Alpha-adrenoceptor-mediated restoration of calcium-dependent potential in the partially depolarized rabbit papillary muscle

α1-adrenergic stimulation increases ventricular action potential duration in the intact mouse heart

The role of α1-adrenergic receptors (α-ARs) in the regulation of myocardial function is less well-understood than that of β-ARs. Previous reports in the mouse heart have described that α1-adrenergic stimulation shortens action potential duration in isolated cells or tissues, in contrast to prolongation of the action potential reported in most other mammalian hearts. It has since become appreciated, however, that the mouse heart exhibits marked variation in inotropic response to α1-adrenergic stimulation between ventricles and even individual cardiomyocytes. We investigated the effects of α1-adrenergic stimulation on action potential duration at 80% of repolarization in the right and left ventricles of Langendorff-perfused mouse hearts using optical mapping. In hearts under β-adrenergic blockade (propranolol), phenylephrine or noradrenaline perfusion both increased action potential duration in both ventricles. The increased action potential duration was partially reversed by subsequent perfusion with the α-adrenergic antagonist phentolamine (1 μmol L−1). These data show that α1-receptor stimulation may lead to a prolonging of action potential in the mouse heart and thereby refine our understanding of how action potential duration adjusts during sympathetic stimulation.

Cardiac electrophysiologic effects of norepinephrine in human beings

BACKGROUND

The electrophysiologic effects of norepinephrine (NE) in human beings have not been previously described.

METHODS

The electrophysiologic effects of NE infused at a rate of 25 ng/kg/min were determined in 21 patients with a mean age of 41 +/- 11 years and without structural heart disease who underwent an electrophysiology procedure. In a subgroup of 10 patients electrophysiologic parameters were measured at baseline, after the infusion of NE, and after administration of beta-blockade while in continuous NE infusion.

RESULTS

The baseline NE plasma concentration of 298 +/- 153 pg/ml increased to 708 +/- 419 pg/ml after the infusion of NE. NE significantly increased the mean blood pressure, sinus cycle length, corrected sinus node recovery time, ventriculoatrial block cycle length, and the atrial and ventricular effective refractory periods. In a subset of 10 patients 0.2 mg/kg propranolol administered during continued infusion of NE resulted in a further increase in sinus cycle length, atrial-His interval, and ventricular refractoriness.

CONCLUSION

A physiologic elevation in the plasma NE concentration results in a depression of sinus node function and atrioventricular conduction and in prolongation of atrial and ventricular refractoriness. Some of NE's effects are partially offset by beta-adrenergic stimulation.

Effects of extracellular Cl- on the inotropic response to alpha-adrenoceptor stimulation

This study was designed to determine if the sustained positive inotropic action of alpha-adrenergic stimulation is affected by the absence of extracellular chloride ion (Clo-). Atrial and papillary muscle were isolated from adult male rats, bathed in Krebs-Henseleit solution (30 degrees C) with and without Cl- (methane-sulfonate substitution), and stimulated at 0.5 Hz. Isometric developed tension was monitored during cumulative addition of phenylephrine, isoproterenol and Ca2+. The dose-dependent positive inotropic effects of isoproterenol and Ca2+ were not altered by the absence of Clo-. However, the magnitude of the response to phenylephrine was diminished in both tissues. In atrial muscle, the maximum positive inotropic effect of phenylephrine was reduced from 2.05 +/- 0.17 g in the presence of Clo- to 0.39 +/- 0.06 g in the absence of Clo-; control developed tension was 0.60 +/- 0.08 and 0.47 +/- 0.10 g in these two groups before exposure to the alpha-adrenoceptor agonist. In papillary muscle, control developed tension was 1.40 +/- 0.11 and 1.17 +/- 0.18 g in the presence and absence of Clo-, respectively; and the maximum inotropic responses to phenylephrine were 0.71 +/- 0.12 and 0.27 +/- 0.13 g. EC50 values for phenylephrine were not significantly affected by substitution for Cl-. Similar results were observed in a Hepes-buffered bathing solution without bicarbonate (HCO3-). These results indicate that the positive inotropic action of alpha-adrenergic stimulation is mediated in part by a mechanism requiring Cl-. Furthermore, data suggest that the antagonistic effect of Clo- removal is not mediated via Cl-/HCO3- exchange.

Effects of coronary artery occlusion and reperfusion on the idioventricular rate in anesthetized dogs

OBJECTIVES

We evaluated the effects of alpha 1- and beta-adrenergic receptor blockade on the changes in idioventricular rate induced by occlusion and reperfusion of the left anterior descending coronary artery in anesthetized dogs.

BACKGROUND

Because sinus rate usually exceeds idioventricular rate, the experimental induction of complete atrioventricular (AV) block may improve the definition of the effects of coronary occlusion and reperfusion on idioventricular pacemaker mechanisms.

METHODS

We injected formaldehyde into the AV node to induce complete AV block in 35 chloralose-anesthetized dogs. Animals were assigned to untreated (n = 22), prazosin-treated (n = 6) and propranolol-treated (n = 7) groups. We paced the hearts at 120 beats/min during a 20- to 60-min period of complete coronary occlusion, but we did not pace the heart during reperfusion.

RESULTS

In the untreated group, the idioventricular rate did not change significantly during coronary artery occlusions of 20 or 40 min, but it did increase significantly during the last 20 min of a 60-min occlusion. Prazosin and propranolol each attenuated but did not abolish this rate increase. The idioventricular rate increased markedly but transiently soon after reperfusion in all untreated animals. This tachycardia was virtually abolished by either prazosin or propranolol.

CONCLUSIONS

The increase in idioventricular rate that develops during the last 20 min of a 60-min coronary occlusion is modulated but probably not mediated by adrenergic mechanisms. The pronounced ventricular tachycardia after reperfusion is virtually abolished by either alpha 1- or beta-adrenergic antagonists. Hence, this tachycardia requires the simultaneous activation of alpha 1- and beta-adrenergic mechanisms in dogs.

Accumulation of potassium and calcium in rat myocardium exposed to alpha-1-adrenoceptor stimulation

Net fluxes of potassium, calcium, sodium and chloride were examined in isolated perfused rat hearts during alpha-1-adrenoceptor stimulation. The ion measurements were performed in the non-recirculating perfusate. Hearts were exposed to alpha-1-adrenoceptor stimulation (phenylephrine 5 x 10(-5) mol/l in the presence of the beta-blocker timolol 10(-6) mol/l). During alpha-1-adrenoceptor stimulation perfusate potassium fell relatively rapidly by about 0.10 mmol/l after approximately 100 sec. followed by a slower rise. About 180 sec. after onset of alpha-1-adrenoceptor stimulation, the potassium level was about 0.06 mmol/l below the control concentration level. This reduction was eliminated by the alpha-1-adrenoceptor blocker prazosin (10(-7) mol/l). The effects on net calcium fluxes were measured at two different calcium concentrations. For both concentrations we found a small but statistically significant reduction of the calcium concentration in the perfusate after alpha-1-adrenoceptor stimulation. Neither sodium nor chloride perfusate concentrations showed statistical significant changes compared to control values. The present observations revealed the existence of alpha-1-adrenoceptor regulated mechanisms related to a net uptake of both potassium and calcium in rat heart.

