Short- and long-term neurohormonal activation following acute myocardial infarction

Sigurdsson, Axel; Held, Peter; Swedberg, Karl

doi:10.1016/0002-8703(93)90656-t

Cited by 124 publications

(87 citation statements)

References 28 publications

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“…The sympathetic response to the cold pressor test was markedly more pronounced compared to controls. An increased sympathetic nervous activity has a negative prognostic impact in patients with cardiovascular disease such as heart failure, [33] myocardial infarction, [34] and stroke. [35] Baroreceptor gain for slow changes of blood pressure was considerably higher in patients with PB representing increased controller gain in the baroreceptor feedback loop.…”

Section: Discussionmentioning

confidence: 99%

Spontanous periodic breathing is associated with sympathetic hyperreactivity and baroreceptor dysfunction in hypertension

Binggeli

Sudano²,

Corti³

et al. 2010

Journal of Hypertension

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OBJECTIVES: Intermittent periods of hypoxemia such as during periodic breathing are associated with hypertension and increased sympathetic activity. In patients with sleep apnea syndrome, hypertension is common. Treating apnea improves hypertension and reduces sympathetic outflow. The aim of the present study was to investigate the phenomenon and mechanisms of spontaneous periodic breathing in patients with hypertension. METHOD: We examined 43 hypertensive patients with untreated hypertension without left-ventricular dysfunction, heart failure or sleep apnea syndrome. Muscle sympathetic nerve activity (MSA), heart rate (HR), blood pressure (BP) and respiration were continuously recorded at rest and during cold-pressor testing. Oxygen and a CO2-enriched gas were used to test central and peripheral chemoreceptors, respectively. Baroreceptor gain was measured using the alpha method. RESULTS: Seven out of 43 patients showed spontaneous periodic breathing while awake. No difference in MSA, HR and BP was seen between patients with and without periodic breathing at rest except the breathing pattern. However, the cold-pressor test caused a larger increase of MSA in patients with periodic breathing (203 +/-62 vs. 62 +/-8%, P < 0.0001 by ANOVA), as well as systolic (46 +/-6 vs. 25 +/-3 mmHg, P = 0.002) and diastolic BP (26 +/-5 vs. 12 +/-1 mmHg, P = 0.004, ANOVA). Baroreceptor gain was markedly higher in patients with periodic breathing. Chemoreceptor sensitivity was comparable. CONCLUSION: Spontaneous periodic breathing is relatively common in patients with hypertension and is associated with greatly enhanced responses to cold-pressor testing. We suggest increased baroreceptor gain and sympathetic outflow as a cause for the oscillatory respiration pattern via barorespiratory coupling.

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Section: Discussionmentioning

confidence: 99%

Spontanous periodic breathing is associated with sympathetic hyperreactivity and baroreceptor dysfunction in hypertension

Binggeli

Sudano²,

Corti³

et al. 2010

Journal of Hypertension

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“…In contrast, neuroactivation tends to be more persistent in chronic heart failure. 34 It is also unknown whether the effects of spironolactone at androgen and progesterone receptors could have a beneficial or harmful effect in patients with heart failure in the immediate post-AMI setting. Therefore, the efficacy data of these drugs are not necessarily interchangeable.…”

Section: Clinical Considerationsmentioning

confidence: 99%

A Comparison of the Aldosterone‐blocking Agents Eplerenone and Spironolactone

Struthers

Krum

Williams

2008

Clinical Cardiology

217

146

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Improved understanding of the adverse pharmacological properties of aldosterone has prompted investigation of the clinical benefits of blocking aldosterone at the receptor level. This article reviews the pharmacology, clinical efficacy, and tolerability of the two available blocking agents, spironolactone and eplerenone. A Medline search identified clinical studies assessing spironolactone and eplerenone. Priority was given to large, wellcontrolled, clinical trials and comparative studies. Pharmacological differences between spironolactone and eplerenone include lower affinity of eplerenone for progesterone, androgen, and glucocorticoid receptors; more consistently demonstrated nongenomic properties for eplerenone; and the presence of long-acting metabolites for spironolactone. Both agents effectively treat hypertension and heart failure but comparisons are complicated by the deficiency of head-to-head trials and differences between patient populations. There are differences in the tolerability profiles; spironolactone is associated with dose-dependent sexual side effects. Both agents produce dose-dependent increases in potassium concentrations, although the effect with spironolactone appears to be greater when both agents are administered at recommended doses. Choice of a specific agent should be based on individual patient issues, such as the nature of heart failure and patient concerns about adverse events.

