Cardiac affection during severe asthma exacerbation and epinephrine adminstration

ABSTRACT

Bronchial asthma is the commonest chronic illness in children. To study the cardiac effects of severe asthma exacerbations and subcutaneous epinephrine administration, serum total CPK and CPK-MB as well as ECG changes were studied in 60 children [6-12 years of age], twenty healthy controls [group III] and 40 with severe asthma attacks. Half the patients received subcutaneous epinephrine just before coming to hospital [group II] and the other half did not [group I], Both total CPK and CPK-MB were significantly elevated in group I Further significant elevations were found in group II. In both groups serum CPK-MB exceeded 6% of the total CPK denoting real myocardial damage aggravated by epinephrine therapy. ECG changes observed in group I included cardiac ischemia [15%], right ventricular hypertrophy [45%], left ventricular hypertrophy [20%] and pulmonary' hypertension [20%]. Subcutaneous epinephrine given to patients of group II increased the risk of cardiac ischemia to 55% and was accompanied by myocardial infarction in one patient [5%] and atriai premature beets in another one [5%]. The risk of right ventricular hypertrophy slightly increased to 50% while that of pulmonary hypertension remained the same [20%]. Left ventricular hypertrophy could not be detected in this group of patients. So, subcutaneous epinephrine may be beneficial, cheap and easy to use, but it may be seriously hazardous. Serum total CPK and CPK-MB as well as ECG monitoring are recommended for all children with severe asthma attacks especially those who received subcutaneous epinephrine