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[Acute heart failure and its treatment in cardiologic drug poisoning]
Insights
Acute intoxication from certain drugs can cause sudden cardiac arrest (SCA) and death. Early treatment with protective agents and antagonists significantly reduced SCA mortality in patients.
Area of Science:
- Cardiology
- Toxicology
- Pharmacology
Background:
- Acute intoxication by amitriptyline, antiarrhythmic agents, and cardiac glycosides poses a significant risk.
- Sudden cardiac arrest (SCA) and early mortality are critical complications of these intoxications.
Purpose of the Study:
- To investigate the causes of SCA in patients with acute drug intoxication.
- To evaluate the effectiveness of early therapeutic interventions in preventing cardiac events and mortality.
Main Methods:
- Analysis of 179 patients with acute intoxications.
- Monitoring for cardiac conduction disturbances and SCA.
- Assessment of treatment strategies including membrane protective agents, pharmacological antagonists, and cardiotonic agents.
- Application of hemosorption in early treatment periods.
Main Results:
- Cardiac conduction disturbances occurred in 39.6% of patients within the initial hours of intoxication.
- SCA caused by acute heart failure and cardiogenic shock led to death in 11.7% of patients, primarily with complete bundle-branch block.
- Combined therapeutic interventions (membrane protection, antagonists, dobutamine, hemosorption) effectively treated acute heart failure and prevented cardiac events in 80% of patients.
- SCA mortality rates decreased from 11.7% to 3.2% with early intervention.
Conclusions:
- Acute intoxication with specific agents can precipitate SCA through acute heart failure and cardiogenic shock.
- Early and comprehensive treatment, including membrane protective agents, antagonists, cardiotonics, and hemosorption, is crucial for managing these cardiac emergencies.
- Aggressive early management significantly reduces mortality associated with drug-induced SCA.
Abstract:
The causes of sudden cardiac arrest (SCA) and its associated early death were examined in 179 patients with acute intoxications due to amitriptyline, antiarrhythmic agents and cardiac glycosides. In the first hours of intoxication, various cardiac conduction disturbances were found to occur in 39.6% of the patients, among whom 11.7% died due to SCA predominantly in complete bundle-branch block. The cause of SCA was an acute (contractile) heart failure that had run as cardiogenic shock and been associated with the specific selective action of the agents in question on cardiomyocytes. Premodulation of acute heart failure with membrane protective agents (unithiol, alpha-tocopherol, hydrocortisone), pharmacological antagonists (novodrin, alupent, isoprenaline), and the cardiotonic agent dobutamine enabled acute heart failure to be effectively treated, hemosorption to be made in early periods and cardiac events to be abolished in 80% of the patients, SCA mortality rates decreased from 11.7 to 3.2%.