Myocardial alpha 1-adrenoceptors mediate positive inotropic effect and changes in phosphatidylinositol metabolism. Species differences in receptor distribution and the intracellular coupling process in mammalian ventricular myocardium

Species-dependent variations of myocardial alpha 1-adrenoceptor-mediated positive inotropic effects of epinephrine were assessed in relation to characteristics of alpha 1-receptor bindings and acceleration of phosphatidylinositol metabolism in the isolated rat, rabbit, and dog ventricular myocardium. Epinephrine in the presence of the beta-adrenoceptor antagonist bupranolol (10(-6) M) elicited a positive inotropic effect through activation of alpha 1-adrenoceptors in rat and rabbit, whereas in dog ventricular myocardium, bupranolol abolished the positive inotropic effect of epinephrine. [3H]Prazosin bound to membrane fractions derived from rat, rabbit, and dog ventricular muscle with high affinities in a saturable and reversible manner. In dog, Bmax and Kd values of alpha 1-adrenoceptor binding sites were identical to those in rabbit ventricular muscle. The Bmax value of alpha 1-adrenoceptors in rat ventricle was the highest, amounting to two to four times those in rabbit and dog. Epinephrine displacement curves for the specific binding of [3H]prazosin in the membrane fraction of these species showed high and low affinity sites with slope factors significantly less than unity, which were shifted to single low affinity sites with slope factors close to unity by addition of 5'-guanylylimidodiphosphate. Accumulation of [3H]inositol 1-phosphate [( 3H]IP1) in ventricular slices prelabeled with [3H]myo-inositol was increased by epinephrine in a time- and concentration-dependent manner in rat ventricular slices. [3H]IP1 accumulation likewise was facilitated by alpha 1-adrenoceptor stimulation in rabbit ventricular slices, whereas the extent of [3H]IP1 accumulation was much less than that in rat. In dog ventricular slices, [3H]IP1 was not accumulated by epinephrine. In rabbit papillary muscle, the time course of increase in contractile force induced by alpha-adrenoceptors coincided with the prolongation of the action potential duration with a similar time course, which is in strong contrast to previous findings in rat that the contractile response was dissociated from the electrophysiological response to alpha-adrenoceptor stimulation. The present results indicate that a wide range of variation of alpha 1-adrenoceptor-mediated regulation of myocardial contractility may be ascribed to different contributions of facilitatory as well as inhibitory regulatory processes that lead to intracellular Ca2+ mobilization subsequent to myocardial alpha 1-adrenoceptor activation among mammalian species.

Depolarization-induced influx of sodium in response to phenylephrine in rat atrial heart muscle

1. The effects of alpha 1-adrenoceptor stimulation on transmembrane potential, currents and ion fluxes were investigated in multicellular preparations and/or single cells obtained from the left atrium of rat hearts. 2. In multicellular preparations, phenylephrine caused a concentration-dependent positive inotropic effect, an increase in action potential duration, and a decrease in resting potential; the effects were antagonized by phentolamine. 3. In the presence of phenylephrine (100 mumol/1), two levels of resting potential were observed when the preparations were, alternately, electrically stimulated or kept at rest (-74 +/- 1 mV during activity and -62 +/- 4 mV at rest; mean +/- S.E.M.; n = 9). 4. In resting preparations, the depolarization in response to phenylephrine was eliminated in low-Na+ solution (12 mmol/l) and antagonized by tetrodotoxin (10 mumol/l). 5. The phenylephrine-induced depolarization was also seen in nominally Ca(2+)-free solution and in the presence of (-)-devapamil (1 mumol/l). 6. The alkylating agent N-ethyl-maleimide (30 mumol/l) abolished the depolarizing effect of phenylephrine. 7. Phorbol 12,13-dibutyrate (10 mumol/l) also abolished the depolarizing effect of phenylephrine. 8. Phenylephrine caused a significant increase of 22Na+ uptake in resting preparations and of 45Ca2+ uptake in beating preparations. 9. The depolarizing effect of phenylephrine was also observed in single atrial myocytes. Steady-state membrane currents in response to 500 ms depolarizing and hyperpolarizing voltage clamp steps were decreased. The cross-over of I-V curves under control and test conditions was at about -70 mV. The effects of phenylephrine were antagonized in the presence of phentolamine. 10. After suppression of potassium currents by substitution of CsCl for internal and external KCl ([KCl]o), phenylephrine had no effect on membrane currents. 11. In conclusion, we presume the following sequence of events in response to phenylephrine in rat atrial heart muscle. First, the stimulation of alpha 1-adrenoceptors decreases the K+ conductance thereby producing a depolarization in the presence of an inward current. Second, the change of the membrane potential in the depolarizing direction induces a TTX-sensitive Na+ window current which further propels the depolarization. Third, the increase in Na+ influx may increase Ca2+ influx by activating the Na(+)-Ca2+ exchange in mechanism. The greater influx of Ca2+ may contribute to the positive inotropic effect in response to phenylephrine.

Antiarrhythmic and antinecrotic effects of yohimbine stereoisomers in rats during coronary occlusion and reperfusion

In pentobarbital-anesthetized rats the left coronary artery was ligated for 5 or 30 min and then opened for reperfusion of the ischemic myocardial area. Twelve min prior to the coronary occlusion yohimbine stereoisomers, namely corynanthine and rauwolscine, or saline solution were given intravenously. In the saline controls both ischemia and reperfusion provoked severe tachyarrhythmias with ventricular fibrillation in 37.5% or 54.6%, respectively. Using corynanthine and rauwolscine a highly significant antiarrhythmic effect was observed. Corynanthine completely prevented ventricular fibrillation and delayed significantly the development of myocardial necrosis. The factors likely underlying the antiarrhythmic and antinecrotic effects are discussed.

Function of myocardial alpha-adrenoceptors

In addition to beta-adrenoceptors (beta ARs), cardiac myocytes of animals and man possess alpha 1ARs, but not alpha 2ARs. Norepinephrine and epinephrine have a higher affinity for myocardial alpha 1ARs than for beta ARs. Unlike beta AR stimulation, myocardial alpha 1AR stimulation does not increase the slow inward current. The alpha 1AR-mediated positive inotropic effect seen in isolated heart preparations appears to involve increased Ca sensitivity of myofibrils and production of inositol triphosphate (IP3) and diacylglycerol (DAG), but the functions of IP3 and DAG are not clear. Myocardial alpha 1AR stimulation reduces rate of isolated atria and Purkinje fibers and lengthens refractory period and action potential duration. Hypoxia increases alpha 1AR density in cardiomyocytes. alpha 1AR-mediated arrhythmias occur in isolated Purkinje fibers during hypoxia, following infarction, and in the presence of Ba2+ or high Ca2+. In animals, coronary artery occlusion and/or reperfusion increase myocardial alpha 1AR density and responsiveness, and alpha AR blocking drugs attenuate arrhythmias. However, an antiarrhythmic effect of alpha AR blocking drugs mediated by action on coronary vascular alpha ARs cannot be excluded. Presently available drugs do not differentiate between myocardial and vascular alpha ARs and thus affect the coronary and systemic circulations and, indirectly, the heart. Additional myocardial alpha 1AR-mediated effects include production of cardiac hypertrophy, stimulation of glucose uptake and phosphofructokinase and cyclic AMP phosphodiesterase activity, and release of atrial natriuretic peptide.

