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1.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 382-385, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018008

RESUMO

An elevated heart rate (HR) often persists in resuscitated septic shock patients, increasing the risk of mortality. Several drugs for HR control, such as esmolol and ivabradine, have been tested in the recent years, but their benefit on the overall cardiovascular system is still under investigation. The aim of this study is to investigate the hemodynamic effects of the two drugs in a protocol of polymicrobial septic shock and resuscitation, mainly focusing on the vascular function. Twelve pigs were divided into three experimental groups: the esmolol-treated group (n=4), the ivabradine-treated group (n=5) and the control group (n=3). The characteristic arterial time constant τ was computed on aortic arterial pressure (AoP), together with estimates of total arterial compliance and peripheral resistance. Power spectral analysis of aortic and radial diastolic BP oscillations was performed to estimate the sympathetic autonomic control of vascular tone. Septic shock induced a severe cardiac and vascular disarray, only partially resolved by resuscitation. The administration of esmolol, but not ivabradine, was beneficial both for cardiac and vascular function, thereby its adjunction to standard therapies could help to improve patient's condition and optimize the resuscitation strategies.Clinical Relevance-This study shows a potential beneficial effect of esmolol on the arterial tree.


Assuntos
Propanolaminas , Choque Séptico , Animais , Humanos , Ivabradina , Propanolaminas/farmacologia , Choque Séptico/tratamento farmacológico , Suínos , Taquicardia/tratamento farmacológico
2.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2756-2759, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018577

RESUMO

Persisting tachycardia is often observed in resuscitated septic shock patients, and it is an independent risk factor for increased mortality. Recently, several drugs, such as esmolol and ivabradine, have been proved to be beneficial in HR control, but their overall impact on cardiac functions needs further investigation. The aim of this study is to study the effects of the two drugs on heart function in a protocol of polymicrobial septic shock and resuscitation. Twelve pigs were divided into three experimental groups: the esmolol-treated group (n=4), the ivabradine-treated group (n=5) and the control group (n=3). Cardiac autonomic activity was estimated by heart rate variability (HRV) indices and baroreflex sensitivity (BRS). The Buckberg index was adopted to evaluate myocardial oxygenation efficiency. Septic shock induced a severe autonomic dysfunction and a lower cardiac efficiency, not resolved by fluids resuscitation. The administration of the drugs improved both the HRV and the BRS, but this favourable condition was preserved after noradrenaline administration only in the esmolol group. The interaction of esmolol with the autonomic system is beneficial in septic shock to restore an improved condition of HRV and control, while ivabradine is not as effective when administered in adjunction to noradrenaline.


Assuntos
Propanolaminas , Choque Séptico , Animais , Humanos , Ivabradina/uso terapêutico , Propanolaminas/uso terapêutico , Choque Séptico/tratamento farmacológico , Suínos , Taquicardia/tratamento farmacológico
3.
Int Heart J ; 61(5): 944-950, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921677

RESUMO

Clinical experience with landiolol use in patients with atrial fibrillation (AF) and a severely depressed left ventricular (LV) function is limited. We compared the efficacy and safety of landiolol with that of digoxin as an intravenous drug in controlling the heart rate (HR) during AF associated with a very low LV ejection fraction (LVEF).We retrospectively analyzed 53 patients treated with landiolol (n = 34) or digoxin (n = 19) for AF tachycardias with an LVEF ≤ 25. The landiolol dose was adjusted between 0.5 and 10 µg/kg/minute according to the patient's condition. The response to treatment was defined as a decrease in the HR of ≤ 110/minute, and that decreased by ≥ 20% from baseline.There were no significant differences between the two groups regarding the clinical characteristics. The responder rate to landiolol at 24 hours was significantly higher than that to digoxin (71.0% versus 41.2%; odds ratio: 4.65, 95% confidence interval: 1.47-31.0, P = 0.048). The percent decrease in the HR from baseline at 1, 2, 12, and 24 hours was greater in the landiolol group than in the digoxin group (P < 0.01, P = 0.071, P = 0.036, and P = 0.016, respectively). The systolic blood pressure (SBP) from baseline within 24 hours after administering landiolol was significantly reduced, whereas digoxin did not decrease the SBP over time. Hypotension (< 80 mmHg) occurred in two patients in the landiolol group and 0 in the digoxin group (P = 0.53).Landiolol could be more effective in controlling the AF HR than digoxin even in patients with severely depressed LV function. However, careful hemodynamic monitoring is necessary when administering landiolol.


