EFFECTS OF SYMPATHOMIMETIC AGENTS ON ELECTROCARDIOGRAM INDEXES IN PATIENTS WITH BRONCHIAL ASTHMA
https://doi.org/10.20996/1819-6446-2007-3-1-15-20
Abstract
Aim. To study effects of sympathomimetic agents on electrocardiogram (ECG) indexes in patients with bronchial asthma (BA) in exacerbation stage complicated by respiratory insufficiency and sympathomimetic agents overdose.
Material and methods. 40 patients with persistent BA of various severities with respiratory insufficiency and sympathomimetic agents overdose were investigated. ECG was performed and P wave, QRS, duration and dispersion of corrected QT interval (QTc) were analyzed.
Results. Mean QTc dispersion correlated with asthma severity and was 76,8±5,9 ms1/2, 87,9±5,1 ms1/2, 87,8±3,1 ms1/2 in patients with mild, moderate and severe BA, respectively. Significant correlation between QTc dispersion and BA duration was found. QTc dispersion level was directly connected with duration of use of β-agonists and their overdose. Average QTc dispersion in patients who used more than 20 daily doses of inhaled β-agonists was 89,0±5,8 ms1/2.
Conclusion. Increase in QTc dispersion directly depends on BA duration and severity. β-agonist overdose results in growth of QTc dispersion, which has arrhythmogenic potential.
About the Authors
I. G. FominaRussian Federation
Chair of Faculty Therapy N2
G. K. Makchnach
Russian Federation
Chair of Faculty Therapy N2
D. A. Zateyschikova
Russian Federation
Chair of Faculty Therapy N2
A. I. Tarzimanova
Russian Federation
Chair of Faculty Therapy N2
References
1. Белоусов Ю.Б., Омельяновский В.В. Клиническая фармакология болезней органов дыхания. М.: Универсум Паблишинг; 1996.
2. Глобальная стратегия лечения и профилактики бронхиальной астмы. Пересмотр 2002 г. Пер. с англ. Под ред. А.Г. Чучалина. М., 2002
3. Кучмин А.Н. Нарушения сердечного ритма у больных с бронхиальной астмой: структура и особенности аритмогенеза. Автореф. дисс. канд. мед. наук. СПб, 2002. 24 с.
4. Пархоменко А.Н., Иркин О.И., Брыль Ж.В. и др. Увеличение дисперсии интервала dQTc электрокардиограммы у больных острым инфарктом миокарда. Кардиология 2000; 8:24-29.
5. Симоненко Б., Бойцов С., Кучмин А. и др. Особенности нарушений сердечного ритма и их лечение дилтиаземом у больных бронхиальной астмой. Клин. мед. 2001; 3:22-26
6. Синопальников А.И., Печатников Л.М., Алексеев В.Г. Нарушения сердечного ритма у больных бронхиальной астмой. Клин. мед. 1987; 65 (3):58-63.
7. Abildskov J.A., Burgess M.J., Urie P.M. et al. The unidentified content of the ECG. Circ Res 1977;40:3-7.
8. Barnes P.J. Effects of β2-agonists and steroids on β2-adrenoceptors. Eur. Resp. Rev. 1998; 8: 210-215.
9. Beasley R., Pearce N., Crane I., Burgess С Beta agonists: What is the evidence that their use increases the risk of asthma morbidity and mortality? J. Allergy Clin. Immunol. 1999; 104 (2): 197-202.
10. Beta2-agonists. From pharmacological properties to everyday clinical practice: International workshop report.— London; 2000.
11. Bonatti V., Rolli A., Botti G. Recording of monophasic action potentials of the right ventricle in long dQTc syndromes complicated by severe ventricular arrhythmias. Eur Heart J 1983;4:168-179
12. Cowan J.C., Hilton C.J., Griffiths C.J. et al. Sequence of epicardial repolarization and configuration of the T wave. Br Heart J 1988; 60: 424-433.
13. Day C.P., McComb J.M., Campbell R.W.F. dQTc dispersion: an indication of arrhythmia risk in patients with long dQTc intervals. Br Heart J 1990;63:342-344.
14. Franz M.R., Bargheer K., Rafflenbeul W. et al. Monophasic action potential mapping in human subjects with normal ECGs: direct evidence for the genesis of the T wave. Circulation 1987;75:379 — 386.
15. Han J., Мое G.K. Nonuniform recovery of excitability in ventricular muscle. Circulation 1964;14:44-60.
16. Janse M.J., Wit A.L. Electrophysiological mechanisms of ventricular arrhythmias resulting from myocardial ischaemia and infarction. Physiol Rev 1989; 69: 1049-1169.
17. Kuo C.S., Munakata K., Reddy C.P., Surawicz B. Characteristics and possible mechanism of ventricular arrhythmia dependent on the dispersion of action potential durations. Circulation 1983;67:1356-1367.
18. Lepeshkin E., Surawicz B. The measurement of the dQTc interval of the electrocardiogram. Circulation 1952;6:378-388.
19. Mirvis D.M. Spatial variation of dQTc intervals in normal persons and patients with acute myocardial infarction. J Am Coll Cardiol 1985; 5: 625-631.
20. National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program. Expert panel report 2: Guidelines for the diagnosis and management of asthma. National Institutes of Health publ. no 97—4051. Bethesda, MD; 1997.
21. Rudolph W, Bierner M. Sudden heart death. Herz. 1984 Feb; 9(1): 1-5.
22. Sarubbi B., Ducceschi V., Esposito V. et al. Assessment of dispersion of ventricular recovery in patients with chronic obstructive pulmonary disease. Cardiologia 1995;40:247-251.
Review
For citations:
Fomina I.G., Makchnach G.K., Zateyschikova D.A., Tarzimanova A.I. EFFECTS OF SYMPATHOMIMETIC AGENTS ON ELECTROCARDIOGRAM INDEXES IN PATIENTS WITH BRONCHIAL ASTHMA. Rational Pharmacotherapy in Cardiology. 2007;3(1):15-20. (In Russ.) https://doi.org/10.20996/1819-6446-2007-3-1-15-20