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1.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Accorsi, Tarso Augusto Duenhas; Gualandro, Danielle Menosi; Oliveira Junior, Múcio Tavares de; Caramelli, Bruno; Kalil Filho, Roberto. Manual da residência em cardiologia / Manual residence in cardiology. Santana de Parnaíba, Manole, 2 ed; 2022. p.342-347, tab.
Monography in Portuguese | LILACS | ID: biblio-1352400
2.
J. Card. Arrhythm. (Impr.) ; 34(3): 105-112, Dec., 2021.
Article in English | LILACS | ID: biblio-1359637

ABSTRACT

This is a series case report of five symptomatic patients presented with diagnosis of sinus bradycardia, first and second degrees atrioventricular (AV) blocks, that were referred to pacemaker implantation. During the screening, a functional cause for the bradycardia and AV blocks were documented by treadmill stress test, 24-hour Holter monitoring and atropine test. After the confirmation of the diagnosis, patients were submitted to cardioneuroablation on an anatomical basis supported by a tridimensional electroanatomical fractionation mapping software. The technique and the acute and short-term results of the cardioneuroablation are described.


Subject(s)
Syncope , Bradycardia , Atrioventricular Block
3.
Rev. colomb. anestesiol ; 49(3): e500, July-Sept. 2021. graf
Article in English | LILACS, COLNAL | ID: biblio-1280182

ABSTRACT

Systemic sclerosis is an immunological disorder characterized by tissue fibrosis and multi-organ dysfunction.1 The accompanying images exhibit electrocardiographic changes in severe systemic sclerosis. Advanced 3:1 atrioventricular block, best observed in Lead Vi, suggests extensive fibrosis of the conduction system (Image A). While one P wave is buried in the T wave (black arrows), two are evident (red arrows) along the isoelectric line. Bradyarrhythmia related prolonged QT interval, best measured in Lead II represents increased risk for torsades-de-pointes, a polymorphic ventricular tachyarrhythmia. Additionally, right bundle branch block with giant T wave inversions (T wave depth > 10 mm) in precordial leads V2- 4 suggests pulmonary hypertension. Post-induction the rhythm abruptly changes to torsades-de-pointes (Image B) necessitating defibrillation.


La esclerosis sistémica es un trastorno inmunológico caracterizado por fibrosis tisular y disfunción multiorgánica. 1 Las imágenes adjuntas muestran cambios electrocardiográficos en la esclerosis sistémica grave. El bloqueo auriculoventricular avanzado 3: 1, que se observa mejor en la derivación VI, sugiere una fibrosis extensa del sistema de conducción ( Imagen A ).Mientras que una onda P está enterrada en la onda T (flechas negras), dos son evidentes (flechas rojas) a lo largo de la línea isoeléctrica. El intervalo QT prolongado relacionado con bradiarritmia, mejor medido en la derivación II, representa un mayor riesgo de torsades-de-pointes, una taquiarritmia ventricular polimórfica. Además, el bloqueo de la rama derecha del haz con inversiones de la onda T gigante (profundidad de la onda T> 10 mm) en las derivaciones precordiales V2- 4 sugiere hipertensión pulmonar. Después de la inducción, el ritmo cambia abruptamente a torsades-de-pointes ( Imagen B ), lo que requiere desfibrilación.


Subject(s)
Humans , Arrhythmias, Cardiac , Scleroderma, Systemic , Electrocardiography , Tachycardia , Bradycardia , Bundle-Branch Block , Risk , Tachycardia, Ventricular , Atrioventricular Block , Hypertension, Pulmonary
4.
Arch. argent. pediatr ; 119(4): e353-e356, agosto 2021. tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1281861

ABSTRACT

La bibliografía no incluye frecuentemente alteraciones en el ritmo cardíaco de los pacientes que reciben corticoesteroides; se desconoce su mecanismo exacto. En este artículo, presentamos el caso de un paciente con bradicardia sinusal asociada con una dosis de estrés de corticoesteroides. Se ingresó a un niño de 9 años con antecedentes de panhipopituitarismo con gastroenteritis y neumonía y presentó choque septicémico el día de la hospitalización. El tratamiento con líquidos intravenosos, dosis de estrés de hidrocortisona y antibióticos permitió la recuperación. Sin embargo, luego se documentó bradicardia sinusal con una frecuencia cardíaca de 45 latidos por minuto. Esta se resolvió después de reducir gradualmente la hidrocortisona. La bradicardia sinusal inducida por corticoesteroides es un efecto adverso que suele resolverse tras interrumpir el tratamiento. Se debe considerar el monitoreo hemodinámico en estos casos. Este es el primer informe de bradicardia sinusal posterior al uso de hidrocortisona en niños con insuficiencia suprarrenal


