RESUMO
This case study describes myocardial ischemia and stunning after the topical application of phenylephrine-soaked pledgets (0.25%) in a 63-year-old female undergoing elective endoscopic sinus surgery. The patient had no previous history of cardiovascular disease or illicit drug use. Transient myocardial ischemia was associated with acute hypertension, chest pain, and S-T segment changes 4 minutes after pledget placement. Angiography revealed normal coronary blood flow and severe left ventricular systolic and diastolic dysfunction. Follow-up echocardiography demonstrated improved left ventricular function within 1 week and total resolution of dysfunction by 4 weeks after ischemia.
Assuntos
Agonistas alfa-Adrenérgicos/efeitos adversos , Isquemia Miocárdica/induzido quimicamente , Miocárdio Atordoado/induzido quimicamente , Fenilefrina/efeitos adversos , Administração Intranasal , Agonistas alfa-Adrenérgicos/administração & dosagem , Feminino , Humanos , Pessoa de Meia-Idade , Fenilefrina/administração & dosagem , Recidiva , Sinusite/cirurgiaRESUMO
STUDY OBJECTIVES: The objectives of this study were to assess the efficacy of parenteral magnesium sulfate (MgSO4), digoxin, and combined MgSO4-digoxin therapies in acutely lowering ventricular rates in patients with newly recognized atrial fibrillation. DESIGN: A randomized, double-blinded, placebo-controlled clinical study. SETTING: US Army tertiary care facility. PARTICIPANTS: Fifteen adults (mean age, 62 +/- 19 years) presenting with newly recognized atrial fibrillation and rapid ventricular rate (more than 99). INTERVENTIONS: Patients were given an initial parenteral MgSO4 bolus with continuous infusion or placebo. After 30 minutes, all patients were given 0.5 mg IV digoxin and followed for 3.5 hours. MEASUREMENTS AND MAIN RESULTS: Ventricular rates were obtained at baseline, every 5 minutes for the first 30 minutes, and then every 30 minutes for 3.5 hours. At 5 minutes, ventricular rates decreased 16 +/- 7% (P < .02) with MgSO4; this was comparable with rate control with digoxin (18 +/- 9%) at 4 hours. Rate control tended (26 +/- 7%) to improve with combined therapy. CONCLUSION: Parenteral MgSO4 may be useful in the acute management of rapid ventricular rates in patients with atrial fibrillation.