ABSTRACT
A 23-year-old male with Duchenne muscular dystrophy (DMD) experienced self-limiting palpitations at age 19 years for the first time. Palpitations recurred not earlier than at age 23 years, and were attributed to narrow complex tachycardia, which could be terminated with adenosine. Since electrocardiography showed a delta-wave, Wolff-Parkinson-White (WPW) syndrome was diagnosed, ajmaline prescribed and radio-frequency catheter ablation of three accessory pathways carried out one week later. One day after ablation, however, a relapse of the supraventricular tachycardia occurred and was terminated with ajmaline. Re-entry tachycardia occurred a second time six days after ablation, and as before, it was stopped only with ajmaline. Despite administration of verapamil to prevent tachycardia, it occurred a third time four months after ablation. This case shows that cardiac involvement in DMD may manifest also as WPW-syndrome. In these patients, repeated radio-frequency catheter ablation of accessory pathways may be necessary to completely block the re-entry mechanism.
Subject(s)
Humans , Male , Adenosine , Ajmaline , Arrhythmias, Cardiac , Catheter Ablation , Catheters , Electrocardiography , Muscular Dystrophies , Muscular Dystrophy, Duchenne , Recurrence , Tachycardia , Tachycardia, Supraventricular , VerapamilABSTRACT
A 23-year-old male with Duchenne muscular dystrophy (DMD) experienced self-limiting palpitations at age 19 years for the first time. Palpitations recurred not earlier than at age 23 years, and were attributed to narrow complex tachycardia, which could be terminated with adenosine. Since electrocardiography showed a delta-wave, Wolff-Parkinson-White (WPW) syndrome was diagnosed, ajmaline prescribed and radio-frequency catheter ablation of three accessory pathways carried out one week later. One day after ablation, however, a relapse of the supraventricular tachycardia occurred and was terminated with ajmaline. Re-entry tachycardia occurred a second time six days after ablation, and as before, it was stopped only with ajmaline. Despite administration of verapamil to prevent tachycardia, it occurred a third time four months after ablation. This case shows that cardiac involvement in DMD may manifest also as WPW-syndrome. In these patients, repeated radio-frequency catheter ablation of accessory pathways may be necessary to completely block the re-entry mechanism.
Subject(s)
Humans , Male , Adenosine , Ajmaline , Arrhythmias, Cardiac , Catheter Ablation , Catheters , Electrocardiography , Muscular Dystrophies , Muscular Dystrophy, Duchenne , Recurrence , Tachycardia , Tachycardia, Supraventricular , VerapamilABSTRACT
<p><b>OBJECTIVE</b>To predict the absorption of corynanthine (COR), yohimbine (YOH), ajmalicine (AMC) and ajmaline (AML) as chemical constituents of some traditional Chinese medicines in human intestinal epithelial.</p><p><b>METHOD</b>By using Caco-2 (the human colonic adenocarcinoma cell lines) cell monolayers as a human intestinal epithelial cell model, the permeability of COR, YOH, AMC and AML were studied from apical side (AP side) to basolateral side (BL side) or from BL side to AP side. The four alkaloids were measured by high performance liquid chromatography (HPLC) coupled with UV detector. Transport parameters and apty) and atenolol (a control substance of poor permeability). The relationship between P(app) and log D values of four alkaloids was investigated by using drugs ADMET predict software.</p><p><b>RESULT</b>The P(app) values of COR, YOH, AMC and AML were (1.863 +/- 0.055) x 10(-5), (1.540 +/- 0.082) x 10(-5), (2.522 +/- 0.246) x 10(-5) and (1.155 +/- 0.099) x 10(-5) cm x s(-1) from AP side to BL side, and (2.390 +/- 0.017) x 10(-5), (1.987 +/- 0.154) x 10(-5), (1.374 +/- 0.260) x 10(-5) and (2.418 +/- 0.124) x 10(-5) cm x s(-1) from BL side to AP side, respectively, which P(app) values were identical with that of propranolol [(2.23 +/- 0.10) x 10(-5) cm x s(-1) from AP to BL side]. The ratio of P(app B --> A)/P(app A -->B) of COR, YOH, AMC and AML were 1.28, 1.29, 0.54 and 2.09, respectively, which suggested that the efflux transport of AML was 2.09 times higher more than its influx transport.