Effect of corticotropin-releasing factor on the electrical and mechanical activities of the guinea-pig ventricular myocardium

1. The effects of the physiological levels of corticotropin-releasing factor (CRF) on isolated guinea-pig ventricular myocardium were studied using a force transducer and standard microelectrode techniques. 2. CRF increased the contractile force of muscles concentration-dependently in normal Tyrode and a high-K+ (27 mM) solution. The positive inotropic effect of CRF was associated with a significant enhancement of the slow action potentials of partially depolarized muscles in high-K+ solution. CRF potentiated the effect of increasing Ca2+ concentration of Tyrode solution. 3. The inotropic effect of CRF was reduced in the presence of diltiazem, and suppressed by phentolamine, metoclopramide, and cimetidine, but was not affected by propranolol and cold condition. 4. It is suggested that an increase in the slow inward Ca2+ current induced by CRF plays an important role in its positive inotropic effect and that its effect differs from that of cardiotonic steroids.

Multiple types of Ca2+ currents in single canine Purkinje cells

Whole-cell Ca2+ channel currents were recorded from isolated single canine Purkinje and ventricular cells to determine whether there were multiple types of Ca2+ channels in these two cell types, as in many other excitable tissues. The experimental conditions were such that currents other than Ca2+ channel currents were largely suppressed. The charge carrier was either Ca2+ or Ba2+ (5mM). In every canine Purkinje cell studied (n = 36), we saw T and L Ca2+ channel currents that are similar to their counterparts in other tissues. Neither current was affected by tetrodotoxin (30 microM), but both were reduced by Mn2+ (5mM). Ni2+ (50 microM) blocked T more than L current. Nisoldipine (1 microM) apparently abolished the L current but also decreased the T current by 50%. Substitution of Ba2+ for Ca2+ augmented and prolonged L current but did not affect T current significantly. At 36 degrees C and with 5 mM [Ca2+]o, T current inactivated over a voltage range from -70 to -30 mV whereas L current inactivated between -30 and +20 mV. T current was detectable in only some of the ventricular cells studied (8 out of 12). In these cells the ratio of maximal T current to maximal L current (0.2 +/- 0.1, n = 8) was lower than the T/L ratio in Purkinje cells (0.6 +/- 0.2, n = 6). The density of peak L current in ventricular cells (7.5 +/- 1.7 pA/pF, n = 8) was higher than that in Purkinje cells (4.4 +/- 3.4 pA/pF, n = 6). Therefore, in ventricular cells the L current is the main Ca2+ current whereas in Purkinje cells, the T current also contributes significantly to membrane electrical activity. In Purkinje cells, beta-adrenoceptor stimulation by isoproterenol (1 microM) increased L current but did not affect T current. On the other hand, in 70% (7 out of 10) of the Purkinje cells, alpha-adrenoceptor stimulation by 10 microM norepinephrine (in the presence of 2 microM propranolol) increased the T current. Our observations show that the distribution of the two types of Ca2+ channels in canine ventricle is heterogeneous and that the two types of Ca2+ channels are modulated by catecholamines by different receptors.

Mechanisms contributing to the arrhythmogenic influences of alpha 1-adrenergic stimulation in the ischemic heart

The majority of deaths associated with ischemic heart disease occur suddenly because of disturbances in cardiac rhythm culminating in ventricular fibrillation. Past research has focused on elucidating the biochemical membrane mechanisms responsible for the adverse electrophysiologic alterations in the ischemic heart, with major emphasis on the influence of adrenergic neural factors. It has been demonstrated that both alpha 1-and beta-adrenergic mechanisms contribute to arrhythmogenesis in the ischemic heart. In the normal heart, alpha 1-adrenergic input has very little effect on electrophysiologic indices. However, during early ischemia and reperfusion, enhanced alpha 1-adrenergic responsivity associated with a twofold reversible increase in alpha 1-adrenergic receptors in vivo has been demonstrated. Likewise, in a variety of species, alpha 1-adrenergic inhibition with prazosin markedly decreases the incidence of malignant ventricular arrhythmias associated with either myocardial ischemia or subsequent reperfusion. One major manifestation of alpha 1-adrenergic receptor activation during reperfusion of ischemic myocardium is an increase in intracellular calcium ion (Ca2+). It has been demonstrated that reperfusion of ischemic myocardium increases intracellular Ca2+ in reversibly injured tissue, and that the gain in intracellular Ca2+ is prevented by alpha 1-adrenergic inhibition with hydroxyphenylethyl aminomethyl tetralone, even when administered just prior to reperfusion. Subsequently, it was demonstrated that the alpha 1-adrenergic-induced increase in mitochondrial Ca2+ contributes to the decline in mitochondrial function. These findings suggest that even single-dose intervention with alpha 1-adrenergic inhibitors may improve markedly the functional recovery and extent of ultimate necrosis in humans after coronary thrombolysis. To investigate the mechanisms responsible for the increase in alpha 1-adrenergic receptors during ischemia, we used isolated adult canine ventricular myocytes exposed to hypoxia. Thirty minutes of hypoxia at 25 degrees C or 10 minutes of hypoxia at 37 degrees C resulted in a threefold reversible increase in the density of surface alpha 1-adrenergic receptors and a threefold increase in the cellular content of long-chain acylcarnitines. Inhibition of carnitine acyltransferase I abolished not only the accumulation of long-chain acylcarnitines during hypoxia but also the increase in alpha 1-adrenergic receptors. Exposure of normoxic myocytes to exogenous long-chain acylcarnitines (1 mumol/liter) for 10 minutes also increased alpha 1-adrenergic receptor number. These findings indicate that the sarcolemmal accumulation of long-cha

Alpha-adrenergic regulation of action potentials in isolated rat cardiomyocytes

Radioligand binding studies and studies in which inositol phosphate levels were assayed have provided substantial evidence for the existence of alpha 1-adrenoceptors in isolated rat ventricular myocytes, a pure cardiac preparation free of neuronal and vascular elements. Since correlational electrophysiological studies have not been carried out in this model, we investigated alpha-adrenergic effects on action potentials using intracellular microelectrodes to impale the myocytes. Epinephrine, in the presence of propranolol (10(-6) M), rapidly increased the action potential duration in a concentration-dependent manner (threshold concentration of 30 nM, EC50 of 100 nM). The maximal upstroke velocity and overshoot of Ca2+-mediated action potentials (15 mM K+) were also increased. Epinephrine did not significantly affect the resting membrane potential. The alpha 1-adrenoceptor antagonist, prazosin (10(-7) M) blocked epinephrine's effects. LiCl (10 mM), an inhibitor of inositol-phosphate phosphatases potentiated the effects of epinephrine (30 nM). The results suggest that the isolated rat cardiomyocyte is a suitable preparation for examining the ionic and molecular mechanisms of direct alpha-adrenergic effects on the cardiac membrane.