Assuntos
Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Digoxina/uso terapêutico , Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca , Morfolinas/uso terapêutico , Taquicardia/tratamento farmacológico , Ureia/análogos & derivados , Disfunção Ventricular Esquerda/fisiopatologia , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Pressão Sanguínea , Feminino , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Volume Sistólico , Taquicardia/etiologia , Taquicardia/fisiopatologia , Resultado do Tratamento , Ureia/uso terapêutico , Disfunção Ventricular Esquerda/complicações
4.
Br J Anaesth ; 125(6): 1018-1024, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32690246

RESUMO

BACKGROUND: During sepsis, heart rate (HR) reduction could be a therapeutic target, but identification of responders (non-compensatory tachycardia) and non-responders (compensatory for 'fixed' stroke volume [SV]) is challenging. We tested the ability of the difference between systolic and dicrotic pressure (SDPdifference), which reflects the coupling between myocardial contractility and a given afterload, in discriminating the origin of tachycardia. METHODS: In this post hoc analysis of 45 patients with septic shock with persistent tachycardia, we characterised features of haemodynamic response focusing on SDPdifference, classifying patients according to variations in arterial dP/dtmax after 4 h of esmolol administration to maintain HR <95 beats min-1. A cut-off value of 0.9 mm Hg ms-1 was used for group allocation. RESULTS: After reducing HR, arterial dP/dtmax remained above the cut-off in 23 patients, whereas it decreased below the cut-off in 22 patients (from 0.99 [0.37] to 0.63 [0.16] mm Hg ms-1; mean [SD], P<0.001). At baseline, patients with decreased dP/dtmax after esmolol had lower SDPdifference than those with higher dP/dtmax (40 [19] vs 53 [16] mm Hg, respectively; P=0.01). The SDPdifference remained unchanged after esmolol in the higher dP/dtmax group (49 [16] mm Hg), whereas it decreased significantly in patients with lower dP/dtmax (29 [11] mm Hg; P<0.001). In the latter, the HR reduction resulted in a significant cardiac output reduction with unchanged SV, whereas in patients with higher dP/dtmax SV increased (from 48 [12] to 67 [14] ml; P<0.001) with maintained cardiac output. CONCLUSIONS: A decrease in SDPdifference could discriminate between compensatory and non-compensatory tachycardia, revealing a covert loss of myocardial contractility not detected by conventional echocardiographic parameters and deteriorating after HR reduction with esmolol. CLINICAL TRIAL REGISTRATION: NCT02188888.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca/efeitos dos fármacos , Choque Séptico/fisiopatologia , Taquicardia/fisiopatologia , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Idoso , Pressão Arterial , Pressão Sanguínea/efeitos dos fármacos , Débito Cardíaco/efeitos dos fármacos , Ecocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Contração Miocárdica/efeitos dos fármacos , Norepinefrina/uso terapêutico , Propanolaminas/uso terapêutico , Estudos Prospectivos , Choque Séptico/diagnóstico por imagem , Taquicardia/diagnóstico por imagem , Taquicardia/tratamento farmacológico , Taquicardia/etiologia , Vasoconstritores/uso terapêutico
5.
J Med Virol ; 92(7): 915-918, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32270515

RESUMO

An 80-year-old man with multiple comorbidities presented to the emergency department with tachypnea, tachycardia, fever, and critically low O2 saturation and definitive chest computerized tomography scan findings in favor of COVID-19 and positive PCR results in 48 hours. He received antiviral treatment plus recombinant human erythropoietin (rhEPO) due to his severe anemia. After 7 days of treatment, he was discharged with miraculous improvement in his symptoms and hemoglobin level. We concluded that rhEPO could attenuate respiratory distress syndrome and confront the severe acute respiratory syndrome coronavirus 2 virus through multiple mechanisms including cytokine modulation, antiapoptotic effects, leukocyte release from bone marrow, and iron redistribution away from the intracellular virus.


