Stress and the induction of intravascular platelet aggregation in the heart

Simultaneous Exposure to Noise and Toluene Induces Oxidative and Inflammatory Damage in the Heart of Wistar Rats: Therapeutic Potential of Olea europaea L. Leaf Extract

Workers in occupational settings often face simultaneous exposure to multiple risk factors, including noise and chemicals. This study aimed to investigate the effects of combined exposure to noise and toluene on the cardiac health of rats, with a focus on assessing the potential mitigating effects of Olea europaea L. (OLE) leaf extract (40 mg/kg/day). The evaluation involved scrutinizing biochemical and hematological markers, quantifying oxidative stress levels, determining proinflammatory cytokines in the serum, and conducting an in silico Docking studies. Forty-two male Wistar rats were divided into eight groups-(n = 6/group):-Control-group-(C),-OLE-group-(Rats administered OLE), NT-group (rats co-exposed to noise and toluene), NT-4 group-(rats co-exposed to noise and toluene four weeks after the exposure period), NT + OLE1-group (rats co-exposed to noise and toluene treated with OLE for one week), NT + OLE2-group-(rats co-exposed to noise and toluene treated with OLE for two weeks), NT + OLE3-group-(rats co-exposed to noise and toluene treated with OLE for three weeks), and NT + OLE4-group (rats co-exposed to noise and toluene treated with OLE for four weeks). The results revealed that combined exposure to noise and toluene led to oxidative damage and increased serum levels of proinflammatory cytokines. However, OLE treatment attenuated these effects by reducing lipid peroxidation and enhancing catalase and superoxide dismutase activities. Additionally, OLE treatment significantly decreased proinflammatory cytokine levels compared to the noise and toluene co-exposed group. The study highlighted the potential of OLE to attenuate the adverse effects of combined exposure to noise and toluene, attributed to its anti-inflammatory and antioxidant properties.

Olea europaea L. leaf extract mitigates oxidative and histological damage in rat heart tissue exposed to combined noise and toluene: An experimental study

In many occupational settings, workers are frequently exposed to toluene and noise. However, the individual and combined effects of these exposures on the cardiovascular system have not been fully elucidated. Therefore, this study aimed to investigate the impact of simultaneous exposure to toluene and noise on the rat heart, while also evaluating the potential preventive effect of olive leaf extract (OLE). Forty-eight male Wistar rats were randomly assigned to eight groups (n = 6/group): control group (C), control group that received OLE (C + OLE), group exposed to noise (N), group exposed to noise and receiving OLE (N + OLE), group exposed to toluene (T), group exposed to toluene and receiving OLE (T + OLE), group co-exposed to noise and toluene (NT), and group co-exposed to noise and toluene and receiving OLE (NT + OLE). The rats in this study were subjected to simultaneous exposure to toluene and noise for a duration of six weeks, within a custom-built plexiglass chamber. Toluene was administered at a concentration of 300 ppm, while the noise level was set to 85 dB(A). The exposure chamber was equipped with a generation system, an exposure system, and a monitoring system, ensuring precise and accurate exposure conditions. After the six-week period, heart and blood samples were collected from the rats for subsequent analysis. Plasma levels of cholesterol (CHOL), triglycerides (TG), lactate dehydrogenase (LDH), and creatine kinase (CK) were measured, and histopathological investigation was conducted using HE staining. Additionally, superoxide dismutase (SOD) and catalase (CAT) activities, as well as malondialdehyde (MDA) levels in heart tissue were measured. Our results showed that simultaneous exposure to noise and toluene altered CHOL, TG, LDH, and CK levels, and also caused an increase in lipid peroxidation levels and superoxide dismutase activity, along with a decrease in catalase activity in the heart. A significant alteration in the myocardium was also observed. However, treatment with OLE was found to modulate these oxidative and histological changes, ultimately correcting the deleterious effects induced by the combined exposure to noise and toluene. Therefore, our study suggests that OLE could be a potential preventive measure for individuals exposed to toluene and noise in industrial settings.

Interaction between ATP and catecholamines in stimulation of platelet aggregation

Platelets, on activation by endothelial damage, release ADP, ATP, serotonin, epinephrine, and norepinephrine. Although ATP is known to augment the action of norepinephrine in cardiovascular and endocrine systems, the possible interaction between ATP and catecholamines in regulation of platelet reactivity has not been reported. The addition of ATP (1-5 microM) to human platelet-rich plasma did not induce platelet aggregation; however, it selectively augmented the aggregatory response to norepinephrine and epinephrine, but not to serotonin. This potentiating action of ATP was dose dependent and was not due to contamination by, or hydrolysis to, ADP. The action of ATP was blocked by 10 microM of adenosine 3'-phosphate 5'-phosphosulfate, a selective P(2)Y(1) receptor antagonist. ATP alone did not cause release of intracellular Ca(2+), but produced a significant Ca(2+) response in the presence of norepinephrine. In contrast, the P(2)X(1) receptor agonists P(1),P(6)-diadenosine-5' hexophosphate and alpha,beta-methylene-ATP had no effect on norepinephrine-induced platelet aggregation even when added at 100 microM. This synergistic interaction between ATP and norepinephrine in stimulating platelet aggregation may have significant clinical implications and suggests a prothrombotic role for ATP in stress.