Antiarrhythmic effects of alpha-adrenoceptor antagonists in guinea pig ventricular myocardium

Antiarrhythmic effects of alpha-adrenoceptor antagonists were assessed in the reserpinized guinea pig ventricular myocardium. Both bunazosin (1 to 3 x 10(-7) M), a new alpha 1-adrenoceptor antagonist, and yohimbine (1 to 3 x 10(-7) M), another adrenoceptor antagonist, suppressed the transient depolarization and triggered activity induced by a train of rapid stimuli in the solution containing low potassium ion (K+), high calcium ion (Ca2+) and strophanthidin (1 to 5 x 10(-7) M). Bunazosin (3 x 10(-6) M) abolished the facilitatory effect of hypoxia on beta-adrenoceptor mediated abnormal automaticity. To clarify the mechanisms underlying the antiarrhythmic properties of alpha-adrenoceptor antagonists, their electrophysiologic effects on the fast and slow action potentials were investigated. Alpha-adrenoceptor antagonists (bunazosin, yohimbine and phentolamine) suppressed the slow response in a dose-related manner. The voltage-dependent block and use-dependent block of the maximal rate of rise (Vmax) of action potentials by bunazosin (10(-5) to 10(-4) M) and yohimbine (10(-6) to 10(-5) M) were studied. The analysis of the onset and recovery kinetics from the use-dependent block of drugs showed that both bunazosin and yohimbine act as slow kinetic drugs. It is concluded that alpha-adrenoceptor antagonists seem to have an antiarrhythmic effect through the inhibition of fast sodium ion (Na+) and slow Ca2+ currents of the cell membrane independently of blockade of myocardial alpha-adrenoceptors.

Alpha 1-adrenergic agonists selectively suppress voltage-dependent K+ current in rat ventricular myocytes

The effects of alpha 1-adrenergic agonists on the waveforms of action potentials and voltage-gated ionic currents were examined in isolated adult rat ventricular myocytes by the whole-cell patch-clamp recording technique. After "puffer" applications of either of two alpha 1 agonists, phenylephrine and methoxamine, action-potential durations were increased. In voltage-clamped cells, phenylephrine (5-20 microM) or methoxamine (5-10 microM) reduced the amplitudes of Ca2+-independent voltage-activated outward K+ currents (Iout); neither the kinetics nor the voltage-dependent properties of Iout were significantly affected. The effects of phenylephrine or methoxamine on Iout were larger and longer-lasting at higher concentrations and after prolonged or repeated exposures; in all experiments, however, Iout recovered completely when puffer applications were discontinued. The suppression of Iout is attributed to the activation of alpha 1-adrenergic receptors, as neither beta- nor alpha 2-adrenergic agonists had measurable effects on Iout; in addition, the effect of phenylephrine was attenuated in the presence of the alpha antagonist phentolamine (10 microM), but not in the presence of the beta antagonist propranolol (10 microM). Voltage-gated Ca2+ currents, in contrast, were not altered measurably by phenylephrine or methoxamine and no currents were activated directly by these agents. Suppression of Iout was also observed during puffer applications of either of two protein kinase C activators, phorbol 12-myristate 13-acetate (10 nM-1 microM) and 1-oleoyl-2-acetylglycerol (60 microM). We conclude that the activation of alpha 1-adrenergic receptors in adult rat ventricular myocytes leads to action-potential prolongation as a result of the specific suppression of Iout and that this effect may be mediated by activation of protein kinase C.

Electrophysiologic effects of epinephrine in humans

The electrophysiologic effects of circulating epinephrine in humans were examined in four study groups of 10 subjects each. In 10 subjects without structural heart disease (Group 1) and in 10 patients with coronary disease or dilated cardiomyopathy (Group 2) epinephrine infusion at 25 and 50 ng/kg body weight per min for 14 min resulted in an elevation of the plasma epinephrine concentration in the physiologic range. In both groups it produced a dose-dependent decrease in the effective refractory period of the atrium, atrioventricular (AV) node and ventricle and improvement in AV node conduction. Epinephrine facilitated the induction of sustained ventricular tachycardia in 3 of the 20 subjects. In Group 3, a beta-adrenergic blocking dose of propranolol was added to the infusion of 50 ng/kg per min of epinephrine. Propranolol not only reversed the effects of epinephrine, but also lengthened these variables compared with baseline values. In Group 4, propranolol was administered first, followed by 50 ng/kg per min of epinephrine. Propranolol alone slowed AV node conduction and mildly prolonged the refractory periods. In the presence of beta-blockade, epinephrine had no effect on AV node properties but resulted in a lengthening of the atrial and ventricular effective refractory periods. In conclusion, epinephrine in physiologic doses shortens the effective refractory period of the atrium, AV node and ventricle, improves AV node conduction and may facilitate the induction of sustained ventricular tachycardia. The overall electrophysiologic effects of epinephrine result from stimulation of beta-receptors. Stimulation of alpha-receptors by epinephrine has no effect on the AV node but prolongs the effective refractory period of the atrium and ventricle, partially offsetting the shortening of refractory periods mediated by beta-receptor stimulation.

Adrenoceptor-mediated changes of action potential and force of contraction in human isolated ventricular heart muscle

1. The effects of alpha-adrenoceptor stimulation on the action potential and force of contraction were investigated in human isolated ventricular heart muscle and compared with those of beta-adrenoceptor stimulation. 2. The maximal stimulation by isoprenaline of beta-adrenoceptors produced large changes in the force of contraction, which were accompanied by moderate increases in the height of the action potential. The maximal inotropic effect produced by stimulation of alpha-adrenoceptors with phenylephrine, in the presence of propranolol (1 mumol 1(-1)) was much smaller (about 10% of that seen in response to beta-adrenoceptor stimulation), and no significant changes of the action potential configuration were observed. 3. The effects of noradrenaline and adrenaline on the force of contraction were not affected by prazosin. 4. It is concluded that the adrenoceptor-mediated changes of the force of contraction (in the presence of either noradrenaline or adrenaline) in the human ventricle are due virtually exclusively to the stimulation of beta-adrenoceptors.