Assuntos
Anemia/tratamento farmacológico , Infecções por Coronavirus/tratamento farmacológico , Eritropoetina/uso terapêutico , Febre/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Taquicardia/tratamento farmacológico , Taquipneia/tratamento farmacológico , Idoso de 80 Anos ou mais , Anemia/complicações , Anemia/diagnóstico , Anemia/virologia , Antivirais/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/genética , Betacoronavirus/patogenicidade , Biomarcadores/sangue , Técnicas de Laboratório Clínico/métodos , Convalescença , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Estado Terminal , Febre/complicações , Febre/diagnóstico , Febre/virologia , Humanos , Irã (Geográfico) , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , RNA Viral/sangue , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Taquicardia/complicações , Taquicardia/diagnóstico , Taquicardia/virologia , Taquipneia/complicações , Taquipneia/diagnóstico , Taquipneia/virologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
Lancet Respir Med ; 8(9): 863-872, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32243865

RESUMO

BACKGROUND: Tachycardia and atrial fibrillation frequently occur in patients being treated for sepsis or septic shock and have a poor prognosis. Treatments for tachyarrhythmias are often ineffective or contraindicated in this setting. We aimed to investigate the efficacy and safety of landiolol, an ultra-short-acting ß-blocker, for treating sepsis-related tachyarrhythmias. METHODS: We did a multicentre, open-label, randomised controlled trial at 54 hospitals in Japan. Patients admitted to the intensive care units who received conventional treatment for sepsis, according to clinical guidelines for the management of sepsis, and who subsequently developed a tachyarrhythmia, were enrolled. The main inclusion criteria were 20 years of age or older, diagnosis of sepsis according to Third International Consensus Definitions for Sepsis and Septic Shock criteria, administration of catecholamine necessary to maintain mean arterial pressure at 65 mm Hg or more for at least 1 h, and heart rate of 100 beats per min (bpm) or more maintained for at least 10 min without a change in catecholamine dose with diagnosis of atrial fibrillation, atrial flutter, or sinus tachycardia. Only patients who developed these symptoms and signs within 24 h before randomisation, and within 72 h after entering an intensive care unit, were prospectively assigned to receive conventional sepsis therapy alone (control group) or conventional sepsis therapy plus landiolol (landiolol group) in an open-label manner. Landiolol hydrochloride was intravenously infused at an initial dose of 1 µg/kg per min within 2 h after randomisation and the dose could be increased per study protocol to a maximum of 20 µg/kg per min. Patients in both groups received conventional therapy (Japanese Clinical Practice Guidelines for the Management of Sepsis and Septic Shock 2016), including respiratory and fluid resuscitation, antimicrobials, and catecholamines. The treating physicians were required to stabilise the patient's haemodynamic status before randomisation. Randomisation was done using a central randomisation system and dynamic allocation with the minimisation method by institution, heart rate at randomisation (≥100 to <120 bpm or ≥120 bpm), and age (<70 years or ≥70 years). The primary outcome was the proportion of patients with heart rate of 60-94 bpm at 24 h after randomisation. Patients without heart rate data at 24 h after randomisation were handled as non-responders. The primary outcome was analysed using the full analysis set on an as-assigned basis, while safety was analysed using the safety analysis set according to the treatment received. This study was registered with the Japan Pharmaceutical Information Center Clinical Trials Information database, number JapicCTI-173767. FINDINGS: Between Jan 16, 2018 and Apr 22, 2019, 151 patients were randomly assigned, 76 to the landiolol group and 75 to the control group. A significantly larger proportion of patients in the landiolol group had a heart rate of 60-94 bpm 24 h after randomisation than in the control group (55% [41 of 75] vs 33% [25 of 75]), with a between-group difference of 23·1% (95% CI 7·1-37·5; p=0·0031). Adverse events were observed in 49 (64%) of 77 patients in the landiolol group and in 44 (59%) of 74 in the control group, with serious adverse events (including adverse events leading to death) in nine (12%) of 77 and eight (11%) of 74 patients. Serious adverse events related to landiolol occurred in five (6%) of 77 patients, including blood pressure decreases in three patients (4%) and cardiac arrest, heart rate decrease, and ejection fraction decrease occurred in one patient each (1%). INTERPRETATION: Landiolol resulted in significantly more patients with sepsis-related tachyarrhythmia achieving a heart rate of 60-94 bpm at 24 h and significantly reduced the incidence of new-onset arrhythmia. Landiolol was also well tolerated, but it should be used under appropriate monitoring of blood pressure and heart rate owing to the risk of hypotension in patients with sepsis and septic shock. FUNDING: Ono Pharmaceutical Co.


