ABSTRACT
A 37-yr-old white female was admitted to hospital with an evolving anterior myocardial infarction. Coronary arteriography revealed multiple aneurysms in the left anterior descending (and right) coronary arteries. In the left anterior descending artery, there was evidence of extensive thrombus formation. The patient was successfully treated with intracoronary urokinase, intravenous heparin, and oral warfarin. There was partial thrombolysis in 16 hr and complete thrombolysis noted 6 wk later. This case of multiple coronary aneurysms, secondary to presumed Kawasaki disease, is the first documentation of antemortem intra-aneurysmal coronary thrombosis treated successfully by thrombolytic and anticoagulant therapy.
Subject(s)
Coronary Aneurysm/complications , Coronary Thrombosis/complications , Heparin/administration & dosage , Myocardial Infarction/drug therapy , Thrombolytic Therapy , Urokinase-Type Plasminogen Activator/administration & dosage , Administration, Oral , Adult , Cardiac Catheterization , Coronary Aneurysm/diagnostic imaging , Coronary Angiography , Coronary Thrombosis/diagnostic imaging , Coronary Thrombosis/drug therapy , Drug Therapy, Combination , Female , Humans , Infusions, Intravenous , Mucocutaneous Lymph Node Syndrome/complications , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/etiology , Warfarin/administration & dosageABSTRACT
The kinetics of distribution and elimination of lidocaine and two of its metabolites, monoethylglycinexylidide (MEGX) and glycinexylidide (GX), were studied in 4 uremic patients on chronic hemodialysis. Each patient received a loading dose of 75 mg of lidocaine, followed by a 30 mug/kh/min lidocaine infusion. No toxic side effects from lidocaine were seen during the study. Average values for lidocaine steady-state plasma levels (2.3 mug/ml) clearance (12.3 ml/min/kg), terminal half-life (148 min), and total volume of distribution (1.9 L/kg) were found, and are similar to those values reported for normal subjects MFGX and after lidocaine infusion averaged 1/5-2/3 of the corresponding lidocaine level, as in nonuremic subjects, and plateaued by 6-8 hr. GX levels did not reach plateau by 12 hr and remained relatively unchanged after infusion. It is concluded that lidocaine infusion in uremic patients is safe, with no abnormal cumulation of lidocaine or MEGX. GX levels, however, may increase progressively, even after 12 hr.
