Listening to Heart Rate for Myocardial Ischemic Site

Tatsuya Kawasaki, Akihiro Azuma, Toshiro Kuribayashi, Hiroki Sugihara


We describe a 63-year-old woman with severe stenosis in the right coronary artery. During the recovery phase of exercise testing, the monitor sound of heart rate changed rhythmically in a delicate fashion. Heart rate variability analysis revealed the association of the rhythm fluctuation with transient vagal enhancement. This phenomenon is known as Bezold-Jarisch reflex, which has been explained by the preferential distribution of cardiac receptors along afferent vagal pathways in the inferior wall of the left ventricle. After coronary angioplasty, the examiner could not notice the fluctuation of heart rate during the recovery phase of a restudy of exercise testing. Listening to heart rate fluctuation during exercise testing, although it may be rare, possibly helps examiners to estimate the site of ischemia to be in the inferior myocardium.

J Med Cases. 2011;2(4):169-171


Heart rate; Vagus nerve; Ischemia; Inferior wall; Bezold-Jarisch reflex

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