Idioventricular rhythm and shock after a honeybee sting / Ritmo idioventricular y shock después de un piquete de abeja

Abstract Objective: The objective of this study was to describe the case of a 19-year-old male presenting with bradycardia and hypotension after a honeybee sting making a review of the literature and pathophysiology of the cardiovascular and electrocardiogram (EKG) changes after a bee sting. Methods: The patient's airway was inspected and secured. Electrocardiogram with an idioventricular rhythm at 41' bpm. Oxygen was administered, an intravenous access was established, and the transcutaneous pacemaker leads were placed on the chest of the patient, then published guidelines management was induced. Results: The EKG showed idioventricular rhythm at a rate of 41 beats/min that resolved to a normal sinus rhythm after treatment. Conclusions: A full and prompt cardiovascular evaluation should be performed in all patients presenting to the emergency department after a bee sting, and published guidelines regarding the management of bradycardia and anaphylaxis should be followed to achieve successful outcomes.

Resumen Objetivo: Describir el caso de un paciente masculino de 19 años que presenta bradicardia e hipotensión después de una picadura de abeja haciendo una revisión de la literatura y fisiopatología de los cambios cardiovasculares y electrocardiográficos después de una picadura de abeja. Métodos: Se inspeccionó y aseguró la vía aérea del paciente. Un rastreo de ECG realizado al ingreso reveló ritmo idioventricular a una ritmo de 41 latidos por minuto. Se administró oxígeno, se estableció un acceso IV y se colocaron los cables del marcapasos transcutáneo en el tórax del paciente, luego se indujo el manejo de las guías publicadas. Resultados: El electrocardiograma mostró un ritmo idioventricular a una frecuencia de 41 latidos por minuto que se resolvió a un ritmo sinusal normal después del tratamiento. Conclusiones: Se debe realizar una evaluación cardiovascular completa y rápida en todos los pacientes que se presentan al departamento de emergencias después de una picadura de abeja, y se deben seguir las pautas publicadas sobre el manejo de la bradicardia y la anafilaxia para lograr resultados exitosos.

A Case of Accelerated Idioventricular Rhythm Lasted for 5 Days after Reperfusion in a Patient with Spasm-induce Myocardial Infaction: A Case Report / 대한구급학회지

A 56-year-old man presented with right coronary arterial spasm accompanied by ST segment elevation in the inferior leads. A reperfusion arrhythmia, accelerated idioventricular rhythm (AIVR), developed 1 hour after a nitroglycerin infusion. The AIVR was sustained for 5 days without hemodynamic instability, and resolved spontaneously during hemodynamic monitoring in the coronary intensive care unit.

Accelerated idioventricular rhythm associated with desflurane anesthesia :A case report / 대한마취과학회지

Accelerated idioventricular rhythm is defined as a ventricular rhythm of 60-100 beats per minute or a ventricular tachycardia that does nor exceed 120 beats per minutes. Although, it rarely converts to a fatal arrhythmia like ventricular fibrillation, it needs to be differentiated from AIVR, which is from another origin. AIVR may occur due to ischemic heart disease (ST elevated myocardial infarction), cardiomyopathy, rheumatic fever and digitalis intoxication. We report here on a case of AIVR that was related to desflurane administration.

Accelerated Idioventricular Rhythm in Children with Normal Heart

Accelerated idioventricular rhythm(AIVR) describes ventricular rates slower than usual tachycardia rates but faster than the ventricular escape rhythm. Ventricular rates of 40- 120 beats/min are usual. Accelerated idioventricular rhythm probably represents enhanced automaticity in the ventricles and manifests itself when sinus rates slow. This arrhythmia has been reported in association with acute myocardial infarction, digitalis excess, cardiomyopathy, and rheumatic heart disease. Only rare case of AIVR without underlying heart disease has been described. It is transient and intermittent, with episodes lasting a few seconds to a minute, and does not appear to seriously affect the patient's clinical course or the prognosis. Suppressive therapy is rarely necessary. Recently, we have experienced four cases of AIVR in children without underlying heart disease with benign clinical course.

Toxic effect of azalea extract on cardiovascular system / 영남의대학술지

The toxic effect of azalea extract, especially on cardiovascular system, in relatively unclear. The purpose of this study is to study the possible underlying mechanism and effect of toxic ingredient of azalea on cardiovascular system. The 71 healthy rabbits were divided into 10 groups: In group as preliminary study; 4 cc of normal saline was administered intravenously (N); 0.7 gm/kg and 1.0 gm/kg of azalea extract was administered respectively in the same route, volume (A1, A2); atropine was administered intravenously (A); after pretreatment with atropine (0.04 mg/kg) to block parasympathetic system, azalea extract was injected like the above groups (AA1, AA2); normal saline, 0.7 gm/kg and 1.0 gm/kg of azalea extract were administered respectively with 0.2 cc (1:1000) epinephrine (E0, E1, E2). We measured the following indices at I minute interval during first 10 minutes and then 10 minute interval during next 30 minutes: RR interval, QTc interval, maximal systolic and diastolic pressure drop with occurring time and presence of significant arrhythmia. The results were as follows: 1. The changes of RR interval, QTc interval were significantly increased in groups by Azalea extract. The blood pressure change was significantly decreased in groups by Azalea extract. There were no significant differences according to dosage of Azalea extract. 2. The changes of RR interval, blood pressure were significant differences between administration of atropine and Azalea extract after pretreatment with atropine, but not in the change of QTc interval. 3. There were no significant differences in the change of RR interval, ATc interval, blood pressure drop according to pretreatment with atropine. 4. The interaction between epinephrine and Azalea extract was not noted by the effect of epinephrine itself. 5. The ST change by 0.7 gm/kg, 1.0 gm/kg of Azalea extract was revealed in 1 case (14.0%), 7 case (100%), respectively. 6. Most of all cases with arrhythmia, ventricular tachycardia, ventricular fibrillation, were noted in the group by epinephrine, except on case by Azalea extract (1.0 gm/kg). It was idioventricular rhythm. In conclusion, azalea extract has negative inotropic and chronotropic effect with arrhythmogenic potential possibly through direct myocardial ischemia or injury but we can't be absolutely exclusive of actions of autonomic nervous system, especially parasympathetic nervous system.