</p><p><b>CONCLUSION</b>COR, YOH, AMC and AML can be transported and absorbed across the human Caco-2 cells monolayers, and they belong to completely absorbed compounds. AML may have been involved in efflux mechanism in Caco-2 cells monolayers model from the BL to AP side direction. The oil-water partition coefficient play key roles in the transport and absorption of the four alkaloids.</p>
Subject(s)
Humans , Ajmaline , Metabolism , Caco-2 Cells , Chromatography, High Pressure Liquid , Epithelial Cells , Metabolism , Intestinal Mucosa , Cell Biology , Molecular Structure , Secologanin Tryptamine Alkaloids , Metabolism , Yohimbine , MetabolismABSTRACT
Un deportista de 26 años, asintomático, fue evaluado por bloqueo AV de larga data con pausas nocturnas de hasta 4,7 segundos. El estudio electrofisiológico mostró bloqueo AV suprahisiano de segundo grado tipo Mobitz I con prueba de ajmalina negativa. En el ECG Holter, el mayor grado de bloqueo AV coincidió con la frecuencia sinusal más baja. El hallazgo se interpretó como lesión crónica nodal AV, de etiología indeterminada, con paroxismos de bloqueo AV por acción vagal. No se indicó electroestimulación cardíaca permanente y se le permitió continuar con actividad física.
Subject(s)
Humans , Male , Adult , Heart Block/physiopathology , Exercise , Atrioventricular Node/physiology , Arrhythmias, Cardiac , Ajmaline/administration & dosage , Electrocardiography, Ambulatory , Electrophysiology , Ergometry , SportsABSTRACT
Se comunica el diagnóstico y tratamiento efectivo de un caso de muerte súbita con Síndrome de Brugada, efectuándose una revisión de la literatura existente al respecto. Para ello se describe el caso de una mujer de 39 años que fue recuperada de una muerte súbita, documentándose un registro ECG de fibrilación ventricular, y en quien la evaluación cardiológica muestra en ECG en ritmo sinusal con bloqueo de rama derecha y elevación del segmento S-T de V1-V3. Se descartaron todas las causas reversibles de muerte súbita arrítmica. Durante el estudio electrofisiológico se indujo con facilidad una taquicardia ventricular polimórfica-fibrilación ventricular. La administración de ajmalina incrementa las alteraciones del segmento S-T en las precordiales derechas. La paciente fue tratada con un cardiodefibrilador implantable, sin el uso de drogas antiarrítmicas y se encuentra bien al mes de seguimiento
Subject(s)
Humans , Female , Adult , Arrhythmias, Cardiac , Bundle-Branch Block/diagnosis , Death, Sudden , Ventricular Fibrillation , Ajmaline/therapeutic use , Defibrillators, Implantable , Electrocardiography , ResuscitationABSTRACT
La detección de compromiso miocárdico precoz en la enfermedad de Chagas es muy importante para la elaboración de estrategias terapéuticas y/o preventivas. Para ello se utilizaron diferentes procedimientos de diagnóstico no invasivo. Con el propósito de evaluar en forma comparativa la capacidad de detectar anormalidades miocárdicas subclínicas se analizaron hallazgos en el ecocardiograma bidimensional, la prueba ergométrica graduada, la prueba de ajmalina y el electrocardiograma ambulatorio de 24 horas con sistema Holter. Se estudiaron 140 pacientes (78 varones y 62 mujeres) con serología positiva para la enfermedad de Chagas. Los resultados de este estudio muestran que la prueba de ajmalina es un marcador más sensible de daño miocárdico que el ecocardiograma bidimensional, el Holter o la prueba ergométrica y permite detectar el compromiso miocárdico chagásico en etapas más tempranas, aunque en algunos pacientes es posible demostrar anormalidades ecocardiográficas en presencia de una prueba de ajmalina negativa
