Adrenergic Mechanisms in Myocardial Ischemia

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This work explores the intricate relationship between cardiac sympathetic innervation and myocardial ischemia, detailing neurotransmission, adrenoceptors, and signal transduction. It begins with an overview of the cardiac sympathetic nervous system and the release and effects of noradrenaline during ischemia. The modulation of β-adrenergic receptors and their intracellular coupling is examined, alongside the roles of β- and α-adrenoceptor agonists and antagonists in chronic heart failure. The text further discusses the supersensitivity of the adenylyl cyclase system in acute myocardial ischemia. The discussion on adrenergic coronary vasomotion highlights the subtypes of β-adrenoceptors in the coronary circulation and their control over large coronary arteries and microcirculation. It also covers neurohumoral regulation of collateral vasomotor tone and the impact of adrenergic regulation on myocardial performance during exercise. In exploring vasoconstriction and blood flow distribution in ischemic myocardium, the work addresses transmural steal phenomena, mechanisms benefiting ischemic myocardium from heart rate reduction, and the role of adrenergic control in coronary blood flow. The impact of sympathetic activation on arrhythmias during ischemia is analyzed, including the influence of noradrenaline on ion accumulation and the effects of β-blockade on ventricular tachyarrhythmias. Finally, the text delves into clinical imp