflex. Br J Anaesth 2001; 86 (6): 859-68.
[15] Boku A, Sugimura M, Morimoto Y, Hanamoto H, Niwa H. Hemodynamic and autonomic response to acute hemorrhage in streptozotocin-induced diabetic rats. CardiovascDiabetol. 2010; 9: 78.
[16] John A. Chiladakis JA, Patsouras N, Manolis AS. The Bezold-Jarisch Reflex in acute inferior myocardial infarction: clinical and sympathovagal spectral correlates. Clin. Cardiol. 2003; 26: 323–8.
[17] Lear CA, GalinskyR, Wassink G, et al. The myths and physiology surrounding intrapartum decelerations: the critical role of the peripheral chemoreflex. J Physiol. 2016; 594 (17): 4711–25.
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  • APA Style

    Sanjeev Arya, Shantanu Belwal, Bhupesh Uniyal, Bhuwan Tiwari, Preeti Sharma. (2020). Bezold Jarisch Reflex- New Interest, Old Phenomenon. American Journal of Internal Medicine, 8(1), 24-29. https://doi.org/10.11648/j.ajim.20200801.15

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    ACS Style

    Sanjeev Arya; Shantanu Belwal; Bhupesh Uniyal; Bhuwan Tiwari; Preeti Sharma. Bezold Jarisch Reflex- New Interest, Old Phenomenon. Am. J. Intern. Med. 2020, 8(1), 24-29. doi: 10.11648/j.ajim.20200801.15

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    AMA Style

    Sanjeev Arya, Shantanu Belwal, Bhupesh Uniyal, Bhuwan Tiwari, Preeti Sharma. Bezold Jarisch Reflex- New Interest, Old Phenomenon. Am J Intern Med. 2020;8(1):24-29. doi: 10.11648/j.ajim.20200801.15

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  • @article{10.11648/j.ajim.20200801.15,
      author = {Sanjeev Arya and Shantanu Belwal and Bhupesh Uniyal and Bhuwan Tiwari and Preeti Sharma},
      title = {Bezold Jarisch Reflex- New Interest, Old Phenomenon},
      journal = {American Journal of Internal Medicine},
      volume = {8},
      number = {1},
      pages = {24-29},
      doi = {10.11648/j.ajim.20200801.15},
      url = {https://doi.org/10.11648/j.ajim.20200801.15},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ajim.20200801.15},
      abstract = {Bezold Jarisch reflex (BJR) is an eponym for a triad of responses namely: bradycardia, hypotension and vasodilation that develops upon stimulation of intracardiac mechanoreceptors and is mediated by vagal afferent nerve fibers. Though it was first reported in 1867 it remains a topic of discussion due to its implications in various clinical scenarios. The reflex can be stimulated either by mechanical or chemical stimulators. Often considered a physiologic response, if identified by the clinician at earlier phase, can avoid cardiac complication, it also acts as a prognostic indicator in various diseases. This review focuses on the physiology of the BJR and its possible physiologic role in several clinical situations. We used evidence obtained from a computerized literature of medical databases search using PubMed/Medline/NIH (all articles till October 2019). The search was carried out with MeSH phrase “Bezold Jarisch reflex” and articles were limited to English language only. The relevant published reports, abstracts and human studies with clinical cases to determine the clinical implications of BJR were considered for the review. It has been concluded that BJR is a physiologic response that can occur in number of clinical scenarios. Therefore, simultaneous occurrence of bradycardia and hypotension should alert clinicians to the possibility of BJR.},
     year = {2020}
    }
    

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Author Information
  • Medical Intensive Care Unit, Max Super Specialty Hospital, Dehradun, India

  • Medical Intensive Care Unit, Max Super Specialty Hospital, Dehradun, India

  • Medical Intensive Care Unit, Max Super Specialty Hospital, Dehradun, India

  • Department of Cardiology, Ram Manohar Lohia Institute of Medical Sciences, Gomti Nagar, Lucknow, India

  • Department of Cardiology, Max Super Specialty Hospital, Dehradun, India

  • Section