RESUMO
A 59-year-old male patient was admitted for possible reflex syncope following loss of consciousness during urination. During the visit, a malaise with unconsciousness occurred. Holter ECG at that time showed increasing sinus bradycardia with transition to a junctional escape rhythm (30/min); in addition, there were several sinus pauses >â¯2.0â¯s (the longest almost 10â¯s). This malaise occurred again during routine EEG, when a focal epileptic seizure on the right fronto-temporal with sinus bradycardia after 15â¯s was documented. Thus, the diagnosis of ictal asystole was made, anticonvulsant therapy was started, and a cardiac pacemaker was implanted.
Assuntos
Parada Cardíaca , Síncope Vasovagal , Anticonvulsivantes/uso terapêutico , Arritmias Cardíacas/tratamento farmacológico , Bradicardia/complicações , Eletrocardiografia , Eletroencefalografia , Parada Cardíaca/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Reflexo , Convulsões/complicações , Síndrome do Nó Sinusal/tratamento farmacológico , Síncope Vasovagal/diagnósticoRESUMO
Sick sinus syndrome (SSS), a complex type of cardiac arrhythmia, is a major health threat to humans. Shenfu injection (SFI), a formula of traditional Chinese medicine (TCM), is effective in improving bradyarrhythmia. However, the underlying mechanism of SFI's therapeutic effect is subject to few systematic investigations. The purpose of the present research is to examine whether SFI can boost the differentiation effectiveness of bone marrow mesenchymal stem cells (BMSCs) into pacemaker-like cells and whether the transplantation of these cells can improve the pacing function of the sinoatrial node (SAN) in a rabbit model of SSS. BMSCs from New Zealand rabbits were extracted, followed by incubation in vitro. The flow cytometry was utilized to identify the expression of CD29, CD44, CD90, and CD105 surface markers. The isolated BMSCs were treated with SFI, and the whole-cell patch-clamp method was performed to detect hyperpolarization-the activated cyclic nucleotide-gated potassium channel 4 (HCN4) channel current activation curve. The SSS rabbit model was established using the formaldehyde wet dressing method, and BMSCs treated with SFI were transplanted into the SAN of the SSS rabbit model. We detected changes in the body-surface electrocardiogram and recorded dynamic heart rate measurements. Furthermore, transplanted SFI-treated BMSCs were subjected to HE staining, TUNEL staining, qPCR, western blotting, immunofluorescence, immunohistochemistry, and enzyme-linked immunosorbent assay to study their characteristics. Our results indicate that the transplantation of SFI-treated BMSCs into the SAN of SSS rabbits improved the pacing function of the SAN. In vitro data showed that SFI induced the proliferation of BMSCs, promoted their differentiation capacity into pacemaker-like cells, and increased the HCN4 expression in BMSCs. In vivo, the transplantation of SFI treated-BMSCs preserved the function of SAN in SSS rabbits, improved the expression of the HCN4 gene and gap junction proteins (Cx43 and Cx45), and significantly upregulated the expression of cAMP in the SAN, compared to the SSS model group. In summary, the present research demonstrated that SFI might enhance the differentiation capacity of BMSCs into pacemaker-like cells, hence offering a novel approach for the development of biological pacemakers. Additionally, we confirmed the effectiveness and safety of pacemaker-like cells differentiated from BMSCs in improving the pacing function of the SAN.
Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Células-Tronco Mesenquimais/efeitos dos fármacos , Síndrome do Nó Sinusal/tratamento farmacológico , Nó Sinoatrial/efeitos dos fármacos , Animais , Diferenciação Celular , Medicamentos de Ervas Chinesas/farmacologia , Feminino , Humanos , Masculino , Coelhos , TransfecçãoAssuntos
Doença de Erdheim-Chester , Doença de Erdheim-Chester/complicações , Doença de Erdheim-Chester/diagnóstico , Doença de Erdheim-Chester/tratamento farmacológico , Humanos , Interferon-alfa/efeitos adversos , Síndrome do Nó Sinusal/diagnóstico , Síndrome do Nó Sinusal/tratamento farmacológico , Síndrome do Nó Sinusal/etiologiaRESUMO
ETHNOPHARMACOLOGICAL RELEVANCE: Yixin-Fumai granules (YXFMs)-composed of Ginseng quinquefolium (L.) Alph. Wood, Ophiopogon japonicus (Thunb.) Ker Gawl, Schisandra arisanensis Hayata, Astragalus aaronsohnianus Eig, Salvia cryptantha Montbret & Aucher ex Benth, and Ligusticum striatum DC-are compound granules used in traditional Chinese medicine to increase heart rate and thus treat bradyarrhythmia. It may be effective in treating sick sinus syndrome (SSS). AIM: To observe the effect of YXFMs on aging-induced SSS in mice and explore whether this effect is related to the Nrf-2/HO-1 signaling pathway. MATERIALS AND METHODS: Mice with a significant decrease in the heart rate due to natural aging were selected to construct an SSS model. After the mice were administered YXFMs, the damage to their sinoartrial node (SAN) was assessed through electrocardiography, Masson's trichrome staining, and terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL). Dihydroethidium staining and immunofluorescence staining were used to assay reactive oxygen species (ROS) content and HCN4, respectively. Moreover, to observe the effects of YXFMs in vitro, the HL-1 cell line, derived from mouse atrial myocytes, was used to simulate SAN pacemaker cells, with H2O2 used as the cellular oxidative stress (OS) inducer. 2,7-Dichlorodihydrofluorescein diacetate staining was used to assay ROS content, whereas immunofluorescence staining and Western blotting were used to elucidate the related protein expression. Finally, mice were injected the Nrf-2 inhibitor ML385 to reversely verify the effects of YXFMs. RESULTS: In our in vivo experiments, YXFMs significantly inhibited aging-induced SSS, shortened the R-R interval, increased heart rate, alleviated fibrosis, reduced apoptosis rate and ROS content, and promote HCN4 expression in the SAN. In our in vitro experiments, YXFMs significantly inhibited H2O2-induced cell peroxidation damage, promoted Nrf-2 activation and nuclear metastasis, increased HO-1 expression- thereby inhibiting ROS accumulation-and finally, upregulated HCN4 expression through the inhibition of histone deacetylase 4 (HDAC4) expression and its nuclear metastasis. Finally, injection of the Nrf-2 inhibitor ML385 after YXFMs administration inhibited their protective effect in the mice. CONCLUSION: Here, we elaborated on the relationship between aging-induced SSS and the Nrf-2/HO-1 pathway for the first time and proposed that YXFMs improve SSS via the Nrf-2/HO-1 axis. Specifically, YXFMs promoted Nrf-2 activation and plasma-nuclear transfer to enhance HO-1 expression via the Nrf-2/HO-1 axis. This inhibited OS and reduced ROS accumulation in the SAN, and then, through the ROS/HDAC4 axis, reduced HDAC4 expression and plasma-nuclear transfer. Thereby, the OS-induced HCN4 loss in the SAN was inhibited-improving the function of If channel and thus producing SAN protection effect against SSS and improving the heart rate and R-R interval. In the future, we plan to use bioinformatics analysis technology to execute the next step of our research, namely to determine the effect of isolated, purified components of YXFMs in SSS, to increase its efficiency and reduce the toxicity of YXFMs.
Assuntos
Medicamentos de Ervas Chinesas/farmacologia , Heme Oxigenase-1/metabolismo , Proteínas de Membrana/metabolismo , Fator 2 Relacionado a NF-E2/metabolismo , Síndrome do Nó Sinusal/tratamento farmacológico , Envelhecimento , Animais , Apoptose/efeitos dos fármacos , Feminino , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Estresse Oxidativo/efeitos dos fármacos , Espécies Reativas de Oxigênio/metabolismo , Síndrome do Nó Sinusal/fisiopatologia , Transdução de Sinais/efeitos dos fármacosRESUMO
Resumen Se presenta el caso de una paciente de 60 años con enfermedad del nodo sinusal (ENS), sintomática con mareos y ángor, con electrocardiograma que evidenciaba episodios de pausas sinusales con escapes nodales. Durante la internación, a la espera de colocación de marcapaso definitivo, se indicó cilostazol (100 mg cada 12 h vía oral), observando a las 48 horas del inicio un incremento en la frecuencia cardíaca y la desaparición de las pausas sinusales en Holter de 24 horas. Nuestro objetivo ha sido demostrar que el cilostazol puede ser útil en pacientes con ENS, aunque es necesario evaluar los efectos cronotrópicos a largo plazo de este tratamiento.