The literature does not commonly describe cardiac rhythm disturbances, including bradycardia, in patients who are receiving corticosteroids, and the exact mechanism of such disturbances remains unknown. Herein, we present a case of sinus bradycardia associated with stress-dose corticosteroid therapy. A nine-year-old boy with a history of panhypopituitarism was admitted with gastroenteritis and pneumonia and developed septic shock on the day of admission. Management using intravenous fluids, stress doses of hydrocortisone, and antibiotics resulted in full recovery. However, within 24 hours following treatment, sinus bradycardia was documented, with a heart rate of 45 beats per minute (BPM). The bradycardia resolved after the dose of hydrocortisone was decreased gradually. Corticosteroidinduced sinus bradycardia is an adverse effect that usually resolves after corticosteroid treatment is discontinued. During stress-dose corticosteroid therapy, hemodynamic monitoring should be considered. To our knowledge, this is the first report of sinus bradycardia following the use of hydrocortisone in children who have adrenal insufficiency.


Subject(s)
Humans , Male , Child , Sinoatrial Node , Bradycardia/chemically induced , Hydrocortisone/adverse effects , Adrenal Insufficiency/drug therapy , Sepsis/drug therapy , Bradycardia/diagnosis , Bradycardia/drug therapy , Hydrocortisone/administration & dosage , Adrenal Insufficiency/complications , Sepsis/complications
6.
Arch. cardiol. Méx ; 91(2): 186-189, abr.-jun. 2021. graf
Article in English | LILACS | ID: biblio-1248783

ABSTRACT

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.


Subject(s)
Humans , Animals , Male , Pacemaker, Artificial , Arrhythmias, Cardiac/diagnosis , Shock , Bees , Bradycardia/etiology , Insect Bites and Stings/complications , Arrhythmias, Cardiac/etiology , Bradycardia/therapy , Electrocardiography , Heart Rate/physiology
7.
Article in Chinese | WPRIM | ID: wpr-921688

ABSTRACT

To systematically review the efficacy and safety of Yangxin Dingji Capsules in the treatment of arrhythmia. PubMed, EMbase, Cochrane Library, CNKI, VIP, CBM and Wanfang databases were electronically retrieved to collect randomized controlled trial(RCT) on the efficacy of Yangxin Dingji Capsules in the treatment of arrhythmia from the time of database establishment to October 20 th, 2020. Two reviewers independently screened out the literatures, input the data, and evaluated the literature quality of the included studies. RevMan 5.3 software was used for Meta-analysis. A total of 127 studies were retrieved, and 15 articles were included after screening, involving 1 371 cases, with 685 cases in the treatment group and 686 cases in the control group. Yangxin Dingji Capsules combined with anti-arrhythmia western medicine was adopted for intervention in the treatment group, while the patients in the control group were treated with the anti-arrhythmia western medicine alone. Meta-analysis results showed that in arrhythmia patients, the combination of Yangxin Dingji Capsules and conventional western medicine significantly increased the clinical efficacy(RR=1.23, 95%CI[1.17, 1.30], P<0.000 01)and left ventricular ejection fraction(MD=4.31, 95%CI[3.10, 5.52], P<0.000 01), reduced heart rate(MD=-3.79, 95%CI[-7.42,-0.15], P=0.04), left ventricular end-diastolic diameter(MD=-7.06, 95%CI[-11.91,-2.21],P=0.004), left ventricular end-systolic diameter(MD=-4.78, 95%CI[-6.63,-2.93],P<0.000 01), N-terminal B-type natriuretic peptide precursor(MD=-200.51, 95%CI[-254.52,-146.51], P<0.000 01)and high-sensitivity C-reactive protein(MD=-1.74, 95%CI[-3.23,-0.24], P=0.02), all with statistically significant differences. Compared with the control group, Yangxin Dingji Capsules had fewer adverse reactions(RR=0.53, 95%CI[0.36, 0.79], P=0.002). The existing evidences showed that Yangxin Dingji Capsules had certain effect in the treatment of arrhythmia, with a safety. However, due to the limitation in sample size, outcome measures and quality of the included studies, more high-quality studies are required to verify the above conclusion.


