The influence of verapamil on dopamine's ability to augment cardiac output

Calcium channel blockers are used in the treatment of angina pectoris, cardiac arrhythmia, and hypertension. Sporadic reports of hypotensive reactions to verapamil have indicated that these reactions are not reversed readily by catecholamine administration. This study was conducted to test the hypothesis that verapamil pretreatment does not alter the ability of dopamine in conventional doses to augment cardiac output. Twelve mongrel dogs, weighing 19 to 25 kg, were anesthetized with pentobarbital and placed on a respirator. Heart rate, cardiac output, and the right atrial, pulmonary artery, pulmonary capillary wedge, and central aortic pressures were measured directly. Dopamine, 10 micrograms/kg/min, increased cardiac index by 52.4 mL/kg/min over baseline. The dopamine was stopped and the animals were allowed to return to baseline. Dopamine, 10 micrograms/kg/min, was administered again after pretreatment with 0.15 mg/kg verapamil, and it increased cardiac index by 47.9 mL/kg/min over the second baseline control. The results were not statistically different using the Student t test for paired data (P greater than .05). It is concluded that verapamil does not affect dopamine's ability to augment cardiac output in the dosages tested.     

Acute verapamil poisoning: Successful treatment with epinephrine

Acute intoxication with verapamil (2400 mg) induced A-V dissociation and circulatory failure in a 38-year-old woman with no previous cardiac disease. Resumption of A-V conduction was observed after administration of orciprenalin, calcium gluconate, and dopamine, with no effect on blood pressure. Epinephrine infusion finally restored satisfactory blood pressure level and allowed a favorable outcome.     

Successful treatment of suicidal verapamil poisoning with calcium gluconate

A 33 year old man ingested approximately 3000 mg of verapamilin attempted suicide. Verapamil and norverapamil concentrations4.5 h after ingestion were 1250 and 1350 ng/ml. The patienthad a heart rate of 79 beats/min, a systolic blood pressureof 60 mm Hg and atrioventricular dissociation. Metaraminol hadno significant effect on blood pressure or heart rate. Duringinfusion of 10 ml 10% calcium gluconate, systolic blood pressurerose to 80 mm Hg and both QRS and P waves changed polarity.The clinical condition improved and sinus rhythm was established5 h later. Calcium can be recommended as the first line of treatmentin verapamil intoxication.     

Epidemiological analysis of single center of acute poisoning cases based on poisoning treatment platform

To studied epidemiological characteristics of 493 cases of acute poisoning in Nantong city, Jiangsu province.Based on the analysis platform of poisoning treatment, adopted single center and prospective investigation method, analyzed data of acute poisoning patients from May 2015 to December 2018 in the second affiliated hospital of Nantong University.Among 493 patients with acute poisoning, men 227 (46.04%), women 266 (53.96%). Age ranged from 12 to 89 years old, average age 41.6 years. In the occupational distribution, farmers were 30.02%; 351 cases (71.20%) visited the hospital within 6 hours after exposure. Oral exposure poisoning 415 cases (84.18%). Pesticide poisoning accounted for 45.45% of deaths.Using the poisoning treatment platform to analyze the clinical characteristic had accurately and reliably in Nantong. The fatality rate of pesticide poisoning in cases of acute poisoning is high. Management of highly toxic pesticides should be continued and effective health education on pesticide use should be carried out.     

Liver transplantation for severe Lepiota helveola poisoning

Orthotopic liver transplantation in patients with fulminant hepatic failure secondary to Lepiota helveola poisoning has not, to our knowledge, been reported. Our recent experience with liver transplantation in a 27-year-old woman with acute hepatic failure secondary to this poisoning is described. The indications for orthotopic liver transplantation are discussed.     