Effect of alpha 1-adrenoceptor stimulation with methoxamine and phenylephrine on spontaneously beating rabbit sino-atrial node cells

Effects of methoxamine and phenylephrine on the action potential and the membrane currents in spontaneously beating rabbit sino-atrial node cells were examined by means of a two-microelectrode voltage-clamp technique. Both methoxamine and phenylephrine (10(-4) mol/l) prolonged the cycle length (CL) and the action potential duration (APD), significantly. At concentrations higher than 3 x 10(-4) mol/l, phenylephrine increased the maximum rate of rise of action potential (Vmax) but methoxamine reduced it. Both agents depolarized the maximum diastolic potential (MDP). These changes in the action potential parameters occurred in a concentration-dependent manner. In the presence of phentolamine (10(-5) mol/l), methoxamine (3 x 10(-4) mol/l) did not modify the action potential parameters. Also, phenylephrine did not affect them during exposure to phentolamine (10(-5) mol/l) and pindolol (10(-7) mol/l). In voltage-clamp experiments, at 10(-3) mol/l both methoxamine and phenylephrine slightly increased the slow inward current (Isi), but decreased the time-dependent outward current (Ik). The steady-state activation variable of Ik (p infinity) was unaffected by these agents. The hyperpolarization-activated current (Ih) was suppressed in the presence of methoxamine, but enhanced in the presence of phenylephrine. An additional application of pindolol (10(-7) mol/l) during exposure to phenylephrine (10(-3) mol/l) depressed the action potential amplitude (APA) and Vmax, and prolonged CL slightly. Under the same condition, all the membrane currents (Isi, Ik and Ih) were decreased. In addition, the time courses of decay for Isi were not modified in the absence and the presence of phenylephrine (10(-3) mol/l) and phenylephrine plus pindolol (10(-7) mol/l).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenoceptor-mediated changes of excitation and contraction in ventricular heart muscle from guinea-pigs and rabbits

1. The influence of alpha-adrenoceptor stimulation on mechanical and electrophysiological parameters was investigated in ventricular preparations from guinea-pigs and rabbits. Action potential and force of contraction were measured in papillary muscles and ionic currents were measured in isolated myocytes. 2. The effects of alpha-adrenoceptor stimulation were compared with those of beta-adrenoceptor stimulation. 3. In the guinea-pig the stimulation of alpha-adrenoceptors caused a small increase in the force of contraction (less than 10% of the response to beta-adrenoceptor stimulation) which was not accompanied by any increase of the slow calcium inward current. beta-Adrenoceptor stimulation produced large increases in both force of contraction and slow inward calcium current. The noradrenaline-induced increase in the slow inward calcium current was not affected by phentolamine. 4. In the rabbit, alpha-adrenoceptor stimulation produced large increases in the force of contraction (about two thirds of those seen in response to beta-adrenoceptor stimulation). Whereas beta-adrenoceptor stimulation also produced large increases in both maximal upstroke velocity of slow-response action potentials and slow inward calcium current, there was almost no change of both parameters in response to alpha-adrenoceptor stimulation. 5. We conclude that, first, the contribution of alpha-adrenoceptors to adrenoceptor-mediated changes of force of contraction is minimal in the guinea-pig ventricle, and second, the pronounced changes of force of contraction in the rabbit ventricle in response to alpha-adrenoceptor stimulation are unrelated to changes in the slow inward calcium current.

Phorbol ester does not mimic, but antagonizes the alpha-adrenoceptor-mediated positive inotropic effect in the rabbit papillary muscle

The phorbol ester 12-O-tetradecanoyl phorbol-13-acetate (TPA) was used to examine the hypothesis that phosphoinositide turnover is involved in the regulation of myocardial contractility mediated by stimulation of alpha-adrenoceptors in the mammalian cardiac muscle. Exposure of the isolated rabbit papillary muscle electrically driven at a rate of 1 Hz at a temperature of 37 degrees C to TPA in concentrations of 10-1000 nmol/l for 30 min did not affect the basal force of contraction. The concentration-response curve for the positive inotropic effect of (-)-phenylephrine mediated by stimulation of alpha-adrenoceptors in the presence of (+/-)-bupranolol (100 nmol/l) was shifted to the right and downward by TPA in concentrations of 30-1000 nmol/l, while the effect of (-)-phenylephrine mediated by stimulation of beta-adrenoceptors in the presence of prazosin (100 nmol/l) was not decreased, but slightly enhanced by exposure of the muscle to relatively low concentrations of TPA (10-100 nmol/l). Incubation of the membrane fraction isolated from the rabbit ventricular muscle with TPA in vitro under the same condition as employed in the physiological experiments decreased the specific binding of [3H]prazosin but not that of [3H]CGP-12177, while the non-tumor promoting phorbol ester, alpha PDD, was ineffective. These results indicate that activation of protein kinase C by TPA does not mimic the positive inotropic effect of catecholamines mediated by activation of myocardial alpha-adrenoceptors.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of BAY K-8644 on positive inotropic agents in guinea pig atrial muscle

This study examined the influence of BAY K-8644, a dihydropyridine Ca2+ agonist, on the positive inotropic effects of strophanthidin, isoproterenol, methoxamine and extracellular Ca2+ (Ca2+0) in atrial muscle isolated from guinea pig heart. BAY K-8644 enhanced both the maximum developed tension observed in the presence of strophanthidin and the sensitivity to its toxic effects. The maximum contractile force observed in the presence of methoxamine was also elevated by BAY K-8644 pretreatment; however, the ED50 value for methoxamine was not affected. The maximum contractile force elicited by BAY K-8644 alone or by strophanthidin or methoxamine in combination with BAY K-8644 was approximately the same as that produced by isoproterenol alone. The Ca2+ agonist did not alter the maximum developed tension elicited by increasing concentrations of isoproterenol or Ca2+0; however, it reduce both the ED50 for Ca2+0 and the concentration of isoproterenol necessary to produce maximum contractility. These results suggest that combinations of BAY K-8644 and cardiac glycosides can elevate contractile force to a level greater than that produced by cardiac glycosides alone.

Effects of alpha-adrenoceptor stimulation on electrophysiological properties and mechanics in rat papillary muscle

1. Electrophysiological and inotropic responses to stimulation of alpha-adrenoceptors were examined in isolated rat papillary muscles. 2. Stimulation of alpha-adrenoceptors caused two major electrophysiological changes, i.e. prolongation of action potential duration (APD) and hyperpolarization of resting membrane potential. 3. The time course of the inotropic responses to alpha-adrenoceptor stimulation was composed of an initial, short-lasting and small positive phase followed by a negative phase and then a second increasing phase. 4. Nifedipine abolished the alpha-adrenoceptor-mediated positive inotropic effect whereas unaffecting the negative inotropic effect, the APD prolongation and the hyperpolarization. 5. In quiescent muscles alpha-adrenoceptor stimulation also produced hyperpolarization, which was blocked by Ba2+.

[Alpha-adrenoceptors in the myocardium: incidence and functional significance]

Alpha-adrenoceptors mediating positive inotropic effects are well established in the heart of various species including human heart. The mechanism by which alpha-adrenoceptor stimulation increases force of contraction is not known. cAMP is unlikely to be involved as a mediator. Evidence has been presented that an increase in magnitude and duration of the slow Ca++ inward current may be partly responsible for the positive inotropic effect. In addition, stimulation of alpha-adrenoceptors may increase Ca++ sensitivity of the contractile proteins. Stimulation of alpha-adrenoceptors by endogenous catecholamines may serve as a reserve mechanism under various conditions of impaired beta-adrenergic influence, e.g. hypothyroidism, bradycardia or ischemia. Furthermore, alpha-adrenoceptors may be involved in the genesis of reperfusion arrhythmias in ischemic heart.

