Byrne Carl, Flynn Lisa, Carroll Carthage
James Connolly Hospital Emergency Department, Blanchardstown, HSE, Dublin, Ireland
University College Dublin, Dublin, Ireland.
BMJ Case Rep. 2023 Dec 19;16(12):e258537. doi: 10.1136/bcr-2023-258537.
A woman in her 40s presented to the emergency department with epistaxis. Anterior nasal packing was unsuccessful in achieving haemostasis. After the exchange of devices and insertion of a posterior nasal pack, the patient developed a junctional rhythm and progressively unstable bradycardia. The rhythm and bradycardia immediately improved following the removal of the posterior nasal pack. This case describes a rare occurrence of Trigeminocardiac reflex (TCR), following an insertion of a posterior nasal pack. Only one other such case has been reported and published. This case highlights the importance of raising awareness of this rare reflex and the need for prompt removal of the triggering cause in such scenarios. TCR can induce a junctional rhythm, which progresses to unstable bradycardia and may lead to asystole in susceptible individuals. The removal of the stimulus resolves the reflex and can result in prompt resolution of the bradycardia and hypotension induced via the TCR.
一名40多岁的女性因鼻出血前往急诊科就诊。前鼻孔填塞未能止血。在更换器械并插入后鼻孔填塞物后，患者出现交界性心律并逐渐发展为不稳定的心动过缓。在后鼻孔填塞物取出后，心律和心动过缓立即改善。本病例描述了后鼻孔填塞物插入后罕见的三叉神经心脏反射（TCR）情况。此前仅报道并发表过一例类似病例。本病例强调了提高对这种罕见反射的认识的重要性，以及在此类情况下迅速消除触发原因的必要性。TCR可诱发交界性心律，进而发展为不稳定的心动过缓，并可能导致易感个体出现心搏停止。去除刺激可消除反射，并可迅速缓解由TCR诱发的心动过缓和低血压。
