ABSTRACT
A patient developed a psychotic-like reaction immediately after receiving an intramuscular injection of procaine penicillin G. The patient complained of a metallic taste, dizziness, ringing of the ears, and the fear of imminent death. No cardiovascular or pulmonary disturbances were noted. The reaction and all symptoms resolved within 15 minutes, and the patient has reported no further episodes. The case and a review of the literature are presented.
Subject(s)
Penicillin G Procaine/adverse effects , Psychoses, Substance-Induced/etiology , Adult , Female , Humans , Injections, Intramuscular , Penicillin G Procaine/administration & dosage , Psychoses, Substance-Induced/diagnosisABSTRACT
Left atrial electrograms were recorded simultaneously from sites located in the coronary sinus, right pulmonary artery and esophagus in order to determine and correlate the interatrial conduction times obtained from these locations. Ten patients with normal-sized atria and 16 patients with isolated left atrial enlargement were studied. A high correlation existed between the P wave duration and the interatrial conduction times obtained from the coronary sinus and pulmonary artery; good correlations were also found for the interatrial conduction times recorded from the pulmonary artery and esophagus correlated well with those recorded from the distal coronary sinus (the generally accepted standard for the indirect interatrial conduction time measurements). In addition to providing information on the mechanism of atrial arrhythmias, the electrograms obtained from the various indirect left atrial recording sites provide satisfactory quantification of interatrial conduction.
Subject(s)
Heart Conduction System/physiopathology , Electrocardiography , Heart Atria/physiopathology , Humans , Time FactorsABSTRACT
A 51 year old woman sustained ventricular fibrillation while receiving perphenazine and protriptyline. After successful resuscitation and clinical stabilization, cardiac electrophysiologic studies were performed before and after the administration of each of these medications. Perphenazine widened the ventricular echo zone and facilitated induction of short salvoes of ventricular tachycardia (repetitive ventricular response). Protriptyline also widened the ventricular echo zone and allowed easy induction of long runs of ventricular tachycardia. Both psychotropic agents increased the incidence of ventricular dysrhythmias in this patient. The electrophysiologic study is a useful technique in determining the interaction between psychotropic drugs and life-threatening arrhythmias; it may provide a means of identifying the patients with cardiac disease in whom administration of these agents may be fatal.
