Wide Complexes Tachycardia in Xenobiotic Poisoning
Keywords:
broad complex tachycardia, WCT, xenobiotics, poisoning
Abstract
Wide complex tachycardias (WCT) represent an electrocardiographic record rate over 100/minute and QRS complex width over 120ms. The classic division of WCT involves ventricular tachycardia and supraventricular aberrantly conducted, but may also caused by metabolic and/or toxic agents. Xenobiotic is a chemical substance presented in an organism, but not produced or expected to be present in it. These are also substances present in the body at a much higher concentration than usual. For humans, drugs are also xenobiotics. One group of xenobiotic poisoning disorders is based on the cardiomyocyte membrane's sodium channels blockage, which are responsible for initial, 0th phase of the action potential. Certain drug groups may induce WCT as a consequence of impaired repolarization and prolongation of QTc intervals. Treatment of WCT within xenobiotic poisoning depends on the type of tachycardia and underlying disorder. Early recognition and initiation of adequate therapy are invaluable for a favorable patient outcome.
References
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35. Purg D, Markota A, Grenc D, Sinkovič A. Low-dose intravenous lipid emulsion for the treatment of severe quetiapine and citalopram poisoning. Arh Hig Rada Toksikol. 2016;67(2):164–166. DOI:10.1515/aiht-2016-67-2802.
36. Bou-Abboud E, Nattel S. Relative role of alkalosis and sodium ions in reversal of class I antiarrhythmic drug-induced sodium channel blockade by sodium bicarbonate. Circulation. 1996; 94(8):1954–61. PMID: 8873674. DOI: 10.1161/01.cir.94.8.1954.
37. Kohlhardt M. A quantitative analysis of the Na+-dependence of Vmax of the fast action potential in mammalian ventricular myocardium. Saturation characteristics and the modulation of a drug induced INa blockade by [Na+]o. Pflugers Arch - Eur J Physiol. 1982; 392(4):379–87. PMID: 6280128. DOI: 10.1007/bf00581635.
2. Uzelac B. Teorija elektrokardiografije, Lapovo: Kolor Pres, 2019.
3. Uzelac BM. EKG artefakti u urgentnoj medicini. ABC - časopis urgentne medicine. 2018;18(3):41-8. doi:10.5937/abc1803035B.
4. Biggs JT, Spiker DG, Petit JM, Ziegler VE. Tricyclic antidepressant overdose: Incidence of symptoms. JAMA. 1977; 238(2):135-38. PMID: 577282.
5. Hutton LMJ, Cave AJ, St-Jean R, Banh HL. Should We be Worried About QTc Prolongation Using Citalopram? A Review. J Pharm Pract. 2017;30(3):353–358. PMID: 26763342. DOI:10.1177/0897190015624862.
6. Wilgenhof A, Michiels V, Cosyns B. An irregular, extremely broad QRS complex rhythm. Am J Emerg Med. 2019;37(10):1989.e1–1989.e3. PMID: 19561700 DOI:10.1016/j.ajem.2019.158356.
7. Tikhonov DB, Zhorov BS. Mechanism of sodium channel block by local anesthetics, antiarrhythmics, and anticonvulsants. J Gen Physiol. 2017;149(4):465–481. PMID: 28258204. DOI:10.1085/jgp.201611668.
8. Havakuk O, Rezkalla SH, Kloner RA. The Cardiovascular Effects of Cocaine. J Am Coll Cardiol. 2017;70(1):101–113. PMID: 28662796. DOI:10.1016/j.jacc.2017.05.014.
9. Khatri UG, Viner K, Perrone J. Lethal Fentanyl and Cocaine Intoxication. N Engl J Med. 2018;379(18):1782. doi:10.1056/NEJMc1809521. PMID: 30380395.
10. Jović-Stošić J, Putić V, Perković-Vukčević N, Babić G, Đorđević S, Šegrt Z. Intravenous lipid emulsion in treatment of cardiocirculatory disturbances caused by glyphosate-surfactant herbicide poisoning. Vojnosanit Pregl. 2016; 73(4):390–2. PMID: 29309108. DOI: 10.2298/VSP141017020J.
11. Jović-Stosić J, Gligić B, Putić V, Brajković G, Spasić R. Severe propranolol and ethanol overdose with wide complex tachycardia treated with intravenous lipid emulsion: A case report. Clinical Toxicology. 2011; 49(5):426–30. PMID: 21740142. DOI: 10.3109/15563650.2011.583251.
12. Alamolhodaei NS, Shirani K, Karimi G. Arsenic cardiotoxicity: An overview. Environ Toxicol Pharmacol. 2015;40(3):1005–1014. PMID: 26606645. DOI:10.1016/j.etap.2015.08.030.
13. Pierog J, Kane B, Kane K, Donovan JW. Management of isolated yew berry toxicity with sodium bicarbonate: a case report in treatment efficacy. J Med Toxicol. 2009; 5(2):84–9. PMID: 19415594. DOI: 10.1007/bf03161094.
14. Uzelac B. EKG primeri iz prakse, Lapovo: Kolor Pres, 2019.
15. Velebit V, Podrid P, Lown B, Cohen BH, Graboys TB. Aggravation and provocation of ventricular arrhythmias by antiarrhythmic drugs. Circulation. 1982; 65(5):886-94.PMID: 6176355.
16. Rosenbaum MB, Elizari MV, Lazzari JO. Mechanism of bidirectional tachycardia. Am Heart J. 1969;78(1):4-12. https://doi.org/10.1016/0002-8703(69)90250-6.