Abstract Here we present the case of a 60-year-old patient with sinus node disease (NSS), symptomatic with dizziness and angor. The electrocardiogram showed episodes of sinus pauses with nodal escapes. During hospitalization, pending the placement of a definitive pacemaker, cilostazol (100 mg every 12 hours orally) was indicated, observing an increase in heart rate 48 hours after starting the medication, and the disappearance of sinus pauses in the 24 hours Holter. Our objective has been to show that cilostazol can be useful in patients with SNN, although long-term chronotropic effects of this treatment has yet to be evaluated.
Assuntos
Humanos , Pessoa de Meia-Idade , Síndrome do Nó Sinusal/induzido quimicamente , Cilostazol/efeitos adversos , Marca-Passo Artificial , Síndrome do Nó Sinusal/tratamento farmacológico , Eletrocardiografia , Frequência CardíacaRESUMO
We report a patient with concealed sick sinus syndrome who developed intraoperative bradycardia and asystole. An 81-year-old man was scheduled to undergo total gastrectomy under general and epidural anesthesia. There was no history of syncope, and preoperative 12-lead ECG showed normal sinus rhythm. Anesthesia was induced with propofol and remifentanil, maintained with sevoflurane, remifentanil and thoracic epidural infusion of lidocaine, fentanyl and levobupivacaine. Bradycardia was detected on ECG 110 minutes after the start of surgery. Intravenous atropine (0.5 mg, repeated up to a total dose of 1.5 mg) was ineffective in restoring a normal heart rhythm. Ten minutes later, the ECG changed to asystole lasting for about 15 seconds. Regular chest compression and intravenous administration of dopamine (5 microg x kg(-1) x min(-1)) resulted in successful recovery of sinus rhythm. Postoperative ECG showed sinus rhythm. The final diagnosis by a cardiologist was concealed sick sinus syndrome. Many anesthetic agents have some effects on the cardiac conduction system. Remifentanil may have played a role in the development of asystole in this patient. The existence of concealed sick sinus syndrome should be kept in mind even in patients who show no clinical abnormalities on preoperative assessment.
Assuntos
Anestesia Epidural , Anestesia Geral , Parada Cardíaca/etiologia , Complicações Intraoperatórias/etiologia , Piperidinas/efeitos adversos , Síndrome do Nó Sinusal/complicações , Síndrome do Nó Sinusal/diagnóstico , Idoso de 80 Anos ou mais , Atropina/administração & dosagem , Bradicardia/tratamento farmacológico , Bradicardia/etiologia , Dopamina/administração & dosagem , Eletrocardiografia , Gastrectomia , Parada Cardíaca/tratamento farmacológico , Humanos , Infusões Intravenosas , Complicações Intraoperatórias/tratamento farmacológico , Masculino , Remifentanil , Síndrome do Nó Sinusal/tratamento farmacológico , Neoplasias Gástricas/complicações , Neoplasias Gástricas/cirurgiaAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Fibrilação Atrial/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células T Precursoras/tratamento farmacológico , Síndrome do Nó Sinusal/tratamento farmacológico , Antineoplásicos/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/patologia , Cisplatino , Citarabina , Etoposídeo , Feminino , Humanos , Metilprednisolona , Pessoa de Meia-Idade , Leucemia-Linfoma Linfoblástico de Células T Precursoras/complicações , Leucemia-Linfoma Linfoblástico de Células T Precursoras/diagnóstico , Leucemia-Linfoma Linfoblástico de Células T Precursoras/patologia , Síndrome do Nó Sinusal/complicações , Síndrome do Nó Sinusal/diagnóstico , Síndrome do Nó Sinusal/patologiaRESUMO
Sinus node dysfunction after surgical repair of an atrial septal defect is a rather uncommon complication. We report a case of protracted post-operative sinus node dysfunction which was managed successfully by oral theophyllines and 'watchful' waiting. This strategy could avoid placement of a permanent pacemaker in this patient group of younger age.
