Aminophylline treatment of ischemic heart disease

e707004304 · Wysłany: Wto 10:40, 22 Mar 2011

Aminophylline treatment of arrhythmias in ischemic heart disease in 3 cases

Line switch to legal residents. Every time bolus or ATP into cedilanid sinus rhythm, heart rate was 48-52 times / min, after discharge long-term oral dipyridamole, atropine or belladonna and other drugs. Last 3 days paroxysmal chest pain admitted to hospital again. Physical examination: blood pressure 20.0/10.7kpa, as lack of heart, heart rate 48 times / min, law Qi, the heart can be heard and the anterior hair-like systolic murmur grade II,[link widoczny dla zalogowanych],> P cholesterol 7.7mmol / L. ECG revealed sinus bradycardia, complete right bundle branch block, coronary insufficiency. Given isosorbide dinitrate, oral atropine, 4 days in the hospital suddenly felt palpitation, ECG showed supraventricular tachycardia, ventricular rate 140 beats / min after intravenous injection of cedilanid into sinus rhythm, heart rate was 40 times / mln . Trial of aminophylline 0.2g, 3 times a day orally, heart rate gradually increased to 60-66 times / min. Example 3, female, 73 years old. 1 year due to episodes of palpitation, paroxysmal chest men Tong, a syncope over 4 days in February 25th, 2000 at admission examination: blood pressure 24.0/10.7kPa, mind clear, as lack of heart, heart rate 44 times / min, no noise. > P glucose 7.22mmol / L, cholesterol 6.94mmol / L. ECG showed sinus rhythm, a high degree of atrioventricular block, junctional escape rhythm, coronary insufficiency. Section Echocardiography no expansion of the atrioventricular and right ventricular anterior wall activity increased, left ventricular posterior wall of the artery was cut into sections less. Diagnosed as hypertensive coronary heart disease, II-III AV block, angina pectoris. Given isosorbide dinitrate 10mg, 3 times a day, 0.18 at 4 oral aminophylline and dexamethasone 10mg by intravenous infusion, day 1, shared 9 days, the patient symptom relief. ECG showed sinus rhythm,[link widoczny dla zalogowanych], heart rate 64-74 times / min. Misdiagnosed as hormone effective, disabled aminophylline. Morse also appeared the next day II. Type II atrioventricular block,[link widoczny dla zalogowanych], ventricular rate of 35-44 times / min, disable the hormone,[link widoczny dla zalogowanych], theophylline and then 0.2g orally 3 times a day, 2 days after the ECG showed sinus rhythm, heart rate 70-92 times / min, continue to observe the 7 days without recurrent disease. 2 to discuss recent studies have shown that ischemic myocardial cells under hypoxic release of adenosine increased, and it had similar effects of exogenous adenosine. Drurg first prove, AMP can slow down and may cause temporary sinus atrioventricular block. This case 1 3 days before admission appeared in paroxysmal chest pain and one had syncope, may be due to acute myocardial ischemia and hypoxia caused increased secretion of adenosine in vivo, increased sinus heart patients over the original A slow one occurs Adams syndrome. Admitted to hospital after being treated with ATP, and ATP hydrolysis in the body can quickly adenosine monophosphate, and further converted to AMP after phosphorylation,[link widoczny dla zalogowanych], this release of AMP and in vivo effect of adding adenosine to patients exacerbations. Just disable the ATP, after treatment with aminophylline to relieve the symptoms. Example 2 long-term use of dipyridamole, which may increase the patient's sinus bradycardia original, leaving the frequent episodes of supraventricular tachycardia due to dipyridamole is cAMP enhancer, and in the disabled students r plus Pan aminophylline before the patient can sustain a faster sinus rhythm. Example 3 after treatment with aminophylline, atrioventricular block disappeared after disabling recurrence of aminophylline, efficacy appeared again applied, this proves aminophylline can antagonize the release of myocardial adenosine during acute ischemia and hypoxia acid number of reasoning. Generally believed that adenosine can cause sinus bradycardia, transient AV block, it can inhibit the slow response was due to the slow fibers Ca influx, inhibition of self-regulation of sinus node, sinus node slowing diastolic slow depolarization rate, and accompanied by action potential amplitude reduced, thus slowing down the frequency of sinus node impulse issued to extend the sinus cycle length, while the occurrence of sinus bradycardia, sinus standstill, while AMP can block lag or delay before AV node conduction, atrioventricular block occurred. It is noteworthy that the role of adenosine in the cell surface is due to purinergic receptor mediation, which acts on M receptors with atropine different, caused by the adenylate bradyarrhythmia treated with atropine invalid, and can be effectively treated with aminophylline, as xanthine derivatives theophylline is a competitive inhibitor of adenosine, which acts on the same receptors with adenosine, it can antagonize the adenosine, but not with inhibition of phosphorylation: two unrelated lipase. Although we successfully treated with aminophylline 3 cases of ischemic heart disease that arrhythmias, but the small number of cases, the exact effect remains to be further explored. It is noteworthy that in the ischemic heart arrhythmias occur, the application of dipyridamole and ATP therapy should be careful, to avoid worse. (Edit Liao Jun)