17. Uzelac B. Značaj izrade elektrokardiograma u prehospitalnim uslovima. ABC časopis urgentne medicine, 2015;15(3):21-26.
18. Uzelac B. Istorija fibrilacije i defibrilacije. Naučni časopis urgentne medicine Halo 94. 2009;15(33):47-53.
19. Fettiplace MR, Weinberg G. Past, Present, and Future of Lipid Resuscitation Therapy. JPEN J Parenter Enteral Nutr. 2015;39(1 Suppl):72S-83S. PMID: 26187938. DOI: 10.1177/0148607115595979.
20. Lam S, Majlesi N. Use of intravenous fat emulsion in the emergency department for the critically ill poisoned patient. The Journal of Emergency Medicine 2016; 51(2):203–214. PMID: 26972018. DOI: 10.1016/j.jemermed.2016.02.008.
21. Bruccoleri RE, Burns MM. A Literature Review of the Use of Sodium Bicarbonate for the Treatment of QRS Widening. J. Med. Toxicol. 2016; 12(1):121–9. PMID: 26159649. DOI: 10.1007/s13181-015-0483-y.
22. Seger DL, Hantsch C, Zavoral T, Wrenn K. Variability of recommendations for serum alkalinization in tricyclic antidepressant overdose: a survey of U.S. Poison Center medical directors. J Toxicol Clin Toxicol. 2003; 41(4):331–8. PMID: 12870873. DOI: 10.1081/clt-120021999.
23. Pellegrino M, Garofalo M. Digoxin-specific Fab and therapeutic plasma exchange for digitalis intoxication and renal failure. Am J Emerg Med. 2019;37(4):798.e3–798.e5. PMID: 30770242. DOI:10.1016/j.ajem.2019.01.038.
24. Sijacki A, Ercegovac M, Djikic M. Triage procedure in early hospital menagement of patients in emergency centres. Medicinski glasnik 2017;12-17. DOI: 10.5937/medgla1764007S.
25. Reddy V, Shen YS, Kundumadam S, Kathi P, Khan MH. A forgotten cause of wide complex tachycardia. J Electrocardiol. 2017;50(2):238-240. DOI: 10.1016/j.jelectrocard.2016.11.013.
26. Sabah KMN, Chowdhury AW, Islam MS, Saha BP, Kabir SR, Kawser S. Amitriptyline-induced ventricular tachycardia: a case report. BMC Res Notes. 2017;10(1):286. PMID: 28709467. DOI:10.1186/s13104-017-2615-8.
27. Koppel C, Oberdisse U, Heinemeyer G. Clinical course and outcome in class Ic antiarrhythmic overdose. Clin toxicol. 1990; 28(4):433-44. PMID: 2176700. DOI: 10.3109/15563659009038586.
28. Bailey Jr DJ. Cardiotoxic effects of quinidine and their treatment. Review and Case Reports. Arch Intern Med. 1960; 105(1):13–22. doi: 10.1001/archinte.1960.00270130029004.
29. Serin SO. Neglected facts in digoxin intoxication. Turk J Emerg Med. 2017;17(2):79. Published 2017 Mar 19. PMID: 29549524. DOI:10.1016/j.tjem.2016.12.001.
30. Castellanos A, Salhanick L. Electrocardiographic patterns of procainamide toxicity. Am J Med Sci. 1967; 253:60.
31. Etchegoyen CV, Keller GA, Mrad S, Cheng S, Di Girolamo G. Drug-induced QT Interval Prolongation in the Intensive Care Unit. Curr Clin Pharmacol. 2017;12(4):210–222. DOI:10.2174/1574884713666180223123947. PMID: 29473523
32. Lee BK, Youn CS, Kim YJ, Ryoo SM, Lim KS, Nam GB, et al. Effect of Prophylactic Amiodarone Infusion on the Recurrence of Ventricular Arrhythmias in Out-of-Hospital Cardiac Arrest Survivors: A Propensity-Matched Analysis. Clin Med. 2019; 8(2). PMID: 30781870. DOI: 10.3390/jcm8020244.
33. Kim ST, Park T. Acute and Chronic Effects of Cocaine on Cardiovascular Health. Int J Mol Sci. 2019;20(3). pii: E584. PMID:30700023. doi: 10.3390/ijms20030584.
34. Joksović D. Akutna trovanja hemijskim materijama: osnovni principi dijagnostike, lečenja i registracije akutno otrovanih. VMA Beograd: Centar za kontrolu trovanja, 2006.
35. Purg D, Markota A, Grenc D, Sinkovič A. Low-dose intravenous lipid emulsion for the treatment of severe quetiapine and citalopram poisoning. Arh Hig Rada Toksikol. 2016;67(2):164–166. DOI:10.1515/aiht-2016-67-2802.
36. Bou-Abboud E, Nattel S. Relative role of alkalosis and sodium ions in reversal of class I antiarrhythmic drug-induced sodium channel blockade by sodium bicarbonate. Circulation. 1996; 94(8):1954–61. PMID: 8873674. DOI: 10.1161/01.cir.94.8.1954.
37. Kohlhardt M. A quantitative analysis of the Na+-dependence of Vmax of the fast action potential in mammalian ventricular myocardium. Saturation characteristics and the modulation of a drug induced INa blockade by [Na+]o. Pflugers Arch - Eur J Physiol. 1982; 392(4):379–87. PMID: 6280128. DOI: 10.1007/bf00581635.
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2020/04/07
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