Assuntos
Comunicação Interatrial/cirurgia , Complicações Pós-Operatórias , Síndrome do Nó Sinusal/etiologia , Nó Sinoatrial/patologia , Adulto , Feminino , Humanos , Síndrome do Nó Sinusal/tratamento farmacológico , Teofilina/uso terapêutico , Toracoscopia , Vasodilatadores/uso terapêuticoRESUMO
A 66-year-old man had a progressive increase in the pacing threshold over a one-year period, resulting from chronic myocarditis. Following steroid therapy, the pacing threshold decreased and became stabilized, and was accompanied by a decrease in the serum creatine kinase, cardiac myosin light chains and pro-collagen III peptide values, but cardiac function did not improve. Endocardial biopsy showed that there was no progression in the fibrosis. The pacing failure improved, but the cardiac function did not. It was believed that the steroid therapy suppressed the progression of the inflammation and fibrosis caused by the chronic myocarditis.
Assuntos
Estimulação Cardíaca Artificial , Miocardite/complicações , Miocardite/tratamento farmacológico , Síndrome do Nó Sinusal/etiologia , Idoso , Doença Crônica , Creatina Quinase/sangue , Progressão da Doença , Fibrose , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Ventrículos do Coração/patologia , Humanos , Masculino , Metilprednisolona/administração & dosagem , Miocardite/sangue , Miocardite/fisiopatologia , Miocárdio/patologia , Fragmentos de Peptídeos/sangue , Prednisolona/administração & dosagem , Prednisolona/uso terapêutico , Pró-Colágeno/sangue , Síndrome do Nó Sinusal/tratamento farmacológico , Falha de Tratamento , Função Ventricular EsquerdaAssuntos
Humanos , Taquicardia Supraventricular/classificação , Flutter Atrial/prevenção & controle , Síndrome do Nó Sinusal/diagnóstico , Síndrome do Nó Sinusal/tratamento farmacológico , Taquicardia Sinusal/fisiopatologia , Complexos Atriais Prematuros/etiologia , Antiarrítmicos/uso terapêutico , Cardioversão Elétrica , Fibrilação Atrial/etiologia , Fibrilação Atrial/terapiaRESUMO
We report a case of visual loss and bilateral papilloedema under therapy with the antiarrhythmic substance amiodarone, which is used in treatment of refractory and life-threatening supraventricular and ventricular cardial tachyarrhythmias. After excluding intracranial hypertension, local tumors and an inflammatory genesis we consider this case to be an amiodarone-induced toxic opticusneuropathy. Amiodarone, a diiodated benzofuran derivative, is a cationic amphiphilic drug, which is able to cause ceratopathy and neuropathy. The rarely described and less known opticusneuropathy caused problems in differential diagnosis. A brief review about current knowledge of pathophysiology, differential diagnosis and course of illness is presented.