汞中毒92例临床分析

目的 总结经血、尿毒检确诊为汞中毒的92例患者的临床诊治特点,以提高该病的诊治水平.方法 对2000年1月至2010年4月我院住院诊治的92例汞中毒患者的原因、临床表现、诊治及预后情况进行回顾性分析.结果 92例(男37例,女55例)患者平均发病年龄33.1(2～65)岁,因职业性接触、生活性接触(医源性、生活、误服或自杀)含汞物质所致,主要经呼吸道、消化道和皮肤吸收而中毒.其受累系统有神经系统,表现为记忆力减退50例(54.3%)、乏力34例(37.0%)、四肢麻木25例(27.2%)、眩晕头痛22例(23.9%)、感觉异常20例(21.7%)、细小震颤(指端、舌尖、眼睑)15例(16.3%)、失眠多梦12例(13.O%);消化系统:恶心16例(17.4%)、腹痛14例(15.2%)、口腔炎5例(5.4%);关节肌肉:肌痛16例(17.4%)、关节酸痛5例(5.4%);心血管系统:胸闷、心悸6例(6.5%);泌尿系统:水肿9例(9.8%);其他系统:多汗20例(21.7%).经驱汞治疗后,患者各系统症状、体征逐渐缓解,其消化系统和心血管系统症状2周内缓解;神经系统症状3个月内缓解;肾脏损害恢复较慢,在6个月内也可临床完全缓解.结论 汞中毒临床表现多样,易被误诊、漏诊,故需进一步提高对此病的认识.及时脱离汞中毒环境,并行驱求治疗,预后较好.

Abstract：

Objective To summarize the clinical features of mercury poisoning diagnosed by blood and urine tests for improving the diagnosis and treatment of the disease.Methods Poisoning causes,clinical manifestations,diagnosis,treatment and prognosis were retrospectively reviewed in 92 in-patients with mercury poisoning in our hospital from January 2000 to April 2010.Results Of the 92 patients,37 were male and 55 were female with an average age of 33.1(2-65)years old.The mercury poisoning was caused by occupational exposure and non-occupational exposure,such as iatrogenic exposure,life exposure and wrong intake or suicidal intake of mercury-containing substances,mainly through respiratory tract,digestive tract and skin absorption.The most common clinical symptoms were as the followings:nervous system symptom,such as memory loss in 50 eases(54.3%),fatigue in 34(37.0%),numb limb in 25 (27.2%),dizziness and headache in 22(23.9%),cacesthesia in 20(21.7%),fine tremor(finger tip,tongue tip,eyelids)in 15(16.3%),insomnia and more dreams in 12(13.0%);gastrointestinal symptoms:nausea in 16 (17.4%),abdominal pain in 14(15.2%),stomatitis in 5(5.4%);joint and muscle symptoms:muscle pain in 16(17.4%),joint pain in 5(5.4%);cardiovaseular system:chest tightness,hean palpitations in 6(6.5%);urinary system:edema in 9(9.8%);other system:hidrosis in 20(21.7%).After the treatment with sodium dimercaptopropane sulfonate (DMPS),the symptoms were gradually alleviated.Their gastrointestinal,cardiovascular symptoms were alleviated within 2 weeks;neurological symptoms were alleviated within 3 months;kidney damage showed a slower recovery and could be completely'alleviated within 6 months.Conclusions Because of its diverse clinical symptoms,the mercury poisoning was easy to misdiagnosis and missed diagnosis:therefore the awareness of the disease should be further enhanced.Leaving from the poisoning environment timely and giving appropriate treatment with DMPS will lead to a satisfactory prognosis.     