Subject(s)
Bradycardia , Capsules , Drugs, Chinese Herbal , Humans , Stroke Volume , Ventricular Function, Left
8.
Article in Chinese | WPRIM | ID: wpr-879028

ABSTRACT

To systematically evaluate the efficacy and safety of Ningxinbao Capsules in treatment of arrhythmia by Meta-analysis. Randomized controlled trial(RCT) or quasi-randomized control trial(Quasi-RCT) on Ningxinbao Capsules treating arrhythmia were obtained by computer-based retrieval in CNKI, Wanfang, VIP, SinoMed, PubMed, Web of Science, Cochrane Library and EMbase as well as manual retrieval, with time limit from database establishment to April 7, 2020. According to the inclusion and exclusion criteria of trials, all RCTs were screened and evaluated. Then the effective data were collected and RevMan 5.3 Meta-analysis software was used for analysis. Thirteen trials were included, involving 1 379 patients in total. Ningxinbao Capsules combined with anti-arrhythmia Western medicine were adopted as the intervention, and the patients in control group were treated with the anti-arrhythmia Western medicine alone. Meta-analysis results showed that as compared to control group, Ningxinbao Capsules combined with anti-arrhythmia Western medicine group was superior in clinical efficacy, dynamic electrocardiogram and average heart rate in patients with bradycardia, with indicated statistically significant differences. Ningxinbao Capsules had fewer adverse reactions and could relieve the toxic and side effects of anti-arrhythmia medicine possibly. The study showed that Ningxinbao Capsules played a role in treatment of arrhythmia and was relatively safe. However, due to the limited quality of the included studies, high-quality clinical trials are needed to verify the conclusions.


Subject(s)
Bradycardia , Capsules , Drugs, Chinese Herbal/adverse effects , Humans , Treatment Outcome
10.
Rev. bras. cir. cardiovasc ; 35(5): 824-830, Sept.-Oct. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137319

ABSTRACT

Abstract Objective: To investigate the cardiovascular effects produced by transthoracic application of low-intensity pulsed ultrasound therapy (LIPUST). Methods: Three-month-old male Wistar rats (± 300 g, N=16) were randomly allocated in two groups, namely SHAM (control group, faked procedures) and UST (animals treated with LIPUST). These animals, under anesthesia, were instrumented (femoral artery and vein catheterization) for hemodynamic recordings (mean blood pressure [MBP], heart rate [HR]) and blood biochemical profile (lipids, creatine kinase-myocardial band [CK-MB]). Then, LIPUST (spatial average-temporal average [ISATA] 1-MHz, power 0.1 to 1.2 W/cm2, pulsed 2:8 ms, cycle at 30%, for three minutes) was applied to animals from the UST group, externally to their thorax. SHAM animals were equally manipulated, but without application of ultrasound energy. After the hemodynamic and biochemical measurements, animals were sacrificed, and their hearts were mounted in a Langendorff apparatus for coronary reactivity evaluation. Standard histology techniques were employed to analyze the hearts. Results: LIPUST application caused statistically significant reductions in MBP (92±4 vs. 106±1 mmHg) and HR (345±14 vs. 380±17 rpm) when compared with SHAM procedures. UST rats exhibited higher CK-MB levels (318±55 vs. 198±26 U/dL) and lower plasma triglycerides levels (38±7 vs. 70±10 mg/dL) than SHAM animals. Coronary reactivity was not significantly changed by LIPUST. Cardiac histopathology showed an increase in capillary permeability in treated animals when compared with SHAM animals. Conclusion: Noninvasive LIPUST induces significant metabolic and hemodynamic changes, including intensity-dependent bradycardia and hypotension, indicating a possible therapeutic effect for cardiac events.