Assuntos
Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Morfolinas/uso terapêutico , Sepse/complicações , Taquicardia/tratamento farmacológico , Ureia/análogos & derivados , Antagonistas de Receptores Adrenérgicos beta 1/efeitos adversos , Idoso , Feminino , Humanos , Masculino , Morfolinas/efeitos adversos , Taquicardia/etiologia , Resultado do Tratamento , Ureia/efeitos adversos , Ureia/uso terapêutico
7.
Int Heart J ; 61(2): 384-389, 2020 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-32132321

RESUMO

Tachycardia and supraventricular tachyarrhythmias often impair cardiovascular capacity in patients with decompensated heart failure (dHF) treated with inotropes. Normalization of heart rhythm or rate typically improves diastolic filling and stroke volume (SV). Thus, isochronal administration of an ultra-short-acting and highly selective ß1-blockers, such as landiolol, along with inotropic calcium-sensitizer medications, such as levosimendan, could benefit patients with dHF.We present a case series of three patients with severe dHF and low ejection fraction who were successfully treated with a combination of landiolol and levosimendan. The co-administration of landiolol and levosimendan was well tolerated, improved cardiac function, normalized SV, and enabled the reduction of norepinephrine dosing in all patients. Additionally, the combination improved the vectorcardiographic spatial QRS-T angle and decreased the corrected QT interval. All patients were successfully discharged from the intensive care unit (ICU).A combination of levosimendan and landiolol was safe and well-tolerated. This combination may be a new option for successful treatment of patients with acute dHF complicated by sinus or supraventricular tachycardias.


Assuntos
Antagonistas Adrenérgicos beta/administração & dosagem , Cardiotônicos/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Morfolinas/administração & dosagem , Simendana/administração & dosagem , Taquicardia/tratamento farmacológico , Ureia/análogos & derivados , Idoso , Quimioterapia Combinada , Feminino , Insuficiência Cardíaca/complicações , Humanos , Masculino , Taquicardia/etiologia , Ureia/administração & dosagem
8.
J Crit Care ; 54: 175-179, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31476653

RESUMO

PURPOSE: To explore the impact of digoxin on hemodynamic parameters in patients with sepsis and tachycardia admitted to the intensive care unit. MATERIALS AND METHODS: Retrospective review of adult patients admitted to the medical and mixed ICU at Mayo Clinic Rochester, Minnesota from March 2008 to February 2018, initiated on digoxin within 24 h of ICU stay. Hemodynamic parameters were reviewed before digoxin administration and at 6, 12 and 24 h after. Adverse events including new onset conduction abnormalities or arrhythmias during the first 48 h after digoxin administration were reviewed by a critical care cardiologist. RESULTS: Study included 180 patients. We observed significant decrease in heart rate from 124 (115-138) beats/min 1 h before digoxin to 101 (87-117) 6 h after digoxin and 94 (84-112) 12 h after (p < .01). Median systolic blood pressure increased from 100 (91-112) mm Hg 1 h before to 110 (100-122) (p < .01) and 111 (103-124) at 6 and 12 h respectively after digoxin. CONCLUSIONS: Early digoxin administration in patients with sepsis and tachycardia is uncommon but associated with improvements of hemodynamic parameters. These preliminary results will help formulate future hypotheses for focused trials on utility, efficacy and safety of digoxin in sepsis.


Assuntos
Cardiotônicos/uso terapêutico , Cuidados Críticos/métodos , Digoxina/uso terapêutico , Hemodinâmica/fisiologia , Sepse/tratamento farmacológico , Taquicardia/tratamento farmacológico , Idoso , Pressão Sanguínea/fisiologia , Cardiotônicos/efeitos adversos , Digoxina/efeitos adversos , Feminino , Frequência Cardíaca/fisiologia , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
Br J Neurosurg ; 33(6): 671-672, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31556758

RESUMO

Introduction: Arnold-Chiari malformation is a group of congenital malformations of the hindbrain. Common symptoms include cephalgia, vestibular, cerebral and cochlear disorders We present a case of pharmacoresistant tachyarrhythmia associated with Arnold-Chiari malformation.Case Description: A 49-year-old female patient had an Arnold-Chiari malformation (ACM), syringomyelia, a retrocerebellar cyst and a 6 year history of tachyarrhythmia. Heart rhythm normalized after Chiari decompression.Conclusion: ACM can lead to heart rhythm disorders.


