{"id":"e987b75501ea","type":"article","url":"https://hartvaat.nl/2026/08/26/de-vaguszenuw-bij-myocardinfarct-mechanismen-reflexen-en-klinische-perspectieven/","title":"De vaguszenuw bij myocardinfarct: mechanismen, reflexen en klinische perspectieven","title_en":"The vagus nerve in myocardial infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehag674","source_url":"https://doi.org/10.1093/eurheartj/ehag674","authors":["Gerd Heusch","Petra Kleinbongard","Alexander V Gourine"],"significance":5,"published":"2026-09-03","source_date":"2026-08-26","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/ischemie-reperfusieschade/","https://hartvaat.nl/kennis/cardiometabool/esc-richtlijn-diabetes-cvd-cardiometabool/"],"congress":"","summary_en":"This review outlines the role of the vagus nerve in myocardial infarction, bridging preclinical mechanisms with early clinical observations. Vagal activation counteracts sympathetic overdrive and may limit infarct size and inflammation via reflexes such as the Bezold-Jarisch response and remote ischaemic conditioning. While experimental data are promising, the clinical efficacy of vagal stimulation in ischaemic heart disease requires validation in larger trials. The article provides a mechanistic overview that may inform future cardioprotective strategies.","created":"2026-08-27T01:28:14Z","updated":"2026-08-27T01:28:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Deze review beschrijft de rol van de vaguszenuw bij myocardinfarct, van experimentele modellen tot eerste klinische studies. Vagale activiteit werkt sympathische overprikkeling tegen en kan via reflexen zoals de Bezold-Jarisch en remote ischaemische conditioning de infarctgrootte en ontsteking beperken. Hoewel preklinische data veelbelovend zijn, moet de effectiviteit van vagale stimulatie bij patiënten met ischemische hartziekte nog in grotere trials worden bevestigd. Het artikel biedt een overzicht van de fysiologische mechanismen die toekomstige cardioprotectieve strategieën kunnen sturen.","abstract_original":"Myocardial infarction can result from and leads to sympathetic activation, whereas vagal engagement provides a counter-regulatory influence that can limit ischaemic injury. This article reviews the organization of vagal sensory and efferent pathways, their transmitters and receptors, and their targets within the myocardium, coronary and systemic vasculature, and other organs including the intestine and spleen. Atrial mechanosensitive afferents mediate the Bainbridge reflex, resulting in tachycardia, whereas activation of ventricular mechano- and chemosensitive afferents trigger the Bezold-Jarisch reflex, eliciting bradycardia and hypotension during coronary occlusion and reperfusion, with probable cardioprotective significance. Vagal pathways contribute to remote ischaemic conditioning, linking peripheral sensory stimulation to vagal activation and the release of circulating protective factors. In experimental models, vagal stimulation reduces infarct size, arrhythmogenesis, and limits inflammation. Smaller clinical studies reported reduced infarct size and improved clinical outcome with remote ischaemic conditioning and electrical auricular vagus stimulation. However, the efficacy of remote ischaemic conditioning in recruiting cardioprotective vagal activity in patients with ischaemic heart disease remains to be definitively established."}