Bradyarrhythmias incident to thrombolysis for acute inferior wall infarction. A caveat.
Of ten consecutive patients (eight men, two women; mean age, 59 years) seen over a ten-month period with acute inferoposterior infarction treated with thrombolytic therapy, seven patients demonstrated significant rhythm disturbances at a time interval consistent with clot lysis and in a setting of other clinical markers predictive of reperfusion. One patient had a ventricular arrhythmia treated with intravenous procainamide, but six patients had marked bradyarrhythmias (sinus bradycardia, four patients; and 2 degrees atrioventricular block, one patient) associated with hemodynamic compromise. Urgent treatment consisting of intravenous atropine sulfate (1 mg) briskly restored sinus rhythm and normal arterial pressure within 1 min. Bradyarrhythmias incident to thrombolysis for acute inferoposterior infarction appear to arise as a vagally mediated cardiovascular reflex (Bezold-Jarisch) and the rapid vagolytic effect of intravenous atropine sulfate makes this therapy specific and appropriate.
Varriale
P
P
Division of Cardiology, Cabrini Medical Center, New York.
Inguaggiato
A
A
David
W
W
D000328:Adult; D000368:Aged; D001919:Bradycardia / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D015425:Myocardial Reperfusion / Q000009:adverse effects; D015912:Thrombolytic Therapy / Q000009:adverse effects*