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In the current study we tested the hypotheses that oropharyngeal afferent blockade (i.e., local anesthesia of the upper airway with lidocaine) as well as systemic \u03b2-adrenergic receptor blockade (i.e., intravenous propranolol) would improve the balance between myocardial oxygen supply and demand in response to the combined stimulus of cold air inhalation (\u221215 to \u221230\u00b0C) and isometric handgrip exercise (Cold + Grip). Young healthy subjects underwent Cold + Grip following lidocaine, propranolol, and control (no drug). Heart rate, blood pressure, and coronary blood flow velocity (CBV, from Doppler echocardiography) were continuously measured. Rate-pressure product (RPP) was calculated, and changes from baseline were compared between treatments. The change in RPP at the end of Cold + Grip was not different between lidocaine (2,441 \u00b1 376) and control conditions (3,159 \u00b1 626); CBV responses were also not different between treatments. With propranolol, heart rate (8 \u00b1 1 vs. 14 \u00b1 3 beats\/min) and RPP responses to Cold + Grip were significantly attenuated. However, at peak exercise propranolol also resulted in a smaller \u0394CBV (1.4 \u00b1 0.8 vs. 5.3 \u00b1 1.4 cm\/s, P = 0.035), such that the relationship between coronary flow and cardiac metabolism was impaired under propranolol (0.43 \u00b1 0.37 vs. 2.1 \u00b1 0.63 arbitrary units). These data suggest that cold air breathing and isometric exercise significantly influence efferent control of coronary blood flow. Additionally, \u03b2-adrenergic vasodilation may play a significant role in coronary regulation during exercise. <\/jats:p>","DOI":"10.1152\/ajpheart.00174.2014","type":"journal-article","created":{"date-parts":[[2014,5,10]],"date-time":"2014-05-10T05:14:09Z","timestamp":1399698849000},"page":"H228-H235","source":"Crossref","is-referenced-by-count":17,"title":["Coronary responses to cold air inhalation following afferent and efferent blockade"],"prefix":"10.1152","volume":"307","author":[{"given":"Matthew D.","family":"Muller","sequence":"first","affiliation":[{"name":"Pennsylvania State University College of Medicine, Penn State Hershey Heart and Vascular Institute, Hershey, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhaohui","family":"Gao","sequence":"additional","affiliation":[{"name":"Pennsylvania State University College of Medicine, Penn State Hershey Heart and Vascular Institute, Hershey, 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