Mouallem M, Friedman E, Shemesh Y, Mayan H, Pauzner R, Farfel Z
Department of Internal Medicine E, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Clin Cardiol. 1991 Feb;14(2):165-8. doi: 10.1002/clc.4960140214.
Cardiac conduction defects have not been previously described in association with hyponatremia, although in patients with congestive heart failure the frequency of ventricular premature beats was found to correlate to the severity of hyponatremia. We describe three patients with second-degree or complete atrioventricular (AV) block which occurred during or shortly after an episode of severe hyponatremia. The first had thiazide-induced hyponatremia while on amiodarone. In the second, definite etiology for hyponatremia which was associated with longstanding polydipsia could not be established. The third had ischemic heart disease and intermittent conversion of his first-degree to second-degree AV block while hyponatremic after diuretics use. Although it is usually difficult to single out hyponatremia as the cause of conduction defects which usually occur in the presence of cardiac disease, potent medications or other electrolyte abnormalities, we suggest that hyponatremia may play a role in the pathogenesis of conduction defects in the diseased heart.
虽然在充血性心力衰竭患者中发现室性早搏的频率与低钠血症的严重程度相关，但此前尚未有心脏传导缺陷与低钠血症相关的描述。我们描述了三名患有二度或完全性房室传导阻滞的患者，这些患者在严重低钠血症发作期间或之后不久出现了这种情况。第一名患者在服用胺碘酮时因噻嗪类药物导致低钠血症。第二名患者，与长期烦渴相关的低钠血症的确切病因无法确定。第三名患者患有缺血性心脏病，在使用利尿剂后出现低钠血症时，一度房室传导阻滞间歇性转变为二度房室传导阻滞。虽然通常很难将低钠血症单独作为传导缺陷的原因挑出来，因为传导缺陷通常发生在存在心脏病、强效药物或其他电解质异常的情况下，但我们认为低钠血症可能在患病心脏传导缺陷的发病机制中起作用。