Cilnidipine more highly attenuates cold pressor stress-induced platelet activation in hypertension than does amlodipine

The clinical significance of N-type calcium channel blockade has not been fully examined. We here compared the effects of the N-type calcium channel blockers cilnidipine and amlodipine on the sympathetic nervous system and platelet function in hypertension under resting and stressed conditions. Thirty-two patients with hypertension (58+/-9 years) received cilnidipine or amlodipine for 4 weeks in this crossover study. On day 28 of each treatment, plasma levels of epinephrine (EP), norepinephrine (NEP), and beta-thromboglobulin (BTG), and EC50 of ADP-induced platelet aggregation (ADPE50) were determined at rest and after a cold pressor test. On day 29, the group receiving cilnidipine was switched to amlodipine treatment, and vice versa. At rest, the blood pressure, heart rates, EP, NEP, ADPEC50, and BTG, were similar in both treatments. After the cold pressor test, increases in EP (35+/-17 to 44+/-25 pg/ml; p<0.05) and BTG (40+/-13 to 49+/-22 ng/ml; p<0.01) and a decrease in ADPEC50 (32+/-26 to 27+/-24 micromol; p<0.05) were observed in the amlodipine treatment, but not in the cilnidipine treatment. In addition, the increase in NEP was significantly greater (p<0.05) in the amlodipine (276+/-78 to 318+/-87 pg/ml; p<0.01) than in the cilnidipine treatment (273+/-88 to 291+/-100 pg/ml; p<0.05). Cilnidipine more highly attenuates the activation of platelet function in response to cold pressor stress than does amlodipine. Attenuated activation of the sympathetic nervous system via N-type calcium channel blockade may contribute to this phenomenon.

Effects of mental stress on brachial artery flow-mediated vasodilation in healthy normal individuals

BACKGROUND

Mental stress is associated with increased risk for cardiovascular events, possibly because of acute increases in endogenous catecholamines. Recently, brachial artery flow-mediated vasodilation has been used for noninvasive assessment of macrovascular endothelial function. The effect of mental stress and its associated changes in sympathetic activation on brachial artery endothelium-dependent vasomotor tone in vivo remains unknown.

METHODS AND RESULTS

Two-dimensional ultrasound was used to measure brachial artery flow-mediated vasodilation before and after mental stress (provoked by a standard arithmetic challenge) in 21 healthy individuals (10 men, 11 women; average age 23.5 years). The flow stimulus resulted from a 3-minute cuff occlusion of distal forearm blood flow, causing distal hyperemia and a transient 2- to 3-fold increase in brachial artery blood flow on cuff release. During mental stress, heart rate increased on average by 29.6% and blood pressure increased on average by 17.9%. The sympathetic stimulus resulted in a 64% average increase in flow-mediated vasodilator response (P <.001). The enhanced vasodilator response during mental stress was similar for men and women.

CONCLUSIONS

Mental stress can have marked effects on endothelium-dependent, flow-mediated vasodilation in healthy, normal individuals. Similar studies in individuals with impaired endothelial function may further our understanding of the role of mental stress in the development of cardiovascular events.

Effects of a novel calcium antagonist, benidipine hydrochloride, on platelet responsiveness to mental stress in patients with essential hypertension

The effects of a novel calcium antagonist, benidipine hydrochloride, on responses of platelets to mental stress were evaluated in nine patients with essential hypertension. Before and 12 weeks after the monotherapy with benidipine (2-4 mg/day), platelet aggregability and plasma beta-thromboglobulin were determined during rest and after a 10-min arithmetic stress. Before the treatment, arithmetic stress significantly increased platelet aggregability in response to adenosine diphosphate (ADP) and plasma beta-thromboglobulin level. Blood pressure, pulse rate, and plasma catecholamines also increased during arithmetic stress. The treatment with benidipine did not affect resting values of platelet functions, but attenuated significantly stress-induced alterations in primary aggregation to 1.0 microM ADP (34 +/- 4% to 40 +/- 3% before treatment vs. 32 +/- 2% to 34 +/- 3% after benidipine), ADP threshold for biphasic aggregation (2.2 +/- 0.4 to 1.8 +/- 0.3 microM before treatment vs. 2.2 +/- 0.3 to 2.2 +/- 0.4 microM after benidipine) and plasma beta-thromboglobulin level (74 +/- 16 to 104 +/- 15 ng/ml before treatment vs. 60 +/- 10 to 52 +/- 8 ng/ml after benidipine; p < 0.05 for Stress x Treatment interactions in all values). The pretreatment elevations in blood pressure and sympathetic activity with stress were not modified by benidipine treatment. In conclusion, the monotherapy with benidipine did not affect platelet function during the resting condition, but significantly suppressed the platelet activation induced by arithmetic stress in patients with essential hypertension.