序贯性血液净化治疗重度毒鼠强中毒的研究

目的 :观察序贯性血液净化治疗重度毒鼠强中毒患者的临床疗效和对预后的影响 ,及对毒鼠强的清除作用。　 方法 :18例重度毒鼠强中毒患者入院后 ,除给予常规治疗外 ,同时进行序贯性活性炭血液灌流 (HP)治疗 3～ 5h ,随后立即进行连续性静脉 静脉血液滤过 (CVVH)治疗 2 4～ 36h。观察患者血压、脉搏、血常规及血清酶学变化 ,测定HP治疗前、后血浆中毒鼠强浓度 ,及CVVH治疗 2h、12h滤器前、后血浆及超滤液中毒鼠强浓度。　结果 :患者在中毒 12h内即进行血液净化治疗 (8例 ) ,死亡 1例 ,其余患者痊愈 ;晚期患者在中毒 12h后才进行血液净化治疗 (10例 ) ,2例死亡 ,1例呈去大脑皮层状态 ,1例精神异常。较早治疗患者痊愈率显著高于晚期治疗患者(87 5 %vs 6 0 % ,P <0 0 5 ,χ2 检验 ) ,而痊愈患者平均昏迷时间 5～ 6 0 (2 3 0± 19 9)h ,明显比晚期治疗痊愈患者短[2 0～ 96 (5 9 7± 2 7 7)h ,P <0 0 1,秩和检验 ]。HP治疗后血浆中毒鼠强浓度从 (0 12 4± 0 0 82 )mg/L降至 (0 0 80±0 0 5 5 )mg/L。CVVH治疗 2h及 12h血浆毒鼠强浓度分别为 (0 0 78± 0 0 6 4 )mg/L ,及 (0 0 74± 0 0 5 9)mg/L ,2h及 12h毒鼠强筛选系数分别为 0 839± 0 4 0 9,0 6 86± 0 2 5 3。CVVH治疗 2h 15例患者血浆毒鼠     

Combination therapy with aprindine and verapamil for paroxysmal supraventricular tachycardia as assessed by transesophageal atrial pacing

To assess the efficacy of combination therapy of aprindine (40 mg/day) and verapamil (160 mg/day), transesophageal programmed atrial stimulation was performed on 21 patients with paroxysmal supraventricular tachycardia (including 12 patients with atrioventricular nodal reentrant tachycardia and nine patients with atrioventricular reentrant tachycardia) under four conditions: a) control, b) aprindine alone, c) verapamil alone, and d) aprindine + verapamil. Results: a) Aprindine, verapamil, and aprindine + verapamil prevented paroxysmal supraventricular tachycardia induction in 2/21, 3/21, and 9/21 patients, respectively;b) aprindine + verapamil prolonged the cycle length of paroxysmal supraventricular tachycardia more than aprindine or verapamil alone; c) aprindine, verapamil, and aprindine + verapamil decreased the AV blocking rate by 15, 23, and 35 beats/min, respectively, in comparison with the control state; d) aprindine, verapamil, and aprindine + verapamil prolonged the effective refractory period of atrioventricular conduction system by 20, 34, and 76 msec, respectively, compared with the control state. In conclusion, aprindine + verapamil appear to be more effective than aprindine or verapamil alone in preventing paroxysmal supraventricular tachycardia with nodal reentry, but there was less benefit in those without nodal reentry (Wolff-Parkinson-White group).     

急性重度氯气中毒22例临床分析

目的探讨急性重度氯气中毒临床特点、治疗方法。方法对22例急性重度氯气中毒患者进行回顾性分析。结果病情严重程度与接触氯气的浓度、时间呈正相关。临床表现包括刺激性咳嗽22例(100%),胸闷22例(100%),肺部干湿罗音22例(100%),约1/2患者出现白细胞升高,胸部X片肺部有阴影者14例(64%)。结论氯气中毒及时纠正低氧血症可避免肝、肾、心肌损害。早期大剂量糖皮质激素 高浓度给氧 对症处理可迅速控制病情,低氧难以纠正者须BiPAP呼吸机辅助呼吸。     

毒蕈中毒3638例临床分型的探讨

目的提高对毒蕈中毒的认识和认知,探讨毒蕈中毒的临床分型、特征和预后。方法检索国内1995年1月至2004年12月公开发表的毒蕈中毒191篇文献,共报道了毒蕈中毒3466例,我院1980年1月至2004年12月收治的毒蕈中毒患者172例,共3638例毒蕈中毒患者进行临床分型的探讨。结果胃肠炎型571例,全部治愈;急性肾衰竭型1450例,治愈1414例（97．5％）,死亡36例（2．5％）;中毒性肝炎型1010例,治愈841例（83．3％）,死亡169例（16．7％）;神经精神型214例,治愈197例（92．1％）,死亡17例（7．9％）;溶血型73例,治愈71例（97．3％）,死亡2例（2．7％）,不同类型毒草中毒疗效和预后差异有统计学意义（P〈0．001）。分型不详者320例,其中以多器官功能障碍综合征者222例,治愈98例（44．1％）,死亡124例（55．9％）,无法分型者98例,治愈90例（91．8％）,死亡8例（8．2％）。结论毒蕈中毒患者的临床表现和中毒发生机制非常复杂,毒蕈中毒的类型和分型应符合临床报道的病例资料及特征,教科书和专著报道的毒蕈中毒分为4型,这与毒蕈中毒临床实际情况和本研究结果不相符。因此,根据本研究3638例毒蕈中毒资料,临床应分为5种类型：（1）胃肠炎型;（2）急性肾衰竭型;（3）中毒性肝炎型;（4）神经精神型;（5）溶血型。是否存在混合型,有待进一步观察更多的毒蕈中毒临床病例资料。     

