Cholinergic stimulation with pyridostigmine blunts the cardiac responses to mental stress

Nóbrega, Antônio Cláudio Lucas da; Carvalho, Ana Catarina; Santos, Kelb Bousquet; Soares, Pedro Paulo da Silva

doi:10.1007/bf02280691

Cited by 28 publications

(21 citation statements)

References 31 publications

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“…These effects were obtained without impairment of systolic or diastolic cardiac functions (16). In addition, a single 45 mg dose of pyridostigmine given orally to healthy subjects blunted the double-product elevation during mental stress (17). Finally, pyridostigmine inhibited the hemodynamic response to central adrenergic stimulation produced by intracerebroventricular injection of glutamate in a rat model (18).…”

Section: Discussionmentioning

confidence: 90%

Cholinergic stimulation with pyridostigmine reduces the QTc interval in coronary artery disease

Castro

Porphirio²,

Serra³

et al. 2002

Braz J Med Biol Res

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Parasympathetic dysfunction is an independent risk factor in patients with coronary artery disease; thus, cholinergic stimulation is a potential therapeutic measure that may be protective by acting on ventricular repolarization. The purpose of the present study was to determine the effects of pyridostigmine bromide (PYR), a reversible anticholinesterase agent, on the electrocardiographic variables, particularly QTc interval, in patients with stable coronary artery disease. In a randomized double-blind crossover placebo-controlled study, simultaneous 12-lead electrocardiographic tracings were obtained at rest from 10 patients with exercise-induced myocardial ischemia before and 2 h after the oral administration of 45 mg PYR or placebo. PYR increased the RR intervals (pre: 921 ± 27 ms vs post: 1127 ± 37 ms; P<0.01) and, in contrast with placebo, decreased the QTc interval (pre: 401 ± 3 ms vs post: 382 ± 3 ms; P<0.01). No other electrocardiographic variables were modified (PR segment, QT interval, QT and QTc dispersions). Cholinergic stimulation with PYR caused bradycardia and reduced the QTc interval without important side effects in patients with coronary disease. These effects, if confirmed in studies over longer periods of administration, may suggest a cardioprotection by cholinergic stimulation with PYR. Correspondence

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Section: Discussionmentioning

confidence: 90%

Cholinergic stimulation with pyridostigmine reduces the QTc interval in coronary artery disease

Castro

Porphirio²,

Serra³

et al. 2002

Braz J Med Biol Res

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show abstract

“…These effects observed in healthy volunteers occurred with no change in systolic and diastolic cardiac function 32 . When used at the oral dosage of 45mg, pyridostigmine limited the elevation of the double product of healthy individuals under mental stress in a cross-sectional, double blind, randomized, placebo-controlled study 33 .…”

Section: Discussionmentioning

confidence: 99%

“…In addition, all studies performed so far by our team have involved the use of a single dose 29,30,32,33 , or a maximum 3 doses 31 of pyridostigmine bromide. Studies with patients may analyze the effect of pyridostigmine bromide administration in fractionated doses at long-term.…”

Section: Postmentioning

confidence: 99%

Reduction of QTc interval dispersion. Potential mechanism of cardiac protection of pyridostigmine bromide

Castro

Serra

Nóbrega

2000

Arq. Bras. Cardiol.

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“…Pyridostigmine is an Food and Drug Administration-approved acetylcholinesterase inhibitor used for the treatment of myasthenia gravis. In healthy subjects, peak plasma levels and peak cholinesterase inhibition (15-20%) occur 90 -150 min after oral dosing with minimal variation in drug levels and degree of cholinesterase inhibition during this time period (3,39,44). The study protocol is shown schematically in Fig.…”

Section: Methodsmentioning

confidence: 99%

Effect of acetylcholinesterase inhibition with pyridostigmine on cardiac parasympathetic function in sedentary adults and trained athletes

Dewland¹,

Androne²,

Lee³

et al. 2007

American Journal of Physiology-Heart and Circulatory Physiology

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Dewland TA, Androne AS, Lee FA, Lampert RJ, Katz SD. Effect of acetylcholinesterase inhibition with pyridostigmine on cardiac parasympathetic function in sedentary adults and trained athletes. Am J Physiol Heart Circ Physiol 293: H86-H92, 2007. First published February 23, 2007 doi:10.1152/ajpheart.01339.2006.-Heart rate variability and postexercise heart rate recovery are used to assess cardiac parasympathetic tone in human studies, but in some cases these indexes appear to yield discordant information. We utilized pyridostigmine, an acetylcholinesterase inhibitor that selectively augments the parasympathetic efferent signal, to further characterize parasympathetic regulation of rest and postexercise heart rate. We measured time-and frequency-domain indexes of resting heart rate variability and postexercise heart rate recovery in 10 sedentary adults and 10 aerobically trained athletes after a single oral dose of pyridostigmine (30 mg) and matching placebo in randomized, doubleblind, crossover trial. In sedentary adults, pyridostigmine decreased resting heart rate [from 66.7 (SD 12.6) to 58.1 beats/min (SD 7.6), P ϭ 0.005 vs. placebo] and increased postexercise heart rate recovery at 1 min [from 40.7 (SD 10.9) to 45.1 beats/min (SD 8.8), P ϭ 0.02 vs. placebo]. In trained athletes, pyridostigmine did not change resting heart rate or postexercise heart rate recovery when compared with placebo. Time-and frequency-domain indexes of resting heart rate variability did not differ after pyridostigmine versus placebo in either cohort and were not significantly associated with postexercise heart rate recovery in either cohort. The divergent effects of pyridostigmine on resting and postexercise measures of cardiac parasympathetic function in sedentary subjects confirm that these measures characterize distinct aspects of cardiac parasympathetic regulation. The lesser effect of pyridostigmine on either measure of cardiac parasympathetic tone in the trained athletes indicates that the enhanced parasympathetic tone associated with exercise training is at least partially attributable to adaptations in the efferent parasympathetic pathway. heart rate variability; heart rate recovery; parasympathetic nervous system; exercise RESTING HEART RATE VARIABILITY and postexercise heart rate recovery are used in human studies to assess cardiac parasympathetic tone (1,30,47). The high-frequency (HF) component of resting heart rate variability quantifies short-term changes in heart rate caused by the effects of central and peripheral respiratory reflexes on vagal efferent activity during a resting steady state with low sympathetic activation (1). Postexercise heart rate recovery assesses the complex interaction of baroreceptor and central command signals that mediate a rapid deceleration of heart rate in the setting of autonomic flux, profound exercise-induced sympathetic stimulation, and high minute ventilation (30).Parasympathetic efferent control of heart rate is ultimately mediated by cholinergic signaling at the sinoatrial node. Acetyl...

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Cholinergic stimulation with pyridostigmine blunts the cardiac responses to mental stress

Cited by 28 publications

References 31 publications

Cholinergic stimulation with pyridostigmine reduces the QTc interval in coronary artery disease

Cholinergic stimulation with pyridostigmine reduces the QTc interval in coronary artery disease

Reduction of QTc interval dispersion. Potential mechanism of cardiac protection of pyridostigmine bromide

Effect of acetylcholinesterase inhibition with pyridostigmine on cardiac parasympathetic function in sedentary adults and trained athletes

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