Assuntos
Amiodarona/efeitos adversos , Atrofia Óptica/induzido quimicamente , Campos Visuais/efeitos dos fármacos , Idoso , Feminino , Humanos , Atrofia Óptica/tratamento farmacológico , Papiledema/induzido quimicamente , Papiledema/tratamento farmacológico , Prednisolona/uso terapêutico , Síndrome do Nó Sinusal/tratamento farmacológico , Resultado do Tratamento , Testes de Campo VisualRESUMO
Atrial tachycardias, in particular atrial flutter after surgery for congenital heart disease, is associated with a high mortality. Treatment with various antiarrhythmic drugs and/or antitachycardia pacemakers is not very successful. Sotalol, a Class III drug, has shown to be a promising drug in adults with atrial tachycardias. However, the experience with sotalol in children after surgery for congenital heart disease is limited. Therefore, we describe our results here. Between December 1990 and February 1997, 26 children with atrial tachycardias, most of them with atrial flutter or fibrillation (n = 20), after surgery for congenital heart disease were treated with sotalol orally. The age of the children at the start of treatment was 7.5 +/- 5.8 years (mean +/- SD). The time interval between surgery and the start of atrial tachycardia ranged from 1 day to 14.3 years (3.8 +/- 3.8 years). Conversion to sinus rhythm was achieved in 16 out of 22 hemodynamically stable children with a dosage of 4.0 +/- 1.6 mg/kg per day. The six children without sinus rhythm on sotalol and four hemodynamically unstable patients were treated prophylactically with sotalol after DC cardioversion for their tachycardias. Two children complained of mild transient fatigue. Heart rate decreased during therapy (95 +/- 33 vs 81 +/- 21 beats/min; P = 0.01). QTc-intervals did not change. Proarrhythmias such as torsades de pointes were not encountered. Two children with a preexistent sick sinus syndrome showed aggravation of bradycardia and needed pacemaker implantation. The percentage of children with a recurrence-free interval of 1 and 2 years was 96% and 81%, respectively, for all atrial tachycardias, and 92% and 66% for atrial flutter. The recurrences of atrial tachycardias during the follow-up period, which ranged from 0.1-6.1 years (2.5 +/- 1.8 years) could be treated with only an increase of the dosage of sotalol in all but one patient. We conclude that sotalol is an effective drug for the treatment and prevention of atrial tachycardia in children after surgery for congenital heart disease.
Assuntos
Antiarrítmicos/uso terapêutico , Cardiopatias Congênitas/cirurgia , Complicações Pós-Operatórias/tratamento farmacológico , Sotalol/uso terapêutico , Taquicardia/tratamento farmacológico , Administração Oral , Adulto , Antiarrítmicos/administração & dosagem , Antiarrítmicos/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/prevenção & controle , Flutter Atrial/tratamento farmacológico , Flutter Atrial/prevenção & controle , Bradicardia/fisiopatologia , Bradicardia/terapia , Estimulação Cardíaca Artificial , Criança , Intervalo Livre de Doença , Cardioversão Elétrica , Eletrocardiografia/efeitos dos fármacos , Fadiga/induzido quimicamente , Seguimentos , Átrios do Coração , Frequência Cardíaca/efeitos dos fármacos , Humanos , Marca-Passo Artificial , Complicações Pós-Operatórias/prevenção & controle , Recidiva , Síndrome do Nó Sinusal/tratamento farmacológico , Síndrome do Nó Sinusal/fisiopatologia , Síndrome do Nó Sinusal/terapia , Sotalol/administração & dosagem , Sotalol/efeitos adversos , Taxa de Sobrevida , Taquicardia/prevenção & controle , Fatores de Tempo , Resultado do TratamentoRESUMO
The disorders of cardiac rhythm in the elderly are frequent and important since they are generally less tolerated than in young patients. Sinus bradycardia is one of the most common disorder of cardiac rhythm; symptomatic sinus bradycardia will be treated by pacemaker insertion in most cases. Atrial fibrillation is frequent in the elderly and often poorly tolerated; the aim of therapy is to restore sinus rhythm and prevent recurrences. In order to avoid strokes (emboli), old patients, with chronic atrial fibrillation should be submitted to low-level anticoagulation. Elderly patients may also suffer from supraventricular and ventricular premature beats which should be treated if they present some degree of malignancy.
Assuntos
Antiarrítmicos/uso terapêutico , Arritmias Cardíacas/tratamento farmacológico , Idoso , Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Bradicardia/tratamento farmacológico , Cardioversão Elétrica , Humanos , Inibidores da Agregação Plaquetária/uso terapêutico , Síndrome do Nó Sinusal/tratamento farmacológicoRESUMO
The authors report a case of a 3-month-old infant with a very rare association: cystic fibrosis and Kawasaki disease. The clinical picture is atypical but cardiovascular signs consist of cardiomegaly, sick sinus syndrome and Q waves in D II, D III and AVF. The diagnosis is confirmed by the pathological changes found at the postmortem examination. The patient is the first case of Kawasaki disease reported in Romania.