TAHIKARDIJE ŠIROKIH KOMPLEKSA U TROVANJU KSENOBIOTICIMA
Ključne reči:
tahikardija širokih kompleksa, WCT, ksenobiotici, trovanje.
Sažetak
Tahikardije širokih kompleksa predstavljaju elektrokardiografski zapis srčanog ritma frekvence preko 100/minutu, a širine QRS kompleksa preko 120ms. Klasična podela tahikardija širokih kompleksa podrazumeva ventrikularne tahikardije i supraventrikularne aberantno sprovedene, ali mogu nastati i kao posledica metaboličkih i/ili toksičnih agenasa. Ksenobiotik je hemijska supstanca prisutna u organizmu, ali se u njemu ne proizvodi niti se očekuje da bude prisutna. To su takodje i supstance prisutne u organizmu u mnogo većoj koncentraciji od uobičajene. Za ljude, i lekovi predstavljaju ksenobiotike. U osnovi jedne grupe poremećaja izazvanih trovanjem ksenobioticima je blokada natrijumskih kanala na membrani kardiomiocita, koji su odgovorni za početnu, 0-tu fazu akcionog potencijala. Pojedine grupe lekova mogu da izazivaju WCT kao posledicu poremećene repolarizacije i produžavanja QTc intervala. Lečenje tahikardije širokih kompleksa u sklopu trovanja ksenobioticima zavisi od pre svega od vrste tahikardije i osnovnog poremećaja. Rano prepoznavanje i rano započinjanje adekvatne terapije su od neprocenjivog značaja za povoljan ishod pacijenta.
Reference
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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.
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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.
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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.
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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