The Bezold-Jarisch reflex: possible role in limiting myocardial ischemia

A patient with a 5-year history of nonexertional episodic chest discomfort terminating in nausea presented with recurrent periods of marked ST elevations. Each observed episode terminated in the triad of bradycardia, hypotension, and nausea. ST elevation normalized almost immediately when this triad supervened. It is hypothesized that this represented activation of the Bezold-Jarisch reflex. Resolution may have been due to reflexly mediated parasympathetic coronary vasodilation. An episode of ST elevation occurred 24 h after admission which did not result in activation of the Bezold-Jarisch reflex. Following this latter episode, Q waves and enzymatic evidence of myocardial infarction were documented.