Assuntos
Malformação de Arnold-Chiari/complicações , Descompressão Cirúrgica/métodos , Procedimentos Neurocirúrgicos/métodos , Taquicardia/etiologia , Malformação de Arnold-Chiari/cirurgia , Resistência a Medicamentos , Feminino , Forame Magno/cirurgia , Cefaleia/complicações , Cefaleia/cirurgia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Siringomielia/complicações , Siringomielia/cirurgia , Taquicardia/tratamento farmacológico , Taquicardia/cirurgia
10.
Lakartidningen ; 1162019 Aug 13.
Artigo em Sueco | MEDLINE | ID: mdl-31408188

RESUMO

Atrial high rate episodes (AHRE) are frequently detected in patients with pacemakers or implantable cardioverter defibrillators. AHRE episodes ≥5 minutes are associated with increased risk of ischemic stroke. There is no clear temporal relationship between AHRE and ischemic stroke, therefore atrial arrhythmia could be suspected to at least in part be a risk marker and not solely a direct cause of stroke. No results have been published on the effect of anticoagulation in patients with AHRE, but several studies are in progress. The European Heart Rhythm Association (EHRA) recommends anticoagulation for patients with AHRE ≥5.5 hours per day and a CHA2DS2-VASc score of ≥2 (≥3 in females). Anticoagulation may be considered for CHA2DS2-VASc scores of 1 (2 in females). In patients with several risk factors anticoagulation should be considered also in cases with shorter duration of AHRE.


Assuntos
Fibrilação Atrial/complicações , Desfibriladores Implantáveis , Marca-Passo Artificial , Acidente Vascular Cerebral/etiologia , Taquicardia/complicações , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto , Fatores de Risco , Acidente Vascular Cerebral/prevenção & controle , Taquicardia/diagnóstico , Taquicardia/tratamento farmacológico
12.
Pediatr Cardiol ; 40(6): 1144-1150, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31152184

RESUMO

Congenital right atrial appendage aneurysm (RAAA) is an extremely rare malformation that can coexist with atrial tachyarrhythmia. There is no consensus on treatment for this condition. This research aimed to investigate the clinical characteristics and efficacy of surgical resection to treat atrial tachyarrhythmia originating from RAAA in children. Four RAAA children diagnosed with atrial tachyarrhythmia at the age of 1-5.25 years weighing 8.3-17.1 kg were discussed in this retrospective study. Patients underwent various treatments, included electrocardiogram (ECG) and echocardiography, antiarrhythmic medication therapy, radiofrequency catheter ablation (RFCA), surgical resection of RAAA and pathological examinations. The results from these treatments along with clinical features of patients were analyzed. The incidence of RAAA in patients with atrial tachycardia originating from the right or left atrial appendages (RAA or LAA) was 7.3% (4/55). The prevalence of RAAA in the RAA was 12.5% (4/32). Atrial tachyarrhythmia was identified both prenatally (26 and 36 weeks of gestational age) and postnatally (1 and 4 months after birth), with two patients per group, respectively. The RAAAs condition in two patients with atrial tachycardia (AT), concomitant atrial flutter (AF) and atrial fibrillation (Af) was identified using echocardiogram. Although, RAAA in two patients with mono AT was unidentified in echocardiogram and failed to be identified in the procedure of RFCA, RAAA was confirmed during surgical resection of the RAA. Multiple pre-surgical antiarrhythmic medications combined therapy used to treat all four patients showed either no effect at all or was only partially effective. The original atrial tachyarrhythmia was successfully abolished after RAAA surgical resection in four patients. AT originating from new foci was established in two patients post-surgically. The conditions of these two patients were successfully reverted and normal sinus rhythm maintained in the application of antiarrhythmic medications. These results confirmed the efficacy of RAAA surgical resection. The pathology study showed cystic dilation in parts of the atrial cavity, fibrosis of the cyst wall, generalized fibrosis of atrial myocardium with myocardium atrophy and cystic dilation. RAAA is prone to misdiagnosis by echocardiogram. Atrial tachyarrhythmia in patients with RAAA is usually resistant to antiarrhythmic medication therapy and RFCA. Surgical resection of RAAA is a safe and effective option that is minimally invasive.