Intravenous verapamil therapy in imminent myocardial infarction

We studied 16 patients with small myocardial infarction who had further episodes of chest pain with ST-segment elevation, a sign of transmural myocardial ischemia and imminent infarction extension. Coronary angiography in 14 showed a critical lesion in 13. Intravenous verapamil abolished chest pain and ST-segment elevation. It caused a fall in right atrial and left ventricular end-diastolic pressures (LVEDP) and cardiac output, reflex systemic vasoconstriction, and a rise in systemic vascular resistance. There was no reflex tachycardia. Volume expansion raised LVEDP and restored a normal cardiac output. Accelerated junctional rhythm with isorhythmic A-V dissociation occurred in 5 patients. Two patients sustained a transmural infarction, 10 underwent coronary artery bypass grafting, and 4 are symptom-free with oral treatment. Intravenous treatment was an effective method of treating acute episodes of transmural myocardial ischemia and preventing their recurrence in patients with critical coronary artery narrowing. Continuous verapamil infusion stabilized the patients' condition and enabled smooth coronary angiography and induction of anesthesia for surgery.     

Deleterious effects of intravenous verapamil in Wolff-Parkinson-White patients and atrial fibrillation

Summary Three patients presented to the emergency room with atrial fibrillation and fast ventricular response with wide preexcited QRS complexes (Wolff-Parkinson-White syndrome). All three patients received intravenous verapamil (5–10mg). The first patient developed ventricular fibrillation requiring several defibrillations; the second patient developed severe hemodynamic deterioration requiring urgent cardioversion; in the third patient a marked increment in the ventricular response was noted, however, there was no hemodynamic impairment.Verapamil may cause detrimental results when given to patients with the Wolff-Parkinson-White syndrome and atrial fibrillation. Its administration should therefore be considered as an absolute contraindication in these patients.     

Fatal ventricular fibrillation following verapamil in Wolff-Parkinson-White syndrome with atrial fibrillation

A 29-year-old man with Wolff-Parkinson-White syndrome and atrial fibrillation developed fatal ventricular fibrillation shortly after receiving intravenous verapamil. The patient presented with an irregular pulse of 190. A total of 23 mg of verapamil was administered in small intravenous doses over 35 minutes. The ventricular rate accelerated as verapamil was administered, and fatal ventricular fibrillation followed. Three theoretical mechanisms by which verapamil may enhance conduction of atrial fibrillation in Wolff-Parkinson-White syndrome, predisposing to ventricular fibrillation, are mentioned.     

Review of postinfarct treatment with verapamil: Combined experience of early and late intervention studies with verapamil in patients with acute myocardial infarction

An overview of the published studies on the use of verapamil during and after an acute myocardial infarction is presented. Meta-analyses of the two small early intervention trials, one early intervention trial followed by a 6-month treatment period (The Danish Verapamil Infarction Trial I, DAVIT I) and one late intervention trial (DAVIT II), demonstrated a 17–20% statistically nonsignificant reduction of mortality, first reinfarctions, and first major events. In DAVIT II was found a statistically significant 20% reduction of first major events in verapamil-treated patients. In patients without heart failure during the acute event mortality, first reinfarctions and first major events were significantly reduced by 30–36% in verapamil-treated patients. No difference was found in patients treated for heart failure in the coronary care unit. A meta-analysis based on patients included in DAVIT I alive day 8 and all patients included in DAVIT II demonstrated a statistically significant 21–26% reduction of mortality, first reinfarctions, and first major events.     