Action of neurotransmitters: acetylcholine, serotonin, and adrenaline in an experimental arterial thrombosis induced by oxygen free radicals

It is well known that high stress and particularly an enhancement of plasma catecholamines and myocardial infarction have a close relation. In addition, adrenaline is presented as a prothrombogenic agent in vivo. The role of the other agents such as serotonin or acetylcholine, in the development of arterial thrombosis is somewhat uncertain, although, the role of each of them is often considered at the level of vascular regulation only. Therefore, the present study was designed to investigate the effects of three neurotransmitters on experimental arterial thrombosis model induced by generation of free radicals. The results demonstrate that intravenously injection of adrenaline or serotonin (1 ng/kg) stimulated arterial thrombosis formation, whereas injection of high dose of acetylcholine (5 mg/kg) slackened the thrombosis formation.

Interactive effects of K+, acid, norepinephrine, and ischemia on the heart: implications for exercise

We tested the hypothesis that cardiac ischemia uncouples the beneficial interaction among hyperkalemia, acidosis, and raised plasma catecholamines when these chemicals are changed to mimic their exercise levels. Potassium chloride, lactic acid, and norepinephrine (NE) were infused intravenously for 2 min into anesthetized, artificially ventilated, thoracotomized rabbits during either occlusion of the left circumflex artery (3 min; n = 10) or after a period of prolonged ischemia (20 min; n = 7) that led to a small infarction. NE (1 microg x kg(-1) x min(-1) iv) offset the negative cardiac effects of hyperkalemia (up to 8.7 +/- 0.7 mM) and acidosis (arterial pH 7.09 +/- 0.03) in normal hearts. Cardiac performance was not significantly depressed by either acute or chronic ischemia before any infusions. However, the protective effect of NE during acute ischemia or after prolonged ischemia with hyperkalemia and acidosis was substantially reduced. These results show that cardiac ischemia attenuates the protective action of NE and increases the depressive effects of hyperkalemia and acidosis. Whether myocardial ischemia amplifies the cardiotoxic effects of hyperkalemia and acidosis during vigorous exercise by attenuating the beneficial effect of catecholamines remains to be determined.

Action of neurotransmitters: acetylcholine, adrenaline and serotonin on arterial thrombosis induced by a laser beam

The releasing of catecholamines is increased in stress situation which promotes the formation of circulating platelet aggregates, and could participate in the arterial thrombosis formation in coronary diseases. The purpose of this study is to evaluate the thrombogenic action of some neurotransmitters, and their participation through the vessel's vasomotoricity, in the growth of an arteriolar thrombosis. Endothelial cells destruction, induced by a laser beam in mesenteric arteriole of the rat were observed to determine changes in thrombus growth, through the embolization and variation of vessel diameter. It is desirable to get insight into the interrelation of thrombus formation and local vasomotoricity in the presence of acetylcholine, adrenaline and serotonin. The administration of acetylcholine (5mg/kg) increases the number of emboli which detached from thrombus, and decreases the thrombus area. Therefore, acetylcholine induces a variation of the vessel's diameter, a vasodilation in the intact vessel and a vasoconstriction when the endothelium is removed. Two vasoconstrictor agents are used: adrenaline and serotonin which increase the number of laser injuries required to induce thrombus formation, decrease the number of emboli and the duration of embolization (p < 0.05). They cause a potent vasoconstriction. These neurotransmitters seem to be involved in the arterial thrombosis induced by laser beam, promoting or not the platelet aggregation, and modulating the vascular tone by the endothelium.

Psychiatric morbidity during the early phase of coronary care for myocardial infarction: association with cardiac diagnosis and outcome

We evaluated the association of psychiatric morbidity during the early phase of admission to a coronary care unit with cardiac diagnosis and subsequent morbidity. Ninety-two patients admitted for the first time for presumed myocardial infarction were evaluated within 48 hours of hospitalization. Anxiety and depressive symptoms and cognitive impairment were rated. Data were collected on cardiac diagnosis and morbidity. Three and 12 months after hospitalization, cardiac morbidity, psychiatric symptoms and psychosocial morbidity were assessed.