Assuntos
Apêndice Atrial/cirurgia , Aneurisma Cardíaco/cirurgia , Taquicardia/cirurgia , Antiarrítmicos/uso terapêutico , Apêndice Atrial/anormalidades , Ablação por Cateter/métodos , Pré-Escolar , Ecocardiografia , Feminino , Aneurisma Cardíaco/complicações , Aneurisma Cardíaco/epidemiologia , Humanos , Incidência , Lactente , Masculino , Estudos Retrospectivos , Taquicardia/complicações , Taquicardia/diagnóstico , Taquicardia/tratamento farmacológico , Resultado do Tratamento
13.
J Physiol ; 597(13): 3255-3279, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31077371

RESUMO

KEY POINTS: We investigated the cardiovascular and respiratory responses of the normotensive Wistar-Kyoto (WKY) rat and the spontaneously hypertensive (SH) rat to inhalation and intravenous injection of the noxious stimuli allyl isothiocyanate (AITC). AITC inhalation evoked atropine-sensitive bradycardia in conscious WKY rats, and evoked atropine-sensitive bradycardia and atenolol-sensitive tachycardia with premature ventricular contractions (PVCs) in conscious SH rats. Intravenous injection of AITC evoked bradycardia but no tachycardia/PVCs in conscious SHs, while inhalation and injection of AITC caused similar bradypnoea in conscious SH and WKY rats. Anaesthesia (inhaled isoflurane) inhibited the cardiac reflexes evoked by inhaled AITC but not injected AITC. Data indicate the presence of a de novo nociceptive pulmonary-cardiac reflex triggering sympathoexcitation in SH rats, and this reflex is dependent on vagal afferents but is not due to steady state blood pressure or due to remodelling of vagal efferent function. ABSTRACT: Inhalation of noxious irritants/pollutants activates airway nociceptive afferents resulting in reflex bradycardia in healthy animals. Nevertheless, noxious pollutants evoke sympathoexcitation (tachycardia, hypertension) in cardiovascular disease patients. We hypothesize that cardiovascular disease alters nociceptive pulmonary-cardiac reflexes. Here, we studied reflex responses to irritants in normotensive Wistar-Kyoto (WKY) rats and spontaneously hypertensive (SH) rats. Inhaled allyl isothiocyanate (AITC) evoked atropine-sensitive bradycardia with atrial-ventricular (AV) block in conscious WKY rats, thus indicating a parasympathetic reflex. Conversely, inhaled AITC in conscious SH rats evoked complex brady-tachycardia with both AV block and premature ventricular contractions (PVCs). Atropine abolished the bradycardia and AV block, but the atropine-insensitive tachycardia and PVCs were abolished by the ß1 -adrenoceptor antagonist atenolol. The aberrant AITC-evoked reflex in SH rats was not reduced by acute blood pressure reduction by captopril. Surprisingly, intravenous AITC only evoked bradycardia in conscious SH and WKY rats. Furthermore, anaesthesia reduced the cardiac reflexes evoked by inhaled but not injected AITC. Nevertheless, anaesthesia had little effect on AITC-evoked respiratory reflexes. Such data suggest distinct differences in nociceptive reflex pathways dependent on cardiovascular disease, administration route and downstream effector. AITC-evoked tachycardia in decerebrate SH rats was abolished by vagotomy. Finally, there was no difference in the cardiac responses of WKY and SH rats to vagal efferent electrical stimulation. Our data suggest that AITC inhalation in SH rats evokes de novo adrenergic reflexes following vagal afferent activation. This aberrant reflex is independent of steady state hypertension and is not evoked by intravenous AITC. We conclude that pre-existing hypertension aberrantly shifts nociceptive pulmonary-cardiac reflexes towards sympathoexcitation.


Assuntos
Pressão Sanguínea/fisiologia , Coração/fisiopatologia , Hipertensão/fisiopatologia , Pulmão/fisiopatologia , Nociceptores/fisiologia , Reflexo/fisiologia , Animais , Pressão Sanguínea/efeitos dos fármacos , Bradicardia/tratamento farmacológico , Bradicardia/fisiopatologia , Captopril/farmacologia , Coração/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Isotiocianatos/farmacologia , Pulmão/efeitos dos fármacos , Masculino , Nociceptores/efeitos dos fármacos , Ratos , Ratos Endogâmicos SHR , Ratos Endogâmicos WKY , Reflexo/efeitos dos fármacos , Taquicardia/tratamento farmacológico , Taquicardia/fisiopatologia , Nervo Vago/efeitos dos fármacos , Nervo Vago/fisiopatologia
14.
J Clin Pharm Ther ; 44(5): 693-700, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30989702