Electrophysiological effects of platelet-activating factor (PAF-acether) in guinea-pig papillary muscles

The effects of PAF-acether (10(-11) to 10(-7) M) were studied on the electrical and mechanical activity of guinea-pig papillary muscles. At 10(-11) M PAF-acether did not modify the amplitude and Vmax of the upstroke or the resting membrane potential. At higher concentrations PAF-acether produced a dose-dependent increase in the amplitude and Vmax of the upstroke, shortened the action potential duration and hyperpolarized the resting membrane potential. These effects were accompanied by a biphasic effect on ventricular contractile force. The shortening of the APD was inhibited in muscles pretreated with tetraethylammonium or verapamil. In papillary muscles depolarized by 27 mM K Tyrode solution PAF-acether induced slow action potentials which were blocked by verapamil. PAF-acether produced a dose-dependent increase in amplitude and Vmax of the upstroke on the slow action potentials elicited by isoproterenol, prolonged the action potential duration and hyperpolarized the resting membrane potential. These results suggest that in guinea-pig papillary muscles PAF-acether increased Ca influx via the slow inward current.

Delayed afterdepolarizations and triggered activity induced in feline Purkinje fibers by alpha-adrenergic stimulation in the presence of elevated calcium levels

We studied the ability of alpha-adrenergic stimulation to induce delayed afterdepolarizations and triggered activity in Purkinje fibers from cat hearts in the presence of an elevated Ca++ concentration. Delayed afterdepolarizations could not be induced at drive cycle lengths of 200 to 500 msec in the presence of extracellular Ca++ concentrations of 2.7 to 8.1 mM. However, the addition of 10(-5)M phenylephrine in the presence of 5 X 10(-7)M propranolol elicited delayed afterdepolarizations in eight of 10 preparations at a Ca++ concentration of 8.1 mM; nondrive-triggered action potentials were recorded from three of the preparations. These afterpotentials were completely suppressed by 5 X 10(-7)M prazosin or 10(-6)M phentolamine. In the presence of 5 X 10(-7)M propranolol, 10(-5)M phenylephrine prolonged action potential duration and this effect was suppressed by 5 X 10(-7)M prazosin. Methoxamine, at a concentration of 5 X 10(-6)M, was also observed to potentiate delayed afterdepolarizations in all of three preparations studied. These results demonstrate that alpha-adrenergic stimulation can induce afterpotentials in the presence of elevated Ca++ levels in cat hearts. Stimulation of alpha-adrenoceptors may be responsible for arrhythmias under Ca++-loaded conditions such as ischemia and coronary reperfusion.

Effects of selective alpha 1-, alpha 2-, beta 1-and beta 2-adrenoceptor stimulation on potentials and contractions in the rabbit heart

Selective adrenoceptor agonists and antagonists have been used to analyse the effects of stimulation of individual types of adrenoceptor in various parts of the rabbit heart. The selective alpha 1- and alpha 2-adrenoceptor agonists used were St 587 and BHT 933 respectively, and the antagonists were prazosin (alpha 1) and WY 25309 (alpha 2). The selective beta 1- and beta 2-adrenoceptor antagonists were atenolol and ICI 118551, respectively. Pirbuterol was a highly selective beta 2-adrenoceptor agonist. The non-selective agonists noradrenaline, adrenaline and isoprenaline were also employed with various combinations of antagonists. Phenylephrine was found to stimulate beta- as well as alpha-adrenoceptors. Rimiterol was a beta-adrenoceptor agonist, partially selective for beta 2-adrenoceptors. In the sinus node beta 1-, but not beta 2-adrenoceptor stimulation increased the fast phase of depolarization (Vmax). Both beta 1- and beta 2-adrenoceptor stimulation increased the slope of slow diastolic depolarization, accelerated repolarization and increased maximum diastolic potential. After blockade of both beta 1- and beta 2-adrenoceptors alpha 1-adrenoceptor stimulation caused bradycardia, due exclusively to delayed repolarization. alpha 2-adrenoceptor stimulation had no effect. In Purkinje cells and papillary muscle both beta 1- and beta 2-adrenoceptor stimulation accelerated repolarization. Stimulation of alpha 2-adrenoceptors had no effect. Beta 1-, not beta 2-adrenoceptor stimulation augmented peak contractions 3-5-fold, and greatly increased rate of development of tension. After beta-blockade alpha 1-adrenoceptor stimulation moderately increased peak contractions (up to 47%), but increased time-to-peak and duration of contractions. These patterns of adrenoceptor-mediated effects were unchanged in animals pre-treated with sufficient 6-hydroxydopamine to eliminate responses to sympathetic nerve stimulation. The results would be consistent with beta 1-, and beta 2-adrenoceptor stimulation increasing inward calcium current, and with stimulation of alpha 1-adrenoceptors delaying its inactivation, rather than increasing its magnitude.

Effects of alpha-adrenoceptor stimulation with phenylephrine in the presence of propranolol on force of contraction, slow inward current and cyclic AMP content in the bovine heart

The mechanism of the cyclic AMP-independent positive inotropic effect of cardiac alpha-adrenoceptor stimulation was studied by analyzing the effects of phenylephrine on force of contraction, calcium-dependent slow action potentials and the slow inward current (Isi) in bovine ventricular trabeculae. The preparations were electrically driven at 0.3 Hz in the presence of propranolol 1 mumol 1(-1). Phenylephrine increased the force of contraction in a concentration-dependent manner (maximum about 200% of control at 30 mumol 1(-1). The effect was surmountably antagonized by phentolamine. The positive inotropic effect of phenylephrine was accompanied by a concentration-dependent increase in time to peak force and occurred without any detectable increase in cyclic adenosine 3',5'-monophosphate (cyclic AMP) levels. The positive inotropic effect of phenylephrine was accompanied by an increase in action potential duration both at 20% and 90% repolarization. Calcium-dependent slow action potentials were also prolonged by phenylephrine and there was a distinct increase in the maximal rate of depolarization (dV/dtmax) of these slow potentials. These effects were also completely reversible on washing and surmountably blocked by phentolamine. However, the increase in dV/dtmax was smaller than that of isoprenaline in concentrations producing similar inotropic effects. Voltage-clamp experiments with the single sucrose-gap method showed that the phenylephrine-induced increase in force of contraction was associated not only with an increase in peak slow calcium inward current, Isi max, but also with a delay in the inactivation of Isi. Outward currents were not detectably altered by phenylephrine. It is concluded that the alpha-adrenoceptor mediated, cyclic AMP-independent positive inotropic effects of phenylephrine in bovine cardiac muscle are associated with an increase in slow inward current. Additionally, the amount of calcium influx during excitation is probably increased by a delay in the inactivation of Isi. Both effects can explain the phenylephrine-produced prolongation of the action potential, and probably contribute to the positive inotropic effect of alpha-adrenoceptor stimulation. However, as the effect on dV/dtmax is smaller than that of isoprenaline, other (still unknown) mechanisms may also be involved.

