IntroductionIn vitro studies indicate that muscarinic cholinergic inhibition of 18-adrenergic cardiac responses may be modulated in part by nitric oxide (NO). The sympathetic and parasympathetic limbs of the autonomic nervous system play important and countervailing roles in regulating heart rate, atrioventricular conduction, and myocardial contractility. Sympathetic stimulation increases heart rate, conduction, and contractility, whereas parasympathetic stimulation slows both sinus node rate and atrioventricular conduction (1-6). Although it has little effect on ventricular contractility under basal conditions, an increase in vagal nerve activity attenuates the contractile response to sympathetic stimulation (1, 4) and infused 6-adrenergic agonists (2, 3, 5, 6). Likewise, the intracoronary infusion of acetylcholine attenuates the inotropic response to sympathetic nerve stimulation (5) and infused f3-adrenergic agonists (5, 6).There is evidence to suggest that nitric oxide (NO)' may influence the autonomic regulation of cardiac function. In isolated myocytes, NO has been shown to play a role in both muscarinic-cholinergic slowing of heart rate and attenuation of the contractile response to /3-adrenergic stimulation (7). NO acts by stimulating soluble guanylyl cyclase (8-10) to produce cyclic GMP (cGMP). In the heart, muscarinic-cholinergic stimulation also leads to increased cGMP production (11)(12)(13)(14)(15) which, in turn, may counteract the contractile effects of cAMP (16,17). Thus, there is theoretical support for the thesis that NO plays a role in modulating the interaction between the adrenergic and cholinergic arms of the autonomic nervous system.Despite the well-characterized role of NO in modulating myocyte function in vitro, the role of NO in modulating myocardial contractility in vivo remains undefined. NO is involved in vagally mediated pulmonary (18)