RESUMO

WHAT IS KNOWN AND OBJECTIVE: There is limited guidance on how to transition critically ill patients from intravenous (IV) to oral (PO) amiodarone. The objective of this study was to assess the impact of IV and PO amiodarone overlap on short-term tachyarrhythmia recurrence and adverse hemodynamic outcomes in the intensive care unit. METHODS: This is a retrospective, single-center analysis of critically ill adults who were treated with IV amiodarone for a supraventricular arrhythmia with rapid ventricular rate (RVR) and transitioned to PO amiodarone while inpatient. Patients were excluded if rate control was not achieved prior to the PO transition. Receipt of concomitant IV and PO therapy for ≤2 hours was considered no overlap (NOV) and >2 hours was considered overlap (OV). Tachyarrhythmia recurrence and adverse hemodynamic events were compared between groups. RESULTS: A total of 90 patients (45 NOV, 45 OV) were included in the analysis. The median overlap duration was 0.1 (-1.3 to 1.2) hours in the NOV arm and 4 (2.6-6.1) hours in the OV arm. Recurrence of RVR occurred in 9 (20%) patients in each arm (P = 1.0). The median time from IV discontinuation to return of tachyarrhythmia was 10.5 hours. There were no significant differences in amiodarone dosing, electrolyte abnormalities, volume status or concomitant cardiac medications at the time of IV to PO transition. Hypotension occurred in 13% and 20% (P = 0.369) and bradycardia in 9% and 13% (P = 0.502) of patients in the NOV and OV arms, respectively. WHAT IS NEW AND CONCLUSION: Providing IV and PO overlap of amiodarone for a median of 4 hours did not decrease the rate of early tachyarrhythmia recurrence. Future studies are warranted to evaluate the impact of alternative amiodarone dosing strategies on breakthrough tachyarrhythmia.


Assuntos
Amiodarona/administração & dosagem , Antiarrítmicos/administração & dosagem , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/tratamento farmacológico , Estado Terminal , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Infusões Intravenosas/métodos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Taquicardia/tratamento farmacológico
15.
Am J Emerg Med ; 37(7): 1340-1345, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31027937

RESUMO

The evaluation and treatment of wide QRS-complex tachycardia remains a challenge, and mismanagement is quite common. Diagnostic aids such as wide-complex tachycardia algorithms perform poorly in the real-life setting. The purpose of this review is to offer a simple clinical-electrocardiographic approach for the initial evaluation and management of the adult patient with stable wide-complex tachycardia that does not require recollection of complex guidelines or algorithms.


Assuntos
Fibrilação Atrial/diagnóstico , Eletrocardiografia , Taquicardia/diagnóstico , Taquicardia/tratamento farmacológico , Síndrome de Wolff-Parkinson-White/diagnóstico , Administração Intravenosa , Antiarrítmicos/administração & dosagem , Fibrilação Atrial/complicações , Diagnóstico Diferencial , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Taquicardia/complicações , Síndrome de Wolff-Parkinson-White/complicações
17.
J Anal Toxicol ; 43(5): e1-e7, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30843073

RESUMO

4-Fluoromethylphenidate (4F-MPH) is an halogenated derivative of methylphenidate (MPH), a re-uptake inhibitor for dopamine and norepinephrine used for the treatment of attention deficit hyperactivity disorders. In the last few years, several compounds structurally related to MPH have been marked as new psychoactive substances (NPS) with stimulating and euphoric effects similar to the parent drug, but with more dopaminergic activity. This report represents the first case of an analytically confirmed non-fatal intoxication by 4F-MPH. A 26-year-old female was admitted to the emergency department with neuropsychiatric and cardiologic symptoms that lasted for a week, during which she sniffed a powder named 4F-MPH acquired as entactogen on the Internet. The patient required sedation with intravenous diazepam and was discharged two days later with a prescription of promazine and quetiapine. The seized product was analytically characterized by gas chromatography-mass spectrometry, liquid chromatography high-resolution mass spectrometry and nuclear magnetic resonance. These analyses confirmed the composition of the product as a 4F-MPH diastereomeric (±)-threo and (±)-erythro mixture, with a large preponderance of the active (±)-threo isomer. A minimal validation, intended for rare analytes, was performed for the quantification of 4F-MPH in the biological samples by liquid chromatography-tandem mass spectrometry. Accuracy (bias) and precision were within ±15% for both blood and urine. The blood and urine concentration of (±)-threo 4F-MPH were 32 ng/mL and 827 ng/mL, respectively. Analyses for classic drugs (opiates, methadone, cocaine, cannabis metabolites, amphetamines, ecstasy and LSD), ethanol, qualitative full screen by gas chromatography-mass spectrometry and targeted analysis for 50 NPS by liquid chromatography-tandem mass spectrometry tested negative; comorbidities were excluded, too. Based on these data, it can be assumed that the clinical manifestations were due to 4F-MPH only.