Influences of extracellular calcium ions, verapamil, and calcium antagonistic cations on the positive inotropic effects mediated by alpha- and beta-adrenoceptors in the left atria of rats

Inotropic responses produced by stimulation of alpha-adrenoceptors were compared with those by isoproterenol in the left atria of rats. The negative frequency-force relationship was abolished or attenuated by isoproterenol, but not counteracted by phenylephrine in the presence of sotalol. The positive inotropic effect of phenylephrine was uniquely modulated by reduction in extracellular Ca2+ concentration. Verapamil at 10(-8) M (at which it produces no negative intropic action) depressed only the effect of phenylephrine. Pretreatment with Ca2+-antagonistic cations in low concentrations depressed the effect of phenylephrine without influencing that of isoproterenol.

Multiple effects of alpha-adrenoceptor stimulation on the action potential of the rabbit atrium

Effects of alpha-adrenoceptor stimulation by phenylephrine (10(-7)-10(-4) mol/l) in the presence of pindolol (10(-7) mol/l) on the action potential and force of contraction were observed in the rabbit left atrium. Phenylephrine reduced resting potential, prolonged action potential duration (APD), decreased maximum rate of rise of action potential (Vmax) and increased force of contraction in a concentration-dependent manner. Effects of phenylephrine (10(-5) mol/l) were antagonized by prazosin (10(-7) mol/l) or phentolamine (10(-6) mol/l). APD which had been prolonged by phenylephrine (10(-5) mol/l) was slightly shortened by Ni2+ (0.3 mmol/l) at the level of 50% repolarization but almost unaffected at the level of 90% repolarization. TTX (10(-6) mol/l) had no effect on ADP which had been prolonged by phenylephrine (10(-5) mol/l). Cs+ (10 mmol/l), which inhibits outward current ik1, depolarized resting potential, but in contrast with phenylephrine Cs+ did not affect APD at 90% repolarization. Phenylephrine (10(-5) or 3 X 10(-5) mol/l) restored Ca2+-dependent action potential and force of contraction in 20 mmol/K+-Tyrode solution. These responses were suppressed by prazosin (10(-7) mol/l) or Ni2+ (0.3 mmol/l). Phenylephrine (10(-5) or 10(-4) mol/l) had no effect on steady-state membrane potential--Vmax relationship. It is concluded that in the rabbit left atrium phenylephrine, via alpha-adrenoceptors may suppress outward currents perhaps ik1 and ix, and might increase slow inward current.

Alpha adrenergic-mediated accumulation of calcium in reperfused myocardium

Reperfusion of ischemic myocardium is associated with increases in total myocardial calcium (Ca+2), which may influence the ultimate extent of ischemic damage as well as the development of arrhythmias. Since reperfusion is also associated with enhanced alpha-adrenergic responsivity, this study was performed to determine the potential interactions between alpha-adrenergic receptors and myocardial calcium during reperfusion. Cats were subjected to 35 min of left anterior descending coronary artery occlusion and 10 min of reperfusion. Total myocardial calcium was measured by atomic absorption spectrometry. Intracellular calcium was calculated from measurements of extracellular space [( 3H]inulin). In control animals with reperfusion, total calcium increased from 0.32 +/- 0.03 to 0.65 +/- 0.05 mmol/100 g dry tissue (P less than 0.0001), while intracellular calcium increased from 0.15 +/- 0.03 to 0.40 +/- 0.05 mmol/100 g dry tissue (P less than 0.001). Pretreatment with the alpha-adrenergic blocking agents phentolamine or prazosin prevented the increase in total and intracellular calcium. Phentolamine and the aqueous soluble alpha 1-adrenergic antagonist BE-2254 administered as late as 2 min before reperfusion similarly attenuated the increase in tissue calcium. Although administration of BE-2254 2 min before reperfusion failed to block the reperfusion-induced increase in extracellular space, the increase in calculated intracellular calcium was prevented. beta-Adrenergic blockade with propranolol partially attenuated but did not prevent an increase in total tissue calcium. Labetalol, a combined alpha- and beta-adrenergic blocking agent completely blocked the increase in tissue calcium during reperfusion. Additional experiments performed after 70 min of ischemia with reperfusion demonstrated a 49% attenuation of the increase in tissue calcium with alpha-adrenergic blockade. Electron microscopy with pyroantimonate and x-ray microprobe analysis demonstrated a large increase in calcium precipitate in mitochondria after reperfusion in untreated animals. Though alpha-adrenergic blockade prevented the calcium deposition in mitochondria, other criteria of ischemia persisted. Thus, alpha-adrenergic blockade specifically prevents the increase in intracellular calcium during reperfusion in reversibly injured tissue, independent of alterations in extracellular space and tissue water.

alpha-Adrenoceptors mediating the positive inotropic effect of phenylephrine in the right ventricular muscle of the monkey (Macaca fuscata)

The property of adrenoceptors mediating the positive inotropic effect (PIE) in the ventricular muscle of the Japanese monkey (Macaca fuscata) was investigated by the use of phenylephrine (PE) and adrenoceptor antagonists. The intrinsic activity (0.6) and the pD2-value (5.41) for PE were comparable to those in other mammalian species. The beta-adrenoceptor antagonist, pindolol (3 x 10(-8) mol/l) shifted only the upper part of the concentration-response curve (CRC) for PE to the right; the pD2-value for PE was not significantly affected by pindolol. On the other hand, phentolamine (10(-6) mol/l) shifted the lower part of the CRC for PE more than the upper part. In the presence of both pindolol and phentolamine the curve was shifted to the right in a parallel manner. The time required for twitch relaxation was negatively correlated to the degree of PIE of PE in the presence of phentolamine but not pindolol. These results indicate that both beta- and alpha-adrenoceptors mediate the positive inotropic action in the ventricular muscle of the Japanese monkey and that in contrast to the action via beta-adrenoceptors the action via alpha-adrenoceptors is not accompanied by the "relaxant effect".

Cyclic AMP-dependent and independent positive inotropic effects of phenylephrine

To summarize, a large number of studies indicate that the effects of phenylephrine on cardiac contractility are mediated through alpha-adrenoceptors, although not exclusively. There are an equally large number of reports indicating some beta-adrenoceptor stimulant effects of phenylephrine. Of the latter, some are based on the finding of antagonism by beta-receptor antagonists and some on the fact that phenylephrine is capable of elevating cyclic AMP levels, which is primarily a beta-, and not alpha-adrenoceptor effect. Although it is now widely accepted that phenylephrine elevates cyclic AMP levels, the contribution and significance of the elevated nucleotide levels to the overall positive inotropy of phenylephrine appears to be small. Alpha-Adrenoceptors may be involved with calcium, although the precise interaction between calcium and the alpha-adrenoceptor is not clear. Finally, the adrenergic effects seem to depend on the experimental and physiological conditions including calcium ion concentration, thyroid state and driving frequency.