Subject(s)
Humans , Male , Female , Adolescent , Adult , Ajmaline/administration & dosage , Ajmaline/therapeutic use , Chagas Cardiomyopathy/diagnosis , Chagas Disease/immunology , Echocardiography , Electrocardiography, AmbulatoryABSTRACT
The effects of a herbal drug, Ajmaloon (Hamdard, India), on the arterial blood pressure, heart rate (HR) and baroreceptor-heart rate reflex were studied in anesthetized rabbits and monkeys. Intravenously administered Ajmaloon produced a dose-dependent hypotensive response in both the species without any significant effect on the heart rate. Only in high doses (200 mg/kg or more). Ajmaloon produced a bradycardia response in rabbits. Even the highest dose (300 mg/kg) of Ajmaloon used in the present investigation did not cause arrhythmia or any other conduction disorder or respiratory distress. Baroreflex SAP-HR curve was shifted to the left of the control following treatment with 100 mg/kg intravenous Ajmaloon in both the species. Loss of tachycardia response to fall in arterial pressure in Ajmaloon treated animals indicated the drug induced suppression of normally existing sympathetic excitatory influence in response to hypotension. Baroreflex regulatory HR response to hypertension remains intact after intravenous administration of 100 mg/kg Ajmaloon, a dose much higher than the prescribed highest oral dose for humans. Intact baroreflex regulation of arterial blood pressure in response to hypertension in Ajmaloon treated mammals suggests that in patients besides lowering the blood pressure. Ajmaloon might not interfere with the normal blood pressure regulatory mechanism through arterial baroreceptors during hypertension.
Subject(s)
Ajmaline/administration & dosage , Analysis of Variance , Animals , Baroreflex/drug effects , Blood Pressure/drug effects , Bradycardia/chemically induced , Disease Models, Animal , Dose-Response Relationship, Drug , Female , Haplorhini , Heart Rate/drug effects , Hypertension/drug therapy , Injections, Intravenous , Male , Phytotherapy , Plant Extracts/administration & dosage , Plants, Medicinal , Rabbits , Random Allocation , RauwolfiaABSTRACT
El objetivo de este trabajo fue comprobar si una de las variables medio-ambientales, la reinfeccion, puede modificar el comportamiento observado en un modelo de rata a nivel de parasitemia, anticuerpos sericos, manifestaciones electrocardiograficas y/o lesion miocardica. Los grupos experimentales fueron: GI: ratas infectadas al destete com 1 x "10 POT 6" T. cruzi; GR: igual a GI mas reinfecciones cada 30 dias hasta los 150 dias post-infeccion inicial (p.i.i.); "GI IND 1". Los xenodiagnosticos fueron negativos en los tres grupos. Los anticuerpos sericos no se modificaron significativamente en GR respecto de GI, salvo en los anticuerpos 7S, pues los del GR presentaron titulos superiores en algunos de los dias estudiados. Los ECG basales no mostraron cambios distintivos en las ratas infectadas. La pruieba de ajmalina mostro una disminucion de la FC independiente del tratamiento; el PR, QaT y QRS se prolongaron significativamente en todos los grupos respecto del basal (p < 0.05), salvo el QaT en el GT; ademas el cambio de PR y QaT fue mayor en los infectados (p < 0.05). En los grupos infectados hubo tambien una amplia variacion en la orientacion del eje electrico respecto del valor basal, acompanado de cambios morfologicos mas manifiestos emGR. La proporcion de lesion cardiaca detectada histologicamente en los grupos
Subject(s)
Rats , Animals , Ajmaline/pharmacokinetics , Trypanosoma cruzi/drug effects , Trypanosoma cruzi/growth & development , Trypanosoma cruzi/metabolism , Myocardium/anatomy & histology , Myocardium/metabolism , Protozoan InfectionsABSTRACT