Subject(s)
Animals , Male , Rats , Bradycardia/therapy , Hypotension , Myocardium , Rats, Wistar , Ultrasonic Waves , Heart , Hemodynamics
11.
Rev. cuba. anestesiol. reanim ; 19(1): e586, ene.-abr. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1093127

ABSTRACT

Introducción: Las bradi-arritmias son cardiopatías graves que ocasionan trastornos hemodinámicos severos; llevar al paciente a un gasto cardiaco normal puede implicar que se implante un marcapasos. Objetivo: Describir algunos aspectos clínicos y epidemiológicos de pacientes que recibieron la técnica de implantar un marcapasos. Métodos: Se realizó un estudio descriptivo y transversal, con 36 pacientes que necesitaron marcapasos transitorio, ingresados en la unidad de cuidados intensivos del Hospital General Docente "Orlando Pantoja Tamayo" de Contramaestre, en el período desde octubre de 2015 hasta mayo de 2019. Las variables utilizadas fueron: grupo de edades y sexo, causas de arritmias y antecedentes patológicos personales, medicamentos más usados previos al ingreso, tiempo de uso del marcapasos transitorio y necesidad de implantación del permanente. Resultados: Predominó el sexo masculino y edades de 80 y más años, el trastorno de la conducción auriculoventricular más frecuente fue el bloqueo auriculoventricular de tercer grado; el tiempo promedio de uso de marcapaso transitorio fue entre 2 y 6 días. Conclusiones: La implantación precoz en esta entidad municipal mejoró notablemente la supervivencia de los pacientes(AU)


Introduction: Bradyarrhythmias are serious heart diseases that cause severe hemodynamic disorders. Bringing the patient to normal cardiac output may imply that a pacemaker be implanted. Objective: To describe some clinical and epidemiological aspects of patients who received the technique of implanting a pacemaker. Methods: A descriptive and cross-sectional study was carried out with 36 patients who needed a temporary pacemaker, admitted to the intensive care unit of Orlando Pantoja Tamayo General Teaching Hospital in Contramaestrem, in the period from October 2015 to May 2019. The variables used were age group and sex, causes of arrhythmias, and personal pathological history, most used medications prior to admission, time of usage of the temporary pacemaker, and the need for permanent implantation. Results: The male sex and ages 80 and older predominated, the most frequent atrioventricular conduction disorder was the third-degree atrioventricular block. The average time of temporary pacemaker usage was between two and six days. Conclusions: Early implantation in this municipal institution significantly improved patient survival(AU)


Subject(s)
Humans , Aged , Aged, 80 and over , Pacemaker, Artificial/standards , Cardiovascular Diseases/prevention & control , Cardiovascular Diseases/therapy , Bradycardia/therapy , Cross-Sectional Studies , Intensive Care Units/standards
13.
Acta odontol. Colomb. (En linea) ; 10(2): 147-155, 2020. ilus, ilus
Article in Spanish | LILACS, COLNAL | ID: biblio-1123486

ABSTRACT

Introducción: el reflejo trigémino cardíaco es una respuesta fisiológica parasimpática repentina, que ocasiona alteraciones cardiovasculares importantes durante la esti-mulación nerviosa en el trayecto del V par craneal, generalmente ocurre al realizar procedimientos quirúrgicos en cirugía oral y maxilofacial, neurocirugía, oftalmología y dermatología. La artroscopia de la articulación temporomandibular ha sido tradicional-mente considerada un procedimiento quirúrgico seguro, mínimamente invasivo, aun así, esta técnica no está exenta de complicaciones neuro y cardiovasculares. Objetivo:presentar un caso clínico que durante una artroscopia de la articulación temporo-mandibular en la fase de instrumentación del espacio articular superior, y que, bajo monitoreo continuo del anestesiólogo, reportó una bradicardia súbita. Conclusión: el diagnóstico intraoperatorio de reflejo trigémino cardíaco, fue descrito por el servicio de anestesiología recibiendo un tratamiento farmacológico temprano para esta condi-ción, lo que permitió obtener una adecuada evolución trans y postoperatoria


Background: Trigeminocardiac reflex is a sudden parasympathetic physiological response causing significant cardiovascular disturbances during nerve stimulation in the path of the fifth cranial nerve, generally during surgical procedures in oral and maxillofacial surgery, neurosurgery, ophthalmology, and dermatology. Arthroscopy of the temporomandibular joint has traditionally been considered a safe, minimally invasive surgical procedure, yet this technique is not without neuro and cardiovascular complications. Objective: To present a clinical case that during an arthroscopy of the temporomandibular joint in the instrumentation phase of the superior joint space, and under continuous monitoring by the anesthetist, report sudden bradycardia Conclusion: The intraoperative diagnosis of trigeminocardiac reflex was described by the anesthesiology service, receiving early pharmacological treatment of this condition, allowing an adequate trans and postoperative evolution.


