Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.
Einstein (Sao Paulo). 2024 Apr 8;22:eRC0522. doi: 10.31744/einstein_journal/2024RC0522. eCollection 2024.
Adenosine is an antiarrhythmic drug that slows conduction through the atrioventricular node and acts as a coronary blood vessel dilator. This case report highlights two unusual life-threatening events following the use of adenosine to revert supraventricular tachycardia in a structurally normal heart: non-sustained polymorphic ventricular tachycardia and myocardial infarction. A 46-year-old woman presented to the emergency department with a two-hour history of palpitations and was diagnosed with supraventricular tachycardia. Vagal maneuvers were ineffective, and after intravenous adenosine administration, the patient presented with chest pain and hypotension. The rhythm degenerated into non-sustained polymorphic ventricular tachycardia and spontaneously reverted to sinus rhythm with ST elevation in lead aVR and ST depression in the inferior and anterolateral leads. The patient spontaneously recovered within a few minutes. Despite successful arrhythmia reversal, the patient was admitted to the intensive care unit because of an infarction without obstructive atherosclerosis. This report aims to alert emergency physicians about the potential complications associated with supraventricular tachycardia and its reversal with adenosine.
腺苷是一种抗心律失常药物，可减缓房室结的传导，并作为冠状动脉血管扩张剂。本病例报告强调了在结构正常的心脏中使用腺苷逆转室上性心动过速后发生的两种罕见的危及生命的事件：非持续多形性室性心动过速和心肌梗死。一名 46 岁女性因心悸两小时就诊于急诊科，并被诊断为室上性心动过速。迷走神经操作无效，静脉内给予腺苷后，患者出现胸痛和低血压。节律演变为非持续多形性室性心动过速，并自发地恢复为窦性节律，aVR 导联 ST 段抬高，下壁和前侧壁导联 ST 段压低。患者在几分钟内自行恢复。尽管心律失常得到成功逆转，但由于非阻塞性动脉粥样硬化性梗死，患者仍被收入重症监护病房。本报告旨在提醒急诊医生注意与室上性心动过速及其腺苷逆转相关的潜在并发症。
