Bradycardia and hypotension following reperfusion with streptokinase (Bezold-Jarisch reflex): A sign of coronary thrombolysis and myocardial salvage

Acute myocardial infarction, particularly of the inferior wall, is frequently associated with bradycardia and hypotension. This study reports the occurrence of transient bradycardia hypotension (TBH) (Bezold-Jarisch reflex) following thrombolytic therapy with intravenous streptokinase. Of the 52 patients, 42 had successful reperfusion, and 12 of the latter developed reflex TBH. The Bezold-Jarisch reflex occurred in 10 of 24 patients with inferior wall acute myocardial infarction and in 2 of 28 patients with anterior wall infarction (p < 0.05). The reflex was associated with significantly more non-Q wave infarctions (p < 0.05) and also with reduction of left ventricular damage, as evidenced by a lower QRS score (4 ± 3.8 vs 8.9 ± 5.6, p < 0.01) and a higher ejection fraction (61 ± 13% vs 49 ± 16%, p < 0.05). Patients with inferior wall acute myocardial infarction were divided into those with TBH (10 patients) and those without TBH (14 patients). TBH was associated with a significantly higher infarct-related regional ejection fraction (60 ± 19% vs 35 ± 18%, p < 0.05). The results of this study confirm previous findings that reperfusion of the inferoposterior myocardium is capable of stimulating reflex TBH. Furthermore, TBH is associated with patency of infarct-related coronary arteries and myocardial salvage.