急性有机磷中毒193例临床分析

目的:探讨急性有机磷中毒(AOPP)所致呼吸衰竭(呼衰)、心力衰竭(心衰)以及重度AOPP合并血清淀粉酶升高的危险因素.方法:193例AOPP患者按毒物种类、中毒程度分组,比较各组间呼衰、心衰发生情况有无差异;分析中毒24h内血清胆碱酯酶(CHE)水平与呼衰、心衰的相关性,重度中毒患者血清淀粉酶升高的危险因素.结果:毒物种类对患者呼衰、心衰影响无统计学差异;重度中毒组呼衰、心衰发生率较轻、中度组明显升高(均P＜0.05);呼衰组和心衰组血清CHE水平均明显低于非呼衰组和非心衰组(均P＜0.05);敌敌畏中毒和中毒24 h内血清CHE水平与血清淀粉酶水平存在一定相关性.结论:中毒程度和血清CHE水平可作为AOPP呼衰、心衰发生的预测指标;敌敌畏中毒和血清CHE水平明显降低是重度AOPP患者血清淀粉酶升高的2个危险因素.     

Long-term oral treatment with high doses of verapamil in lone atrial fibrillation

It has earlier been shown that verapamil given intravenously or orally in sufficiently high single doses, may result in regular ventricular rhythm in patients with atrial fibrillation. We have analyzed whether this effect of verapamil can be utilized in long-term oral treatment. Eleven patients with lone atrial fibrillation were studied. Verapamil was given in gradually increasing doses from 40 mg three times a day to 320 mg three times a day, either alone or in combination with digoxin. Resting ECG was recorded and supine and standing blood pressures were measured on each dose level. When the patients were treated with verapamil alone, only a slight decrease in heart rate was noted, while during combined treatment with verapamil and digoxin a more marked heart rate decrease occurred with increasing doses of verapamil. The variation coefficient of the RR interval, a sign of ventricular regularity, decreased during verapamil treatment regardless of whether or not digoxin was also taken. A dose-dependent blood pressure decrease was noted during verapamil treatment. Side effects were common and led to discontinuation of the attempted protocol in all patients. Three patients were unexpectedly converted to stable sinus rhythm. Five patients improved subjectively, with a marked decrease in the sensation of palpitations during intake of increasing doses of verapamil. The study indicates that chronic oral treatment with verapamil may sometimes relieve the subjective sensation of palpitations in patients with atrial fibrillation. Side effects do, however limit the value of this mode of treatment in the majority of patients.     

Effects of verapamil in normal elderly individuals with left ventricular diastolic dysfunction

Treatment with oral verapamil for 3 to 4 days has been found to enhance left ventricular (LV) diastolic filling in elderly subjects as assessed by radionuclide angiography. However, there are no Doppler echocardiographic studies to assess the long-term effect of verapamil in normal elderly subjects. Thirteen healthy elderly subjects (mean age, 64 +/- 7 years; 8 men and 5 women) with LV diastolic dysfunction underwent this placebo-controlled cross-over trial. The effect of verapamil on LV diastolic function was assessed by treadmill exercise test and Doppler echocardiography at baseline, and after each 3-month treatment period (placebo or verapamil 120 mg once daily), separated by a 1-week washout period before cross-over. Blood pressure, heart rate, LV ejection fraction, LV mass, and cardiac output were unaltered by placebo or verapamil. The exercise time was similar at baseline (11.4 +/- 2.4 min) and after placebo treatment (11.4 +/- 2.3 min) but significantly increased (P < 0.05) after verapamil treatment (12.3 +/- 2.0 min). The ratio of mitral A wave duration/pulmonary venous atrial systolic reversal duration increased after verapamil treatment (1.12 +/- 0.08) compared to placebo (0.93 +/- 0.06, P < 0.05) and baseline (0.89 +/- 0.09), which had similar durations. The isovolumic relaxation time (IVRT) was significantly decreased (P < 0.05) from 85 +/- 13 msec at baseline and 87 +/- 13 msec with placebo to 73 +/- 9 msec with verapamil. The results of this study suggest that in normal elderly patients with Doppler evidence of diastolic dysfunction, 3 months treatment with verapamil can increase exercise tolerance and improve LV diastolic function.