Accumulation of hyaluronan and tissue edema in experimental myocardial infarction

Experimental myocardial infarction was induced in rats. The myocardial accumulation of hyaluronan (HA) and water during the development of infarction was measured. The extractable HA content of the infarcted area increased progressively from day 1 and on day 3 reached a threefold increase compared with the HA amounts in myocardium of sham operated controls. The relative water content of infarcted areas also increased progressively reaching a maximum value by day 3 and was strongly correlated with the HA accumulation. Affinity histochemistry visualized a thin rim of HA in the endoperimysium in healthy myocardium. By day 2 an interstitial edema with inflammatory cells was apparent. The widened endoperimysium stained extensively for HA. By its water-binding ability, interstitial accumulation of HA will contribute to the interstitial edema in infarcted myocardial tissue. An interstitial edema is likely to influence the electromechanical characteristics of the myocardium and facilitate reentry phenomena due to a loss of contact between muscle cells. The edema also induces an increased extracellular pressure and an altered myocardial wall compliance that might impair myocardial microcirculation. The findings are relevant to an understanding of the beneficial effect of hyaluronidase treatment in limiting cellular damage during myocardial ischemia.

Primary platelet activation in recent-onset type 1 diabetes mellitus

Platelet function (as production of thromboxane B2 by platelets stimulated with collagen, and plasma beta-thromboglobulin) and thrombin activity (as plasma fibrinopeptide A) were investigated in eight young (mean age 27 +/- 3 SE years) male patients in which type 1 diabetes mellitus had been diagnosed 2 to 6 months previously. They were all in excellent stable metabolic control (mean HbA1c 5.6 +/- 0.4 SE %) and free from any complications. The haemostatic variables were assessed at rest and after cycloergometric exercise to exhaustion. When compared to age- and sex-matched healthy controls, patients showed higher beta-thromboglobulin, fibrinopeptide A and thromboxane B2 at rest. After exercise, plasma beta-TG increased only in the controls. Platelet and thrombin activation are present in the very early stages of type 1 diabetes mellitus, in the absence of any complications.

Haematological changes during acute mental stress

To study haematological effects of emotional stress, blood samples were obtained from 29 healthy, normotensive, non-smoking males aged 20-34 years before, during and after 10 min of mental arithmetic. There were significant increases in peripheral blood cell count, haemoglobin concentration, and haematocrit in response to mental stress. Parallel to these changes significant increases in heart rate, and systolic and diastolic blood pressure were observed. The relative increments of leucocyte (8%) and platelet (3.5%) count were significantly higher than the increase in haemoglobin concentration (2%). There was a significant positive correlation between the blood pressure increase and the mobilization of leucocytes, whereas the increase in erythrocyte count, haemoglobin concentration, and haematocrit showed significant positive correlations with heart rate reactivity. It is concluded that mental stress causes an increase in leucocyte and platelet count that could not solely be accounted for by the concurrent haemoconcentration.

Determinants of improved left ventricular function after thrombolytic therapy in acute myocardial infarction

Many studies have been performed to evaluate the efficacy of thrombolytic therapy in achieving reperfusion, salvaging myocardium and enhancing survival. This review discusses the concordance between the results of these clinical studies and the observations made in experimental animals of the effect of reperfusion on the recovery of left ventricular function. The evaluation of functional recovery is affected by the timing of the measurement and the sensitivity of the method for detecting regional abnormalities. In addition, the underlying coronary anatomy also determines outcome, so that infarct location, collateral circulation and the degree of coronary obstruction merit consideration. Two factors are of paramount importance in determining the amount of myocardium salvaged, the recovery of left ventricular function and the reduction in mortality. These factors are: the time delay until reperfusion is achieved and the adequacy of the coronary reflow. The close agreement between studies measuring the effect of reperfusion on left ventricular function and studies with mortality as the end point provides indirect evidence that enhancement of survival in patients treated with thrombolytic agents is mediated by recovery of ventricular function.

Intravenous verapamil therapy in imminent myocardial infarction

We studied 16 patients with small myocardial infarction who had further episodes of chest pain with ST-segment elevation, a sign of transmural myocardial ischemia and imminent infarction extension. Coronary angiography in 14 showed a critical lesion in 13. Intravenous verapamil abolished chest pain and ST-segment elevation. It caused a fall in right atrial and left ventricular end-diastolic pressures (LVEDP) and cardiac output, reflex systemic vasoconstriction, and a rise in systemic vascular resistance. There was no reflex tachycardia. Volume expansion raised LVEDP and restored a normal cardiac output. Accelerated junctional rhythm with isorhythmic A-V dissociation occurred in 5 patients. Two patients sustained a transmural infarction, 10 underwent coronary artery bypass grafting, and 4 are symptom-free with oral treatment. Intravenous treatment was an effective method of treating acute episodes of transmural myocardial ischemia and preventing their recurrence in patients with critical coronary artery narrowing. Continuous verapamil infusion stabilized the patients' condition and enabled smooth coronary angiography and induction of anesthesia for surgery.