Assuntos
Acatisia Induzida por Medicamentos/diagnóstico , Estimulantes do Sistema Nervoso Central/toxicidade , Metilfenidato/análogos & derivados , Metilfenidato/toxicidade , Taquicardia/diagnóstico , Adulto , Acatisia Induzida por Medicamentos/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/sangue , Estimulantes do Sistema Nervoso Central/urina , Diazepam/uso terapêutico , Feminino , Humanos , Metilfenidato/sangue , Metilfenidato/urina , Taquicardia/induzido quimicamente , Taquicardia/tratamento farmacológico , Resultado do Tratamento
19.
Circ J ; 83(4): 793-800, 2019 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-30814430

RESUMO

BACKGROUND: Landiolol, an ultra-short acting ß1-selective blocker, is more effective for controlling the heart rate (HR) than digoxin in patients with atrial tachyarrhythmias and left ventricular (LV) dysfunction. The impact of the type of atrial tachyarrhythmias on the effectiveness of landiolol is uncertain. We evaluated the efficacy and safety of landiolol on tachycardiac atrial fibrillation (AF) and tachycardiac atrial flutter/atrial tachycardia (AFl/AT) in patients with reduced LV function. Methods and Results: Seventy-seven patients treated with landiolol were retrospectively analyzed. There were no significant differences in the baseline characteristics between the AF group (n=65) and AFl/AT group (n=12). Despite a higher dosage, the %change in HR from baseline to 12 and 24 h was only -10.2±12.7% and -16.1±19.4% in the AFl/AT group, while it was -28.3±13.2% and -31.3±11.3% in the AF group (P<0.02), respectively. The prevalence of the responders to landiolol treatment was much greater in the AF group than in the AFl/AT group (P<0.001). Alternative treatments such as i.v. amiodarone and electrical cardioversion were required in 83% of the AFl/AT patients. CONCLUSIONS: Landiolol was ineffective in the majority of AFl/AT patients. An alternative management to prevent any worsening of heart failure might be considered in those patients.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Flutter Atrial/tratamento farmacológico , Morfolinas/farmacologia , Taquicardia/tratamento farmacológico , Ureia/análogos & derivados , Disfunção Ventricular Esquerda , Idoso , Antiarrítmicos/farmacologia , Fibrilação Atrial/complicações , Flutter Atrial/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taquicardia/complicações , Ureia/farmacologia
20.
J Echocardiogr ; 17(3): 123-128, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30905042

RESUMO

Takotsubo cardiomyopathy (TC) is characterized by transient wall motion abnormalities most commonly involving the left ventricle (LV). Although biventricular TC had been considered uncommon condition, recently biventricular TC has been reported as a new variant observed in 19-42% of all TC presentations. Since biventricular TC has a poor prognosis as compared with isolated TC, it is important to distinguish between isolated LV TC and biventricular TC. We present a case of 70-year-old female with dyspnea persisting for 2 days. Electrocardiogram showed symmetrical T-wave inversion in leads V2-V4. Transthoracic echocardiography (TTE) revealed diffuse hypo-kinesis except for the apical inferior LV and LV ejection fraction of 32%. Hyper-kinesis of the right ventricular (RV) basal segment and dys-kinesis of the RV apical segment. 2 weeks after admission, coronary angiography showed no evidence of significant stenosis. LV ejection fraction improved to 51% and wall motion abnormalities of the RV basal and apical segments were ameliorated to normo-kinesis. Electrocardiogram revealed symmetrical and deepened T-wave inversion in leads V2-V3. The presence of a transient abnormality in biventricular wall motion beyond a single coronary artery perfusion territory with new electrocardiographic change met the diagnostic criteria of definite TC defined by Mayo Clinic criteria. 4 weeks after admission, no recurrence of wall motion abnormalities in both ventricles were found and T-wave inversion ameliorated. To our knowledge, this is the first report of biventricular TC with asymmetrical abnormities of wall motion between LV and RV.


Assuntos
Insuficiência Cardíaca/diagnóstico por imagem , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/fisiopatologia , Angiografia Coronária , Digoxina/uso terapêutico , Diuréticos/uso terapêutico , Ecocardiografia , Eletrocardiografia , Feminino , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Taquicardia/complicações , Taquicardia/diagnóstico , Taquicardia/tratamento farmacológico , Taquicardia/fisiopatologia , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/fisiopatologia , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Direita/complicações , Disfunção Ventricular Direita/fisiopatologia
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