Subject(s)
Humans , Arthroscopy , Reflex, Trigeminocardiac , Temporomandibular Joint , Trigeminal Nerve , Bradycardia
14.
Arq. bras. cardiol ; 113(5): 925-932, Nov. 2019. graf
Article in English | LILACS | ID: biblio-1055040

ABSTRACT

Abstract Background: D-limonene (DL) is a monoterpene and is the major component in the essential oil of citrus fruit. It presents antihyperglycemic and vasodilatation activities. Objectives: This study evaluated the cardiovascular effects and potential antiarrhythmic of DL in rats. Methods: Hemodynamic and electrocardiographic (ECG) parameters were measured in male Wistar rats, which under anesthesia had been cannulated in the abdominal aorta and lower vena cava and had electrodes subcutaneously implanted. In the in vitro approach, the heart was removed and perfused using the Langendorff technique. The significance level adopted was 5% (p < 0.05). Results: DL, in doses of 10, 20, and 40 mg/kg (i.v), produced intense and persistent bradycardia associated with hypotension. Bradycardia with prolonged QTc was observed in the ECG in vivo recording. In the in vivo model of arrhythmia induced by Bay K8644, DL (10 mg/kg) decreased the arrhythmia score from 15.33 ± 3.52 to 4.0 ± 2.64 u.a (p < 0.05, n = 4). In isolated perfused hearts, DL (10-3 M) promoted significant reductions in heart rate (from 228.6 ± 8.5 ms to 196.0 ± 9.3 bpm; p < 0.05) and left ventricular development pressure (from 25.2 ± 3.4 to 5.9 ± 1.8 mmHg; n = 5, p < 0.05). Conclusions: DL produces bradycardia and antiarrhythmic activity in rat heart.


Resumo Fundamento: O D-limoneno (DL) é um monoterpeno e o principal componente do óleo essencial de frutas cítricas. Ele apresenta atividades anti-hiperglicêmicas e vasodilatadoras. Objetivos: Este estudo avaliou os efeitos cardiovasculares e antiarrítmicos potenciais do DL em ratos. Métodos: Os parâmetros hemodinâmicos e eletrocardiográficos (ECG) foram mensurados em ratos Wistar machos que, sob anestesia, tiveram a aorta abdominal e a veia cava inferior canuladas e receberam eletrodos implantados subcutaneamente. Na abordagem in vitro, o coração foi removido e perfundido utilizando a técnica de Langendorff. O nível de significância adotado foi de 5% (p < 0,05). Resultados: DL, nas doses de 10, 20 e 40 mg/kg (i.v), produziu bradicardia intensa e persistente associada à hipotensão. A bradicardia com QTc prolongado foi observada no registro in vivo do ECG. No modelo in vivo de arritmia induzida por Bay K8644, DL (10 mg / kg) houve diminuição do escore da arritmia de 15,33 ± 3,52 para 4,0 ± 2,64 u.a (p < 0,05, n = 4). Em corações perfundidos isolados, o DL (10-3 M) promoveu reduções significativas na frequência cardíaca (de 228,6 ± 8,5 ms para 196,0 ± 9,3 bpm; p < 0,05) e na pressão desenvolvida do ventrículo esquerdo (de 25,2 ± 3,4 para 5,9 ± 1,8 mmHg; n = 5, p < 0,05). Conclusões: O DL produz bradicardia e atividade antiarrítmica no coração de ratos.


Subject(s)
Animals , Male , Arrhythmias, Cardiac/drug therapy , Bradycardia/drug therapy , Limonene/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/chemically induced , Blood Pressure/drug effects , Bradycardia/diagnosis , Rats, Wistar , Ventricular Pressure/drug effects , Models, Animal , Electrocardiography , Isolated Heart Preparation , Limonene/pharmacology , Heart Rate/drug effects , Hemodynamics/drug effects , Hypotension , Anti-Arrhythmia Agents/pharmacology
15.
Rev. colomb. cardiol ; 26(5): 272-278, sep.-oct. 2019. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1092937