Early deleterious hemorheologic changes following acute experimental coronary occlusion and salutary antihyperviscosity effect of hemodilution with stroma-free hemoglobin

Viscometric measurements were made on the blood of anesthetized dogs before and following acute occlusion of the left anterior descending coronary artery. Within an hour of the occlusion, the low-shear viscosity of whole blood was significantly increased and continued to rise thereafter. This was accompanied by significant increments in the yield-shear stress of whole blood, suggesting accelerated tendencies in aggregation and plasma viscosity. In another group of dogs, 1 hour after coronary occlusion, rapid isovolemic hemodilution was performed with an 8% solution of stroma-free hemoglobin, reducing the hematocrit to 24%. This was followed by marked reduction of whole blood viscosity at all shear rates, abolition of the yield-shear stress, and reduction of plasma viscosity. These findings suggest that a hyperviscosity state develops early in acute myocardial ischemia which is detrimental to collateral perfusion of the marginal zone of ischemic myocardium. Such hyperviscosity syndrome can be blocked by hemodilution with stroma-free hemoglobin.

Platelet aggregation measured by the screen filtration pressure method in hypertensive patients

In this study platelet aggregation was measured by the screen filtration pressure method in 2 groups of hypertensives separated according to age. They were perfectly matched for levels of various "risk factors", with normotensive "controls". No significant difference in platelet aggregate filtration pressure (PAFP) was found between hypertensives and normotensives. Contrary to normotensive subjects, there was no significant increase in the PAFP values with age in the hypertensives. This might be due to the significantly higher blood urea values in the hypertensives as compared to the normotensives. An inverse relationship between blood urea concentration and PAFP values was in fact confirmed by in vivo and in vitro studies.

Thrombosis of epicardial coronary veins in acute myocardial infarction

Thrombosis of epicardial coronary veins was demonstrated in 16 of 50 cases of left ventricular acute myocardial infarction and/or recent coronary arterial thrombosis. All patients with valvular heart disease had venous thrombosis. In cases without valvular heart disease, venous thrombosis was seen in infarctions involving more than 30% of the left ventricular myocardial mass with a post-attack survival time of at least 24 hours. The veins thrombosed were in all cases those draining the infarcted myocardium. Coronary vein thrombosis seems not to be prevented by anticoagulant medication.

Beneficial effect of continuation of propranolol through coronary bypass surgery

The safety and beneficial effect of continuation of propranolol (Pr) through coronary bypass surgery (CBS) was studied in two groups of patients. In the control group (50 patients) Pr was discontinued 24 h before CBS without reinstitution afterwards. In the propranolol group the drug was maintained up to 4 to 10 h before surgery and was restarted within 24 h afterwards. The incidence of subendocardial myocardial infarction was significantly lower in the Pr group (1 out of 30 vs 10 out of 50, p less than 0.05) while the incidence of transmural infarction was the same in both groups (3 out of 30, 10%, vs 5 out of 50, 10%). The incidence of supraventricular tachycardias during the first three postoperative days was significantly lower in the propranolol group compared to control (5% vs 30%, p less than 0.01). The 24 h urinary epinephrine and norepinephrine excretion was significantly greater than normal the day before surgery (136 +/- 12 vs 39 +/- 4 micrograms/24 h, p less than 0.01), and was still high two weeks after surgery (115.1 +/- 14 micrograms/24 h). There were no complications related to propranolol. The left ventricular function as measured from the systolic time intervals was the same pre- and postoperatively in both groups. The results of this study show that administration of propranolol up to 4 h before coronary bypass and reinstitution immediately afterwards is safe and beneficial.

Platelet aggregation in relationship to plasma catecholamines in patients with hypertension

Plasma catecholamine concentration and platelet aggregation were studied in 22 patients with uncomplicated primary hypertension and 13 age-matched normotensive, healthy subjects at rest and in some during isometric handgrip exercise. The effect of norepinephrine (NE) infusion upon platelet aggregation was also examined. Plasma catecholamine concentration was slightly higher in the hypertensive than the normotensive group, but the difference was not significant. However, platelet aggregation to ADP was significantly greater in the hypertensive than the normotensive subjects. Exercise increased significantly both catecholamines and aggregation in both groups. Platelet aggregation was correlated with age (r = 0.62, P less than 0.01) and plasma NE (r = -0.34, P less than 0.05 for the total group of subjects). The infusion of NE increased significantly plasma NE and platelet aggregation and there was an inverse correlation between NE increase and threshold decrease (r = -0.69, P less than 0.05). Thus, plasma catecholamines and important determinants of platelet aggregation. However, in our study, uncomplicated primary hypertension was not associated with abnormal plasma catecholamine concentration. It is likely that the observed abnormal platelet aggregability to ADP represents a secondary phenomenon, possibly related to more advanced atherosclerotic vascular changes in hypertensive than normotensive subjects.

