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Psychosomatic Medicine, Vol 50, Issue 4 381-393, Copyright © 1988 by American Psychosomatic Society

ORIGINAL ARTICLES

Mechanisms of myocardial ischemia induced by epinephrine: comparison with exercise-induced ischemia

BH Sung, MF Wilson, C Robinson, U Thadani and WR Lovallo
College of Pharmacy, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City.

The role of epinephrine in eliciting myocardial ischemia was examined in patients with coronary artery disease. Objective signs of ischemia and factors increasing myocardial oxygen consumption were compared during epinephrine infusion and supine bicycle exercise. Both epinephrine and exercise produced myocardial ischemia as evidenced by ST segment depression and angina. However, the mechanisms of myocardial ischemia induced by epinephrine were significantly different from those of exercise. Exercise-induced myocardial ischemia was marked predominantly by increased heart rate and rate-pressure product with a minor contribution of end-diastolic volume, while epinephrine-induced ischemia was characterized by a marked increase in contractility and a less pronounced increase in heart rate and rate-pressure product. These findings indicate that ischemia produced by epinephrine, as may occur during states of emotional distress, has a mechanism distinct from that due to physical exertion.




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Copyright © 1988 by the American Psychosomatic Society