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.
Highlights
Cardiopulmonary reflexes belong to the autonomic or involuntary nervous system
Of which Bezold Jarisch reflex (BJR) is an inhibitory reflex induced by the stimulation of receptors located in the epicardium of the infero-posterior region of the left ventricle
BJR is interrupted by cervical vagotomy which indicates that the parasympathetic innervation of the cardiopulmonary organs is essential in the transmission of the afferent and/or efferent groups of nerve impulses
Summary
Cardiopulmonary reflexes belong to the autonomic or involuntary nervous system. Of which Bezold Jarisch reflex (BJR) is an inhibitory reflex induced by the stimulation of receptors located in the epicardium of the infero-posterior region of the left ventricle.Stimulation of these ‘inhibitory cardiac receptors’ by stretch, chemical substances or drugs increases parasympathetic activity and inhibits sympathetic activity.BJR is interrupted by cervical vagotomy which indicates that the parasympathetic innervation of the cardiopulmonary organs is essential in the transmission of the afferent and/or efferent groups of nerve impulses.In vasoplegic states, peripheral venous blood pooling may lead to hyper stimulation of the myocardium paradoxically resulting in reflex cardiovascular depression with vasodilation, hypotension and bradycardia which in turn modulates renin release and vasopressin secretion [1,2,3].Upon administration of iv veratrum alkaloids in experimental animals von Bezold and Hirt in 1867 first observed the profound decrease in blood pressure and heart rate in conjunction with apnea. Of which Bezold Jarisch reflex (BJR) is an inhibitory reflex induced by the stimulation of receptors located in the epicardium of the infero-posterior region of the left ventricle. Later in the late 1930s, Jarisch and Richter reported that the powerful depressor action induced by intravenous veratridine was attributable to the cardiac branches of vagus nerves in cats. They confirmed that the depressor effect initially observed in 1867 by Bezold was reflex in origin whose receptors were located in the ventricle
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