Transient ischemic attacks due to increased platelet aggregation and adhesiveness. Ultrastructural and functional correlation

The authors report 22 cases of transient ischemic attacks (TIA's) manifested by amaurosis fugax or hemiparesis or paresthesia of less than 24 hours' duration. None of the patients demonstrated 1) evidence of atherosclerotic cerebral vascular disease on angiography, 2) evidence of intracranial lesion on brain scan, 3) cardiac source of emboli, 4) arteritis or collagen disease, or 5) history of migraine. The only abnormalities found to explain the TIA's were abnormally increased platelet adhesiveness and/or aggregation. All of these patients were followed from 1 to 5 years, and had repeated coagulation studies. Treatment with antiplatelet drugs showed an excellent clinical response with associated decrease in platelet adhesiveness and aggregation. Discontinuance of the antiplatelet drug resulted in a recurrence of the TIA's which coincided with an increase in aggregation and adhesiveness. In two cases the platelet morphology was studied by transmission and scanning electron microscopy. It appears that there is a specific group of patients with TIA's in whom the sole cause of the attack is an abnormality of platelet function. For these people there is a specific therapy and a method monitoring the treatment.

Platelet aggregation studies in coronary artery disease. Past 4. Effect of aspirin

We evaluated platelet aggregation in vitro in blood samples drawn simultaneously from aorta and coronary sinus. Platelet aggregation was significantly lower in the coronary venous blood than in the aortic blood in patients with coronary artery disease. Lower platelet counts were also observed in coronary venous blood. No such differences were seen in subjects with normal coronary arteries. Oral administration of aspirin eliminated the differences in platelet aggregation and counts across the myocardial vascular bed. These observations suggest that platelet sequestration in the myocardial vasculature may be related to the presence of disease in the coronary arteries.

Safety and rationale for continuation of propranolol therapy during coronary bypass operation

Thirty consecutive patients undergoing coronary bypass were studied. Oral propranolol therapy was maintained up to 4 to 10 hours before operation. Nineteen of the patients had a history of myocardial infarction (MI), 14 had hypoakinetic areas, and 8 had decreased ejection fraction indicating advanced coronary artery disease. Twenty-four-hour urinary epinephrine and norepinephrine obtained the day before operation were markedly increased at 136 +/- 12 microgram per 24 hours (normal, 39 +/- 4 microgram, rho less than 0.01). There were 4 perioperative MIs (13%) and no deaths. Plasma propranolol 1 hour before operation was 43.3 +/- 8 ng per milliliter, indicating good beta blockade. Propranolol was started within 24 hours postoperatively. There were no preoperative, intraoperative, or postoperative complications related to propranolol therapy. We conclude that because of markedly increased adrenergic tone the day before operation and transient hypersensitivity to adrenergic stimulation after withdrawal of propranolol, this agent should be continued through coronary bypass operation.

Differences in platelet aggregation in coronary sinus and aortic blood in patients with coronary artery disease: effect of propranolol

Platelet aggregation was studied in aortic and coronary sinus blood samples obtained from 18 patients with coronary artery disease (CAD). Using epinephrine and ADP as aggregating agents, platelet aggregation was lower in coronary venous blood than in aortic blood. In nine patients on long-term propranolol therapy, platelet aggregation was lower in both aortic and coronary venous blood compared to the nine patients not taking propranolol. Four other subjects without angiographic evidence of coronary disease exhibited no difference in platelet aggregation in aortic and coronary sinus blood. These data suggest that platelet aggregation is lower in the coronary venous blood of certain patients with coronary disease and chronic propranolol treatment may reduce aggregation in both aortic and coronary sinus blood.

A possible role of noradrenaline in the development of myocardial infarction: an experimental study in the isolated rat heart

Isolated rat hearts were perfused with buffer containing noradrenaline 10(-7) to 10(-4) M. A dose-dependent depletion of glycogen and ATP were seen together with a leakage of ASAT and creatine phosphokinase (CK). The damage induced by noradrenaline could be prevented by addition of a beta-blocker (metoprolol), verapamil, or lidocaine to the perfusion medium. When the endogenous myocardial stores of noradrenaline are rapidly depleted by perfusion with tyramine a similar cell damage was demonstrated. Electron micrographs from hearts subjected to noradrenaline showed three different types of cell damage that could be correlated to earlier described findings. The importance of noradrenaline for the ischemic injury was demonstrated. It was hypothesized that acute myocardial infarction may start because of a sudden release of endogenous noradrenaline.