ABSTRACT

Resumen Introducción: cada día se reportan efectos tóxicos de la quimioterapia en el corazón, entre ellos las arritmias; sin embargo, las publicaciones sobre bradicardia ocasionada por antineoplásicos son escasas. Objetivo: describir y analizar la presencia de bradicardia posquimioterapia en el paciente oncológico. Materiales y métodos: estudio no experimental, descriptivo, retrospectivo, en el que se incluyeron pacientes atendidos durante el año 2017 en un Servicio de Cardiología, a causa de bradicardia posquimioterapia. Resultados: se evaluaron 59 pacientes, 31 varones (52,5%) y 28 mujeres (47,5%), con una mediana de edad de 42 años. La mediana de la frecuencia cardiaca fue 46 latidos por minuto. La bradicardia fue más frecuente en leucemia mielocítica aguda (25,42%), seguida por leucemia linfoblástica aguda (20,34%). Fue asintomática en el 88,13% de los casos. Los fármacos quimioterápicos relacionados con bradicardia en leucemia mielocítica aguda fueron la citarabina en combinación con la daunorubicina, mientras que en leucemia linfoblástica aguda fueron la vincristina en combinación con la daunorubicina. Se presentó intervalo QTc largo en 12 casos (20,34%). El tiempo entre quimioterapia y el inicio de la bradicardia fue 24 a 48 horas en 35,6% y la recuperación de la frecuencia cardiaca fue entre 24 a 48 horas en el 61,02%. Conclusiones: la bradicardia sinusal como efecto adverso de la quimioterapia, es más frecuente en la leucemia mielocítica aguda, mientras que los medicamentos antineoplásicos relacionados con la bradicardia más comunes fueron la citarabina y la daunorubicina.


Abstract Introduction: There are daily reports of the toxic effects of chemotherapy on the heart, among them are the arrhythmias. However, there are very few publications on bradycardia caused by anti-neoplastic treatment. Objective: To describe and analyse the presence of post-chemotherapy bradycardia in the oncology patient. Materials and methods: A non-experimental, descriptive and retrospective study was conducted on patients seen during the year 2017 in a Cardiology Department due to post-chemotherapy bradycardia. Results: A total of 59 patients were evaluated, of whom 31 (52.5%) were males and 28 (47.5%) women, and with a median age of 42 years. The median heart rate was 46 beats per minute. The bradycardia was more common in acute myelocytic leukaemia (25.42%), followed by acute lymphoblastic leukaemia (20.34%). It was asymptomatic in 88.31% of cases. The chemotherapy drugs associated with bradycardia in acute myelocytic leukaemia were cytarabine in combination with daunorubicin, whilst in acute lymphoblastic leukaemia they were vincristine in combination with daunorubicin. A prolonged QTc interval was present in 12 (20.34%) of cases. The time between the chemotherapy and the onset of bradycardia was 24 to 48 hours in 35.6%, and the recovery of the heart rate was between 24 and 48 hours in 61.02%. Conclusions: Sinus bradycardia as an adverse effect of chemotherapy is more frequent in acute myelocytic leukaemia, whilst the most common anti-neoplastic drugs associated with bradycardia were cytarabine and daunorubicin.


Subject(s)
Humans , Male , Female , Adult , Arrhythmias, Cardiac , Bradycardia , Pharmaceutical Preparations , Cardiology , Leukemia, Myeloid , Cytarabine/adverse effects , Drug Therapy
17.
Arq. bras. cardiol ; 112(4): 410-421, Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1001291

ABSTRACT

Abstract Background: Considering the potential deleterious effects of right ventricular (RV) pacing, the hypothesis of this study is that isolated left ventricular (LV) pacing through the coronary sinus is safe and may provide better clinical and echocardiographic benefits to patients with bradyarrhythmias and normal ventricular function requiring heart rate correction alone. Objective: To assess the safety, efficacy, and effects of LV pacing using an active-fixation coronary sinus lead in comparison with RV pacing, in patients eligible for conventional pacemaker (PM) implantation. Methods: Randomized, controlled, and single-blinded clinical trial in adult patients submitted to PM implantation due to bradyarrhythmias and systolic ventricular function ≥ 0.40. Randomization (RV vs. LV) occurred before PM implantation. The main results of the study were procedural success, safety, and efficacy. Secondary results were clinical and echocardiographic changes. Chi-squared test, Fisher's exact test and Student's t-test were used, considering a significance level of 5%. Results: From June 2012 to January 2014, 91 patients were included, 36 in the RV Group and 55 in the LV Group. Baseline characteristics of patients in both groups were similar. PM implantation was performed successfully and without any complications in all patients in the RV group. Of the 55 patients initially allocated into the LV group, active-fixation coronary sinus lead implantation was not possible in 20 (36.4%) patients. The most frequent complication was phrenic nerve stimulation, detected in 9 (25.7%) patients in the LV group. During the follow-up period, there were no hospitalizations due to heart failure. Reductions of more than 10% in left ventricular ejection fraction were observed in 23.5% of patients in the RV group and 20.6% of those in the LV group (p = 0.767). Tissue Doppler analysis showed that 91.2% of subjects in the RV group and 68.8% of those in the LV group had interventricular dyssynchrony (p = 0.022). Conclusion: The procedural success rate of LV implant was low, and the safety of the procedure was influenced mainly by the high rate of phrenic nerve stimulation in the postoperative period.