Los efectos de diferentes concentraciones de bitertrato de N-n propil ajmalina (BNPA), sintetizado en Cuba) sobre las corrientes de Na y Ca, fueron estudiados en células ventriculares aisladas de corazón de rana, con la técnica de patch-clamp. El BNPA redujo i en forma dependiente de la concentración. Esta reducción en i ocurrió con desplazamientos hacia las hiperpolarizaciones, en la curva de disponibilidad. Los resultados muestran que a concentraciones a las cuales el BNPA tiene efectos importantes sobre i Na, su acción antiarritmica esencial provoca un incremento en i Ca. Esto sugiere que a niveles terapéuticos, su acción carecería de inotropismo negativo. Se discute la importancia de estos resultados
Subject(s)
Animals , Ajmaline/pharmacology , Calcium/metabolism , Ion Channels , Ranidae , Sodium/metabolism , Heart Ventricles/drug effectsABSTRACT
1. The following changes may be observed in the resting ECG of Wistar rats having different forms of heart disease: pathological Q wave, QRS deviations, lengthening of both P wave and QRS complex, increased PR interval and J point alterations. 2. The ajmaline test, when applied to rats with myocardial disease but with normal resting ECG, presented the following ECG alterations which were not observed in normal rats: indeterminate axis (QRS axis in the 3 rd space), increased PR interval and lengthening of both P wave and QRS complex. 3. When compared with histopathological studies, the ECG changes have a high positive predictive value for detecting underlying myocardial disease. 4. The surface ECG can be a useful tool for detecting myocardial disease in different experimental models of rat heart disease. It can also be used to characterize rat models of heart disease and to evaluate treatment of experimental rat heart disease
Subject(s)
Rats , Animals , Electrocardiography/methods , Heart Diseases/diagnosis , Ajmaline , Heart Rate , Rats, Wistar , Sensitivity and SpecificitySubject(s)
Animals , Rats , Chagas Cardiomyopathy/diagnosis , Ajmaline , Electrocardiography , Disease Models, AnimalSubject(s)
Adult , Aged , Ajmaline/diagnosis , Bundle-Branch Block/diagnosis , Chronic Disease , Electrocardiography , Female , Heart Conduction System/drug effects , Humans , Male , Middle AgedSubject(s)
Adult , Aged , Ajmaline/administration & dosage , Electrophysiology , Female , Heart Block/diagnosis , Humans , Male , Middle Aged , Pacemaker, ArtificialSubject(s)
Adult , Aged , Ajmaline/therapeutic use , Female , Humans , Infusions, Parenteral , Male , Middle Aged , Tachycardia/drug therapyABSTRACT
Se presentan los resultados obtenidos con la prueba de ajmalina en dos pacientes con sindrome de WPW. En uno de ellos existia una imagen de falsa necrosis de pared anterolateral, ocasionada por una forma tipo C de dicho sindrome, mientras que en el otro coexistia un verdadero infarto agudo de miocardio, que aparentaba gran extension. En ambos enfermos la prueba de ajmalina permitio establecer el verdadero origem de los cambios electrocardiograficos
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Ajmaline , Myocardial Infarction , Wolff-Parkinson-White Syndrome , Diagnosis, DifferentialABSTRACT
Se presentaron los efectos de la ajmalina (50 mg de droga base, endovenosa) en un paciente de 60 anos con una miocardiopatia hipertrofica y sindrome de WPW, cuya asociacion otorga con frecuencia un aspecto caracteristico al ECG. Esta simple prueba farmacologica permitio sin necesidad de estudio electrofisiologico: 1o. descartar una seudo onda delta causada por la activacion anormal del septum interventricular dependiente de la desorganizacion de las fibras miocardicas, propia de la miocardiopatia hipertrofica, y 2o. poner en evidencia que el ECG caracteristico de la asociacion de esta ultima con el sindrome de WPW puede obedecer a la sumacion de las imagenes de pre-excitacion-hipertrofia ventricular izquierda-bloqueo incompleto de rama izquierda