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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\u2013Jarisch 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.<\/jats:p>","DOI":"10.1093\/eurheartj\/ehag674","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T11:37:27Z","timestamp":1786448247000},"source":"Crossref","is-referenced-by-count":2,"title":["The vagus nerve in myocardial infarction"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7078-4160","authenticated-orcid":false,"given":"Gerd","family":"Heusch","sequence":"first","affiliation":[{"name":"Cardioprotection Unit, Institute for Pathophysiology, West German Heart and Vascular Center, University of Duisburg-Essen , Hufelandstr. 55, Essen 45147 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3576-3772","authenticated-orcid":false,"given":"Petra","family":"Kleinbongard","sequence":"additional","affiliation":[{"name":"Cardioprotection Unit, Institute for Pathophysiology, West German Heart and Vascular Center, University of Duisburg-Essen , Hufelandstr. 55, Essen 45147 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3068-491X","authenticated-orcid":false,"given":"Alexander V","family":"Gourine","sequence":"additional","affiliation":[{"name":"Centre for Cardiovascular and Metabolic Neuroscience, Department of Neuroscience, Physiology, and Pharmacology, University College London , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"2026082604303197300_ehag674-B1","doi-asserted-by":"publisher","first-page":"2053","DOI":"10.1056\/NEJMra1606915","article-title":"Acute myocardial infarction","volume":"376","author":"Anderson","year":"2017","journal-title":"N Engl J Med"},{"key":"2026082604303197300_ehag674-B2","doi-asserted-by":"publisher","first-page":"774","DOI":"10.1093\/eurheartj\/ehw224","article-title":"The pathophysiology of acute myocardial infarction and strategies of protection beyond reperfusion: a continual challenge","volume":"38","author":"Heusch","year":"2017","journal-title":"Eur Heart J"},{"key":"2026082604303197300_ehag674-B3","doi-asserted-by":"publisher","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur Heart J"},{"key":"2026082604303197300_ehag674-B4","doi-asserted-by":"publisher","first-page":"1154","DOI":"10.1016\/S0140-6736(25)01394-7","article-title":"Prevention of heart failure after acute myocardial infarction","volume":"406","author":"Udell","year":"2025","journal-title":"Lancet"},{"key":"2026082604303197300_ehag674-B5","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.48893","article-title":"Autonomic responses during acute anterior versus inferior myocardial infarction: a systematic review and meta-analysis","volume":"15","author":"Schismenos","year":"2023","journal-title":"Cureus"},{"key":"2026082604303197300_ehag674-B6","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1007\/BF01881528","article-title":"Pharmacolocigal mechanisms to attenuate sympathetically induced myocardial ischemia","volume":"3","author":"Schulz","year":"1989","journal-title":"Cardiovasc Drugs Ther"},{"key":"2026082604303197300_ehag674-B7","doi-asserted-by":"publisher","first-page":"1729","DOI":"10.1113\/JP284740","article-title":"Neurocardiology: translational advancements and potential","volume":"603","author":"Herring","year":"2025","journal-title":"J Physiol"},{"key":"2026082604303197300_ehag674-B8","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1113\/jphysiol.1885.sp000173","article-title":"Some observations on the influence of the vagus and accelerators on the heart etc. of the turtle","volume":"5","author":"Mills","year":"1885","journal-title":"J Physiol"},{"key":"2026082604303197300_ehag674-B9","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1007\/BF01738910","article-title":"\u00dcber humorale \u00dcbertragbarkeit der Herznervenwirkung. 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