Cardiac responsiveness after acute withdrawal of chronic propranolol treatment in rats

1. This study examined possible effects of chronic beta-adrenergic blockade on (a) rat myocardial beta-adrenergic receptors and (b) the responsiveness of isolated atria and right ventricular strips to various agents. 2. Following withdrawal of propranolol or saline treatment, significant left shifts were noted in the inotropic responses of propranolol-treated right ventricular strips to isoproterenol and norepinephrine. 3. This supersensitivity could not be demonstrated in left atrial inotropic or right atrial chronotropic responses. 4. Treatment and withdrawal did not alter (a) the inotropic responsiveness of right ventricular strips to extracellular calcium, methoxamine, ouabain, glucagon, 3-isobutyl-l-methylxanthine, acetylcholine or methacholine, or (b) beta-adrenergic receptors in ventricular membranes.

Enhanced alpha-adrenergic responsiveness in ischemic myocardium: role of alpha-adrenergic blockade

alpha-Adrenergic blockade with phentolamine or prazosin but not beta-adrenergic blockade reduces premature ventricular complexes and abolished ventricular fibrillation induced by coronary artery ligation or reperfusion in cats. The protective influences were independent of regional coronary flow or systemic hemodynamics. Efferent sympathetic nerve stimulation increased the idioventricular rate (IVR) prior to myocardial ischemia, a response blocked by propranolol, whereas during reperfusion the increased IVR was abolished only by alpha-blockade. Enhanced alpha-adrenergic responsiveness during reperfusion was also apparent with the alpha-agonist methoxamine. More recently we have demonstrated that alpha-adrenergic receptors, assessed by ligand binding with 3H-prazosin, increased nearly twofold in ischemic myocardium by 30 minutes (Bmax = 14 + 2 to 27 + 3 fmol/mg prot) and remain elevated during early reperfusion (12 + 1 to 18 + 1) before returning to control values by 15 minutes after reperfusion. 3H-DHA binding or Na+- -K+ adenosine triphosphatase activity was not altered at any time, indicating the specificity of the alteration. Thus enhanced alpha-adrenergic receptors and suggests the potential use of alpha-adrenergic blockade as one intervention to alleviate these malignant dysrhythmias.

Multiple effects of putative alpha-adrenoceptor agonists on the electrical and mechanical activity of guinea-pig papillary muscle

The effects of the putative alpha-adrenoceptor agonists phenylephrine, methoxamine and clonidine on force of contraction and on calcium-dependent action potentials were studied in guinea-pig papillary muscles. Phenylephrine increased the force of contraction by stimulating alpha-adrenoceptors as well as beta-adrenoceptors. It increased the amplitude and duration of slow action potentials, but this effect was exclusively due to stimulation of beta-adrenoceptors. The positive inotropic effect mediated by alpha-adrenoceptors can presumably not be explained by an increase in calcium influx during the action potential via the slow inward current. Methoxamine had no effect on the force of contraction at 10(-5) and 10(-4) mol/l, but at 10(-4) mol/l it slightly decreased amplitude and duration of slow action potentials. Clonidine produced a large increase in force of contraction and in amplitude and duration of slow action potentials. These effects were due to stimulation of H2-histamine receptors. It is concluded that in guinea-pig papillary muscle the tested putative alpha-adrenoceptor agonists do not share a common alpha-adrenoceptor effect, but produce prominent effects which are mediated through either beta-adrenoceptors (phenylephrine), or H2-histamine-receptors (clonidine) or are non-specific (methoxamine) in nature.

alpha-Sympathomimetic amines and calcium-mediated action potentials in guinea-pig ventricular muscle

1 The ability of amines, having alpha- or alpha- and beta-adrenoceptor stimulating activity, to restore excitability and contractility in heart preparations partially depolarized by potassium, was investigated in guinea-pig ventricular muscle in order to elucidate the mechanism of the positive inotropic effect mediated via alpha-adrenoceptors. 2 In preparations in which fast sodium channels were inactivated by K+-rich medium (22 mM) slow electrical responses as well as contractions were consistently induced by high concentrations of phenylephrine (10(-4) to 3 X 10(-4) M) and synephrine (3 X 10(-4) M). 3 The restorative effective effects of both phenylephrine and synephrine were unaffected by phentolamine (10(-5) M) but were readily abolished by practolol (10(-5) M) or sotalol (10(-5) M). 4 Methoxamine induced a dose-dependent positive inotropic effect in ventricular strips paced at 0.5 Hz in normal Tyrode solution; the maximum increase in contractile tension was obtained with methoxamine 10(-4) M. However, at the same concentration, the amine did not induce slow electrical responses in potassium-depolarized preparations. 5 It is concluded that the induction of slow responses by phenylephrine and synephrine is due to beta-adrenoceptor stimulation, and that the increase in cardiac contractility caused by alpha-adrenoceptor stimulation does not involve an increase in slow inward calcium current.

Alpha adrenergic contributions to dysrhythmia during myocardial ischemia and reperfusion in cats

Alpha compared to beta adrenergic contributions to dysrhythmias induced by left anterior descending coronary occlusion and by reperfusion were assessed in chloralose-anesthetized cats (n = 96). Alpha receptor blockade with either phentolamine or prazosin significantly reduced the number of premature ventricular complexes during coronary reperfusion (321 +/- 62-14 +/- 10 premature ventricular complexes, P less than 0.001), abolished early ventricular fibrillation (from 25% in controls to 0%), and prevented the increase in idioventricular rate seen with coronary reperfusion. However, beta-receptor blockade was without effect. Ventricular dysrhythmias induced by coronary occlusion alone (without reperfusion) were attenuated markedly by alpha-receptor blockade under conditions in which perfusion (measured with radiolabeled microspheres) within ischemic zones was not affected. Alternative sympatholytic interventions including pretreatment with 6-hydroxydopamine to deplete myocardial norepinephrine from 8.8 +/- 1.4 to 0.83 +/- 0.2 ng/mg protein and render the heart unresponsive to tyramine (120 microgram/kg) attenuated dysrhythmias induced by both coronary occlusion and reperfusion in a fashion identical to that seen with alpha-receptor blockade. Although efferent sympathetic activation induced by left stellate nerve stimulation increased idioventricular rate from 66 +/- 6 to 144+/- 7 beats/min (P less than 0.01) before coronary occlusion, this response was blocked by propranolol but not by phentolamine. In contrast, during reperfusion the increase in idioventricular rate induced by left stellate nerve stimulation (to 203 +/- 14) was not inhibited by propranolol but was abolished by phentolamine (79 +/- 10). Intracoronary methoxamine (0.1 microM) in animals depleted of myocardial catecholamines by 6-hydroxydopamine pretreatment did not affect idioventricular rate before coronary occlusion. However, early after coronary reperfusion, methoxamine increased idioventricular rate from 33 +/- 7 to 123 +/- 21 beats/min (P less than 0.01). Thus, enhanced alpha-adrenergic responsiveness occurs during myocardial ischemia and appears to be primary mediator of the electrophysiological derangements and resulting malignant dysrhythmias induced by catecholamines during myocardial ischemia and reperfusion.