Plasma levels of norepinephrine and epinephrine were measured in 84 patients aged 56 +/- 9 (mean +/- SD) years with chronic ischemic heart disease (IHD), anterior acute myocardial infarction (AMI), posterior AMI, acute or chronic IHD associated with various types of electrical instability and in the control subjects. During the first day of hospitalization, plasma epinephrine levels were higher in patients with AMI in both localizations and chronic IHD in comparison with control values. There were no significant differences in plasma epinephrine levels among these groups of patients. However, in the same time period, plasma norepinephrine concentrations in patients with chronic IHD and posterior AMI did not differ from the control values; in patients with anterior AMI they reached by approximately 60% higher values than in the control group. Moreover, all myocardial lesions showing different types of electrical instability were associated with increased plasma levels of both norepinephrine and epinephrine. In conclusion, high plasma levels of epinephrine may result from sympathoadrenal activation. High plasma levels of norepinephrine in patients with anterior AMI and no change in patients with posterior AMI suggest a rather myocardial than an extramyocardial origin of plasma norepinephrine level in anterior AMI. Norepinephrine released from the ischemic area might contribute to the electrical instability of the myocardium and generation of dysrrhythmias.

Department of Physiology Medical School and Teaching Hospital Plzen Charles University Czech Republic

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Remme WJ: The sympathetic nervous system and ischaemic heart disease. Eur Heart J 1998; 19: F62–F71. PubMed

Bacaner M, Brietenbucher J, LaBree J: Prevention of ventricular fibrillation, acute myocardial infarction (myocardial necrosis), heart failure, and mortality by bretylium: is ischemic heart disease primarily adrenergic casdiovascular disease? Am J Ther 2004; 11: 366–411. PubMed

Remme WJ, de Leeuw PW, Bootsma M, Look MP, Kruijssen DA: Systemic neurohumoral activation and vasoconstriction during pacing‐induced acute myocardial ischemia in patients with stable angina pectoris. Am J Cardiol 1991; 68: 181–186. PubMed

Remme WJ, Kruijssen DA, Look MP, Bootsma M, de Leeuw PW: Systemic and cardiac activation and severity of myocardial ischemia in humans. J Am Coll Cardiol 1994; 23: 82–91. PubMed

Schömig A, Fischer S, Kurz T, Richardt G, Schömig E: Nonexocytotic release of endogenous catecholamines in the ischemic and anoxic rat heart: mechanism and metabolic requirements. Circ Res 1987; 60: 194–205. PubMed

Richardt G, Waas W, Kranzhöfer R, Mayer E, Schömig A: Adenosine inhibits exocytotic release of endogenous noradrenaline in the rat heart: a protective mechanism in early myocardial ischemia. Circ Res 1987; 61: 117–123. PubMed

Schömig A: Adrenergic mechanisms in myocardial infarction: cardiac and systemic catecholamine release. J Cardiovasc Pharmacol 1988; 12: S1–S7. PubMed

Sigursson A, Held P, Swedberg K: Short‐ and long‐term neurohumoral activation following acute myocardial infarction. Am Heart J 1993; 126: 1068–1076. PubMed

Waldenström AP, Hjalmarson AC, Thornell L: A possible role of noradrenaline in the development of myocardial infarction. Am Heart J 1978; 95: 43–51. PubMed

Malliani A, Schwartz PJ, Zanchetti A: Neural mechanisms in life‐threatening arrhythmias. Am Heart J 1980; 100: 705–715. PubMed

Strange RC, Rowe MJ, Oliver MF: Lack of relation between plasma total catecholamine concentrations and ventricular arrhythmias after acute myocardial infarction. Br Med J 1978; 2: 921–922. PubMed PMC

Hjalmarson AC, Olsson G: Myocardial infarction. Effects of β‐blocade. Circulation 1991; 84: 101–107. PubMed

Pitt B: The role of β‐adrenergic blocking agents in preventing sudden cardiac death. Circulation 1992; 85: I107–I111. PubMed

Schömig A, Dart AM, Dietz R, Mayer E, K–bler W: Release of endogenous catecholamines in the ischemic myocardium of the rat. Part A: Locally mediated release. Circ Res 1984; 55: 689–701. PubMed

Freeman R: Assessment of cardiovascular autonomic function. Clin Neurophysiol 2006; 117: 716–730. PubMed

Johansson M, Rundqvist B, Eisenhofer G, Friberg P: Cardiorenal epinephrine kinetics: evidence for neuronal release in the human heart. Am J Physiol 1997; 273: H2178–H2185. PubMed

Slavikova J, Kuncova J, Reischig J, Dvorakova M: Catecholaminergic neurons in the rat intrinsic cardiac nervous system. Neurochem Res 2003; 28: 593–598. PubMed

Goncalvesova E, Krizanova O, Micutkova L, Mravec B, Ksinantova L, et al.: Phenylethanolamine N‐methyltransferase gene expression in transplanted human heart. Transplant Proc 2005; 37: 1340–1342. PubMed

Kaye DM, Lefkovits J, Cox H, Lambert G, Jennings G, et al.: Regional epinephrine kinetics in human heart failure: evidence for extra‐adrenal, nonneural release. Am J Physiol 1995; 269: H182–H188. PubMed

Kuchel O: Stress and catecholamines In In Stress Revisited. 1. Neuroendocrinology of Stress. (Eds. Jasmin G, Cantin M.), pp 80–103. Basel: Karger, 1991.

Esler M, Jennings G, Leonard P, Sacharias N, Burke F, et al. Contribution of individual organs to total noradrenaline release in humans. Acta Physiol Scand 1984; 527(S): 11–16. PubMed

Brown MJ, Allison DJ, Jenner DA, Lewis PJ, Dollery CT: Increased sensitivity and accuracy of phaeochromocytoma diagnosis achieved by use of plasma‐adrenaline estimations and pentolinium‐supression test. Lancet 1981; 1: 174–177. PubMed

Esler M, Jackman G, Bobik A, Leonard P, Kelleiier D, et al.: Norepinephrine kinetics in essential hypertension. Defective neuronal uptake of norepinephrine in some patients. Hypertension 1981; 3: 149–156. PubMed

Esler M, Jennings G, Korner P, Blombery P, Sacharias N, et al.: Measurement of total and organ‐specific norepinephrine kinetics in humans. Am J Physiol 1984; 247: E21–E28. PubMed

Goldstein DS, Brush JE, Eisenhofer G, Stull R, Esler M: In vivo measurement of neuronal uptake of norepinephrine in the human heart. Circulation 1988; 78: 41–48. PubMed

Webb SW, Adgey AA, Pantridge JF: Autonomic disturbance at onset of acute myocardial infarction. Br Med J 1972; 3: 89–92. PubMed PMC