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“…10 Sigurdsson A, Held P, Swedberg K in their study of 55 patients with acute myocardial infarction concluded that sustained neurohormonal activation after myocardial infarction mainly occurs in patients with clinical heart failure and is related to the magnitude of myocardial damage, even in patients without heart failure. 8 Tang et al also documented in their study that hyponatremia was independentaly associated with in hospital death and heart failure 11 .…”

Section: Discussionmentioning

confidence: 88%

“…In fact, the neurohormonal activation that accompanies acute myocardial infarction is similar to that which accompanies heart failure 8 .In myocardial infacrtion hyponatremia aggravated by concomitant activation of the rennin angiotensin system and increased catecholamine production sustained neurohormonal activation after myocardial infarction mainly occurs in patients with clinical heart failure and is related to the magnitude of myocardial damage, even in patients without heart failure. 8 Hyponatremia is a simple marker of neurohormonal activation during the acute phase of myocardial infarction and predicts the short-term survival. 10 …”

Section: Introductionmentioning

confidence: 99%

Impact of Hyponatremia on Survival of Acute St-Elevation Myocardial Infarction Patients during 30 Days

2015

IJSR

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Objective: Hyponatremia has been shown to be a predictor of cardiovascular mortality among patients with heart failure.Hyponatremia is intial insult for neurohormonal activation and left ventricular remodeling in acute myocardial infarction, both these factors are responsible with other factors for predicting short term survival in patient of acute myocardial infarctions. Hence we aimed to investigate the impact of hyponatremia in the setting of acute ST elevation MI and to determine its usefulness in predicting short term survival. Material and methods: 100 consecutive patients presenting with acute ST-elevation myocardial infarction admitted to M.B.S. HOSPITAL ,G.M.C. KOTA, from aug 2013 to dec 2014 were studied. Qualifying patients underwent detailed history and clinical examination. Plasma sodium concentrations were obtained on admission and at 24, 48 and 72 hours thereafter. Hyponatremia was correlated with various parameters like age, male sex, diabetes, anterior infacrtion, killip class, mean ejection fracrtion. The primary end point was all cause mortality within 30 days following myocardial infarction. Results: In our study ,substantial proportion of patients who presented with acute ST elevation myocardial infarction were hyponatremic on admission or developed hyponatremia shortly after admission.Corelation of hyponatremia was found highly significant with male sex(pvalue=0.012),diabetes(p value=0.04),killip class(p value=0.02),ejection fraction(p value=0.008),but no correlation was found with age,sex,smoking. We also found a significant linear relationship between severity of hyponatremia and mortality. Multivariate analysis was performed which identified hyponatremia on admission or early development of hyponatremia as a significant independent predictor of 30 day mortality. Conclusion: In our study we concluded that hyponatremia on admission or early development of hyponatremia in patients with acute ST elevation myocardial infarction is an independent predictor of 30-day mortality.

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Short- and long-term neurohormonal activation following acute myocardial infarction

Cited by 124 publications

References 28 publications

Spontanous periodic breathing is associated with sympathetic hyperreactivity and baroreceptor dysfunction in hypertension

Spontanous periodic breathing is associated with sympathetic hyperreactivity and baroreceptor dysfunction in hypertension

A Comparison of the Aldosterone‐blocking Agents Eplerenone and Spironolactone

Impact of Hyponatremia on Survival of Acute St-Elevation Myocardial Infarction Patients during 30 Days

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