Autonomic disturbances

The Bezold reflex also leads to reflex vagal activation and sympathetic withdrawal. Bradycardia and hypotension due to vasodilatation may lead to circulatory collapse and shock, particularly in large inferior infarction. This responds dramatically to intravenous atropine which blocks the vagal bradycardia and the vagally induced fall in left ventricular stroke volume. In some patients the picture is dominated by sympathetic overactivity as a result of the action of both carotid baroreceptor unloading due to the fall in blood pressure and stimulation of sympathetic afferents in the left ventricle. These autonomic effects can be very dramatic and usually occur in the first hour or two after the coronary occlusion.

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