Department of Cardiovascular Medicine, Saiseikai Nakatsu Hospital, 2-10-39, Shibata, Kita-ku, Osaka, 530-0012, Japan.
J Cardiol. 2009 Dec;54(3):507-11. doi: 10.1016/j.jjcc.2009.03.011. Epub 2009 May 7.
An 83-year-old female, who had a history of anterior myocardial infarction, was treated for Alzheimer's disease with donepezil. She suffered from repeated diarrhea and vomiting, and experienced syncope. She was admitted to our hospital and was diagnosed with acute colitis and syncope. On admission, her heart rate was 54 beats/min with regular rhythm. Laboratory data showed a low plasma potassium level. Electrocardiogram (ECG) showed poor R progression, ST elevation, negative T in precordial leads, and marked QT prolongation. Transthoracic echocardiogram showed the enlargement of the left atrium and aneurysmal area at the apex. Torsades de Pointes (TdP) with syncope and convulsion were confirmed on ECG monitoring twice after admission. We treated her with potassium chloride and started magnesium sulfate and lidocaine, and then added isoprenaline injection. After these treatments, her heart rate increased and we did not detect TdP again. With the aging population in Japan, prescriptions for donepezil are increasing. We have to be vigilant for syncope in patients taking donepezil, which is possibly related to QT prolongation and TdP.
一位 83 岁女性，有心肌梗死前病史，因阿尔茨海默病接受多奈哌齐治疗。她反复腹泻和呕吐，并出现晕厥。她被收入我院，诊断为急性结肠炎和晕厥。入院时，心率为 54 次/分，节律规则。实验室数据显示血浆钾水平低。心电图（ECG）显示 R 波进展不良，ST 段抬高，心前区导联 T 波倒置，QT 延长明显。入院后两次心电图监测均证实尖端扭转型室性心动过速（TdP）伴晕厥和抽搐。我们用氯化钾治疗她，并开始使用硫酸镁和利多卡因，然后加用异丙肾上腺素注射。经过这些治疗，她的心率增加，我们没有再次检测到 TdP。随着日本人口老龄化，多奈哌齐的处方量正在增加。我们必须警惕服用多奈哌齐的患者发生晕厥，这可能与 QT 延长和 TdP 有关。