Resumo Fundamento: Considerando-se os potenciais efeitos deletérios da estimulação do ventrículo direito (VD), a hipótese desse estudo é que a estimulação unifocal ventricular esquerda pelo seio coronário é segura e pode proporcionar melhores benefícios clínicos e ecocardiográficos aos pacientes com bradiarritmias que apresentam função ventricular normal, necessitando apenas da correção da frequência cardíaca. Objetivos: Avaliar a segurança, a eficácia e os efeitos da estimulação do ventrículo esquerdo (VE), utilizando um cabo-eletrodo com fixação ativa, em comparação à estimulação do VD. Métodos: Estudo clínico, randomizado, simples-cego em pacientes adultos com indicação de marca-passo (MP) devido a bradiarritmias e função ventricular sistólica ≥ 0,40. A randomização aleatória (VD vs VE) ocorreu antes do procedimento. Os desfechos primários do estudo foram: o sucesso, a segurança e a eficácia do procedimento proposto. Os desfechos secundários foram: a evolução clínica e alterações ecocardiográficas. Empregou-se os testes Qui-quadrado, Exato de Fisher e t de Student, com nível de significância de 5%. Resultados: De junho de 2012 a janeiro de 2014 foram incluídos 91 pacientes, sendo 36 no grupo VD e 55 no grupo VE. As características basais dos pacientes dos dois grupos foram similares. O implante de MP foi realizado com sucesso e sem nenhuma intercorrência em todos os pacientes do grupo VD. Dos 55 pacientes inicialmente alocados para o grupo VE, o implante do cabo-eletrodo em veias coronárias não foi possível em 20 (36,4%) pacientes. Dentre os 35 pacientes que permaneceram com o cabo-eletrodo no VE, a estimulação frênica foi a complicação mais frequente e foi detectada em 9 (25,7%) pacientes. Na fase de seguimento clínico, não houve hospitalizações por insuficiência cardíaca. Reduções superiores a 10% na fração de ejeção do VE foram observadas em 23,5% dos pacientes do grupo VD e em 20,6% dos pacientes do grupo VE (p = 0,767). A análise feita pelo Doppler tecidual mostrou que 91,2% dos indivíduos do grupo VD e 68,8% dos do grupo VE apresentaram dissincronia interventricular (p = 0,022). Conclusões: A taxa de sucesso do implante no VE foi baixa e a segurança do procedimento foi influenciada, principalmente, pela alta taxa de estimulação frênica no pós-operatório.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Pacemaker, Artificial/adverse effects , Bradycardia/therapy , Cardiac Pacing, Artificial/methods , Heart Ventricles/physiopathology , Stroke Volume , Bradycardia/physiopathology , Cardiac Pacing, Artificial/adverse effects , Single-Blind Method , Reproducibility of Results , Treatment Outcome , Prosthesis Implantation/methods , Heart Failure/etiology , Heart Failure/physiopathology
19.
Rev. bras. anestesiol ; 69(2): 218-221, Mar.-Apr. 2019.
Article in English | LILACS | ID: biblio-1003411

ABSTRACT

Abstract Background and objectives: Sugamadex is a modified gamma-cyclodextrin, the first selective agent for reversal of neuromuscular blockade induced by steroidal non-depolarizing muscle relaxants, with greater affinity for rocuronium. In this article we present a case of severe bradycardia and asystole following sugammadex administration. Case report: A 54-year-old male patient, ASA II, with a history of hypertension, dyslipidemia and obesity, who underwent an emergency umbilical herniorrhaphy under balanced general anesthesia. Intraoperative muscle relaxation was maintained with rocuronium. At the end of the surgery, the patient maintained a neuromuscular block with two TOF responses, and sugammadex (200 mg) was administered. About thirty seconds after its administration, the patient developed marked bradycardia (HR 30 bpm) followed by asystole. Conclusions: Documented bradycardia and asystole were attributed to the administration of sugammadex. This case shows that, although rare, cardiac arrest is a possible adverse effect of this drug, and that the knowledge of this situation can be determinant for the patient's evolution.