Changes in the coronary vascular system following prolonged exposure to stress

Hearts of stressed rats showed marked changes in the coronary vasculature. It was suggested that such morphological changes could be explained on the basis of an increased coronary vascular permeability. Endogenous inflammatory substances could induce swelling of the endothelial cells and cause separation of the neighbouring cells from one another, thus allowing the passage of lipid molecules through the endothelial lining. In order to gain supportive evidence for the above hypotheses an electron microscope study was undertaken. The presence of junctional gaps in the endothelial lining of the coronary vascular system was observed following prolonged stress, as well as platelet aggregation. The use of lipid staining of frozen sections indicated the presence of large lipid deposits in the arteriole walls, corresponding to vacuoles seen previously. It would appear therefore, that prolonged exposure to stress may result in pathological changes in the myocardium associated with changes in the vascular endothelial permeability, and platelet aggregation. Pathological changes induced in this way, however, should be inhibitd by high glucocorticoid levels and should not be manifested until adaptation of the steroid response to stress has occurred. Measurement of plasma glucocorticoid levels over the period of prolonged stress shows a good correlation between the adaptation of the steroid response and the onset of a progressive degeneration of the coronary vascular system.

Inhibition of adrenaline-induced platelet aggregation by the orally administered alpha-adrenergic receptor blocker phentolamine (Regitine)

In eight healthy volunteers pretreatment with phentolamine 40 mg p o inhibited platelet aggregation (1st and 2nd phases) induced by low concentrations of adrenaline (2, 1 and 0.5 muM) in plasma from blood sampled 30 min after administration of the compound. The lower the concentration of adrenaline use, the greater was the degree of inhibition elicited. These results are indicative of competitive inhibition of the action of adrenaline on the platelet membrane by phentolamine. Four to six hours after administration of the compound, the aggregation characteristics had reverted to normal. It is concluded that the increased tendency toward platelet aggregation associated with elevated blood levels of catecholamines can be prevented by therapeutic doses of phentolamine.

The effect of a potent inhibitor of platelet aggregation, BL-3459, on adrenaline-induced myocardial necrosis in beagle dogs

The effect of a potent inhibitor of platelet aggregation, BL-3459, on adrenaline-induced myocardial necrosis was investigated in beagle dogs. BL-3459, an alpha-adrenergic receptor blocking agent, phenoxybenzamine, and a beta-adrenergic receptor blocking agent, propranolol, were compared for their ability to modify the effects of adrenaline on platelet function, arterial blood pressure and myocardial damage. Adrenaline infusion led to a dose-related myocardial damage, elevation in arterial blood pressure, elevation in screen filtration pressure (SFP) and fall in platelet count. BL-3459 inhibited the elevation in SFP and the fall in platelet count as well as limiting the extent of myocardial damage. Phenoxybenzamine significantly modified all adrenaline-induced changes except the elevation in SFP. Propranolol had little effect alone and seemed to antagonize the beneficial effects of BL-3459 when the two drugs were combined. These results suggest that while other factors may also be involved, platelet aggregation and transient hypertension are correlated with the extent of adrenaline-induced myocardial necrosis observed in this model. A potent inhibitor of platelet aggregation, BL-3459, and the alpha-adrenergic receptor blocking agent, phenoxybenzamine, appear to afford protection against the observed pathological effects.

Effect of emotional stress on platelet aggregation in humans

In 16 young house physicians, each of whom presented a case at grand rounds, the effect on platelet function of the emotional stress involved in presenting the case was determined. Platelet-aggregation curves, using adenosine diphosphate and epinephrine, were determined immediately before, immediately after, and seven days after stress. Platelet aggregation was diminished during the stress period in 15 of the subjects. These findings may possibly be of importance in the relationship between stress and myocardial infarction; they also suggest that the emotional state of the patient must be considered when interpreting platelet-aggregation curves.

