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. 2022 Oct 1;12(4):e12147.
doi: 10.1002/pul2.12147. eCollection 2022 Oct.

Bezold-Jarisch reflex mediated syncope in pulmonary arterial hypertension: An illustrative case series

Kolade M Agboola  1 , Gurukripa N Kowlgi  1 , Ibolya Csecs  2 , Hilary M DuBrock  3 , Hector R Cajigas  3 , Thomas G Allison  1   4
Affiliations

Bezold-Jarisch reflex mediated syncope in pulmonary arterial hypertension: An illustrative case series

Kolade M Agboola et al. Pulm Circ. .

Abstract

We present a novel description of Bezold-Jarisch Reflex (BJR) during cardiopulmonary exercise testing (CPET) in three young female patients with Group 1 pulmonary arterial hypertension (PAH). These three cases presented within 26 months, representing only 0.8% of 11,387 tests on patients with PAH undergoing CPET during this time frame.

Keywords: Bezold–Jarisch reflex; cardiopulmonary exercise testing; pulmonary arterial hypertension; syncope.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A series of single‐lead rhythm strips covering the syncopal event from onset to resolution are presented for each case. Times are postpeak exercise in active recovery at 1.7MPH/0% grade. Case 1. Electrocardiogram demonstrates a swift transition from sinus tachycardia to profound junctional bradycardia, likely due to intense vagal tone, occurring simultaneously with syncope. Note also a brief run of ventricular tachycardia thought to be an escape rhythm triggered by rapid heart rate slowing. Case 2. Electrocardiogram similarly demonstrating a sudden, vagally mediated decrease in heart rate in recovery with transient atrioventricular (AV) block occurring simultaneously with syncope. Case 3. Electrocardiogram demonstrating a sudden decrease in heart rate during recovery, occurring simultaneously with syncope. The abrupt slowing of the hazard ratio is likely vagally mediated.
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