Resumo Justificativa e objetivos: O sugamadex é uma gama ciclodextrina modificada, o primeiro agente seletivo para reversão do bloqueio neuromuscular induzido pelos relaxantes musculares não despolarizantes do tipo esteroide, com maior afinidade para o rocurônio. Neste artigo apresentamos um caso de bradicardia grave e assistolia após administração de sugamadex. Relato do caso: Doente do sexo masculino, 54 anos, ASA II, com antecedentes pessoais de hipertensão, dislipidemia e obesidade, submetido à herniorrafia umbilical em regime de urgência sob anestesia geral balanceada. O relaxamento muscular intraoperatório foi mantido com rocurônio. No fim da cirurgia o doente mantinha bloqueio neuromuscular com duas respostas no TOF, pelo que foi administrado sugamadex 200 mg. Cerca de trinta segundos após a sua administração, o doente desenvolveu bradicardia acentuada (FC 30 bpm) seguida de período de assistolia. Conclusões: A bradicardia e a assistolia documentadas foram atribuídas à administração do sugamadex. Este caso evidencia que, apesar de rara, a parada cardíaca é um efeito adverso possível desse fármaco e que o conhecimento dessa situação pode ser determinante para a evolução do doente.


Subject(s)
Humans , Male , Bradycardia/chemically induced , Sugammadex/adverse effects , Heart Arrest/chemically induced , Severity of Illness Index , Neuromuscular Nondepolarizing Agents/administration & dosage , Neuromuscular Nondepolarizing Agents/antagonists & inhibitors , Neuromuscular Blockade/methods , Sugammadex/administration & dosage , Rocuronium/administration & dosage , Rocuronium/antagonists & inhibitors , Middle Aged
20.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(2): 155-159, abr.-jun. 2019. ilus, graf
Article in English, Portuguese | LILACS | ID: biblio-1009492

ABSTRACT

A apneia obstrutiva do sono (AOS) é uma condição prevalente, que tem sido associada com diversas consequências cardiovasculares, sendo a hipertensão arterial a mais bem descrita. Entretanto, doença arterial coronariana, arritmias cardíacas, acidente vascular cerebral e risco aumentado de mortalidade cardiovascular têm sido descritos na literatura em populações clínicas e na população geral, com diferentes níveis de evidência. Ressaltamos também a maior prevalência de AOS em pacientes com doenças cardiovasculares estabelecidas, possivelmente explicada pela coexistência de fatores de risco comuns tais como a idade, o sexo masculino e o sobrepeso/obesidade. Neste artigo discutiremos brevemente a associação de AOS e cada uma dessas condições clínicas, bem como o que há de evidência até o momento para o efeito do tratamento da AOS com a pressão positiva contínua de vias aéreas (CPAP) na prevenção dos desfechos cardiovasculares e mortalidade


Obstructive sleep apnea (OSA) is a prevalent condition that has been associated with several cardiovascular sequelae, among which hypertension is the best documented condition. However, coronary artery disease, cardiac arrhythmias, stroke and increased risk for cardiovascular mortality have been described in the literature in both the general population and in clinical settings, with different levels of evidence. We also emphasize the higher prevalence of OSA in patients with established cardiovascular disease, possibly due to the coexistence of common risk factors such as age, male sex and overweight/obesity. In this article we will briefly discuss the association of OSA and each of these clinical conditions, as well as the current evidence for the effect of OSA treatment with continuous positive airway sure (CPAP) on the prevention of cardiovascular outcomes and mortality


Subject(s)
Humans , Male , Female , Cardiovascular Diseases , Sleep Apnea, Obstructive/complications , Sleep Apnea, Obstructive/diagnosis , Arrhythmias, Cardiac , Atrial Fibrillation , Bradycardia , Sex Factors , Prevalence , Risk Factors , Age Factors , Heart Atria , Heart Ventricles , Hypertension
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