Localization by autoradiography of tritiated isoproterenol in "infarct-like" lesions of rat myocardium

A number of physiopathogenic mechanisms have been outlined to explain the "infarct-like" lesions produced by isoproterenol (ISP) in the hearts of various animals: Excess of oxygen consumption and inotropic effect, coronary vasoconstriction, deleterious action on glucose and lipid metabolism, direct cardiotoxic effect, platelet aggregation in the small cardiac vessels and formation of microclots, excessive mobilization of fatty acids, fluid and electrolytic imbalances, loss of high-energy intracellular coupling, and inadequate activation of the "calcium pump." For this reason, localization of the tritiated ISP in the normal myocardial fibers and in the induced lesions was studied. The first control group (G-1), consisted of 40 Wistar rats, weighing from 180 to 200 grams; they were injected intraperitoneally with ISP sulfate (10 mg. per kilogram) and were killed under ether anesthesia after periods of 5, 30, and 120 minutes, and 12 and 24 hours. A similar group (G-2) was injected intraperitoneally with an equal dose of ISP plus 5 muCi of tritiated ISP sulfate (3H). In this group animals were killed at the same periods as above. In rats treated with ISP-3H an abundant amount of the labeled drug was observed on the sarcolemma surface and a smaller quantity was noted inside the myocardial fibers. This observation was noted in the autoradiographs obtained 5 minutes after the injection and persisted in all subsequent observation times. In those animals which were killed 5 and 30 minutes after injection, the deposit was noted in "grooves" along the edge of the sarcolemma, strongly suggesting a primary action on the cellular membrane. These findings and the peculiar topography suggest that (1) myocardial necrosis induced by ISP is probably due to an increased activation of the "calcium pump"; the early presence of contracture bands and the positivity of the ischemia test further emphasize this statement; (2) the ISP effect is rapid; (3) the morphologic alterations are similar to those recently described as "coagulation myocytolysis" and present in human infarctions or following sudden death.

Aspirin therapy in angina pectoris: effects on platelet aggregation, exercise tolerance, and electrocardiographic manifestations of ischemia

If altered platelet function contributes to poorly perfused zones of myocardium in patients with angina pectoris, then specific antiplatelet therapy might improve cardiovascular function and exercise performance. Exercise tolerance on a bicycle ergometer, heart rate-blood pressure product, and ischemic ECG changes at exercise end-point were compared before and during oral aspirin therapy (2.4 Gm. per day for 2 weeks) in 11 normal subjecs and in 11 patients with stable angina pectoris. Platelet aggregation threshold in response to ADP and epinephrine was measured. Untreated patients had increased platelet aggregability when compared to normal subjects...

Usefulness of systolic time intervals in coronary artery disease

This review summarizes current knowledge concerning the value of systolic time intervals in coronary artery disease. Although the usual pattern of prolongation of the preejection period (PEP) and shortening of the left ventricular ejection time (LVET) characteristic of left ventricular failure is seen in acute myocardial infarction, the systolic time intervals (as well as all other measures) are profoundly influenced by adrenergic hyperactivity characteristics of this disorder. Adrenergic stimulation normally shortens both the PEP and LVET indexes and decreases the PEP/LVET ratio. The degree of shortening of electromechanical systole (QS2) is directed related to the excessive adrenergic tone. Patients with the greatest systolic time interval abnormalities have a poorer prognosis, a greater incidence of congestive heart failure and more abnormalities of directly measured indexes of left ventricular performance. The systolic time intervals are useful for assessing left ventricular performance in chronic coronary artery disease as well. In chronic coronary artery disease the PEP/LVET ratio and angiographically determined left ventricular ejection fraction are closely correlated ( r = -0.76), but the level of this correlation is less than that in other forms of left ventricular disease. The left ventricular ejection time index is prolonged after exercise in patients with angina pectoris when compared with findings in normal subjects. Failure of the ischemic ventricle to respond to adrenergic stimulation is the most likely mechanism. Addition of the postexercise left ventricular ejection time to standard treadmill stress testing identifies a significant number of patients (23 percent) who would have had false negative results by electrocardiographic criteria alone. In addition, this index provides confirmatory evidence in those with apparently positive electrocardiographic test data. The systolic time intervals have been useful in assessing both medical and surgical therapy in coronary artery disease. The test can be performed repeatedly and provides a measure of both left ventricular performance and extent of adrenergic hyperactivity. Thus, evaluation of therapy represents the most useful future application of systolic time intervals.

Morphological changes induced in rats following prolonged exposure to stress

Prolonged exposure of male C. S. F. rats to irregular signalled footshick from which they could escape for up to 71 days produced profound morphological changes. Retardation in growth, adrenal hypertrophy associated with an increase in the zona fasiculata a-nd zona reticularis, and changes in the microcirculation of the heart were observed. There was a significant degree of congestion and dilatation of the microcirculation which was most marked in large venules, collecting venules and veins. An increase in PAS +ve material marginated in the venous endothelium was observed also, together with a suggested increase in mast cells and presence of vacuoles in the intima-media of the coronary arterioles. No pathological changes were observed in the renal cortex and medulla or the gastric lining. The changes in the microcirculation of the heart are discussed in terms of an oedematous reaction and a histamine type leakage of the endothelial lining.