Klinische Wochenschrift

, Volume 60, Issue 17, pp 965–971 | Cite as

Dysrhythmias caused by histamine release in guinea pig and human hearts

  • Roberto Levi
  • Aida A. Chenouda
  • Jerome P. Trzeciakowski
  • Zhao-Gui Guo
  • Laura M. Aaronson
  • Roger D. Luskind
  • Chi-Ho Lee
  • William A. Gay
  • Valavanur A. Subramanian
  • John C. McCabe
  • John C. Alexander
3. Effects Of Histamine On The Cardiovascular And Respiratory System

Summary

Histamine is released into the systemic circulation during anaphylaxis, by drugs and by surgical procedures. Studies in animal models have conclusively demonstrated that released cardiac histamine is a major mediator of arrhythmias that occur during anaphylaxis and following the administration of histamine-releasing drugs. Several lines of evidence suggest a similar arrhythmogenic role for cardiac histamine in humans: (1) The human heart is rich in histamine; (2) cardiac histamine can be readily released from human heartin vitro by therapeutic concentrations of drugs; (3) histamine has potent arrhythmogenic effects on the human heartin vitro.

Arrhythmogenic effects of histamine include enhancement of normal automaticity, induction of abnormal automaticity, induction of triggered tachyarrhythmias, depression of atrioventricular conduction, and increase in the vulnerability of the ventricles to fibrillation. A combination of H1 and H2 antihistamines is needed to block the arrhythmogenic effects of histamine. Certain arrhythmogenic effects of histamine (e.g. induction of slow responses and delayed afterdepolarizations) can also be blocked by drugs which inhibit the influx of cations through slow channels. In contrast, the commonly-used drug digitalis potentiates the arrhythmogenic effects of histamine.

We propose that histamine release produced by drugs and surgical procedures may be an overlooked factor in fatal cardiac arrhythmias. Experimental studies suggest that selective pharmacological methods can be developed to block the arrhythmogenic effects of histamine.

Key words

Arrhythmogenic effects Histamine release H1- and H2 receptor antagonists 

Rhythmusstörungen durch Histaminfreisetzung im Herz von Meerschweinchen und Mensch

Zusammenfassung

Während der Anaphylaxie durch Arzneimittel und chirurgische Eingriffe wird Histamin in den systemischen Kreislauf freigesetzt. Durch Tierstudien konnte eindeutig gezeigt werden, daß freigesetztes Histamin aus dem Herzen ein Hauptmediator für Arrhythmien ist, die während Anaphylaxie nach Gabe von histaminfreisetzenden Arzneimitteln auftreten. Verschiedene Gründe weisen auf eine ähnliche arrhythmogene Rolle für kardiales Histamin beim Menschen hin:

(1) Das menschliche Herz ist reich an Histamin; (2) kardiales Histamin kann vom menschlichen Herzenin vitro durch therapeutische Arzneimittelkonzetrationen schnell freigesetzt werden; (3) Histamin hat einen starken arrhythmogenen Effekt auf das menschliche Herzin vitro.

Arrhythmogene Effekte des Histamins schließen die Erhöhung der normalen Herztätigkeit, die Induktion einer abnormalen Herztätigkeit, die Induktion von verstärkten Tachyarrhythmien, die Verminderung arterioventrikulärer Reize und eine Erhöhung in der Empfindlichkeit der Ventrikel für Herzflimmern ein. Eine Kombination von H1-and H2-Antihistaminika ist notwendig, um die errhythmogenen Effekte des Histamins zu blockieren. Bestimmte arrhythmogene Effekte des Histamins (z.B. die Induktion von verlangsamten Reaktionen und verzögerten Nachdepolarisationen) können auch durch Arzneimittel blockiert werden, die den Einfluß von Kationen durch die langsamen Kanäle hemmen. Im Gegensatz dazu verstärkt das allgemein gebräuchliche Mittel Digitalis die arrhythmogenen Effekte des Histamins.

Wir vermuten, daß Histaminfreisetzung durch Arzneimittel und chirurgische Eingriffe ein häufig übersehener Faktor bei tödlichen Herzarrhythmien sein könnte. Experimentelle Studien legen nahe, daß selektive pharmakologische Methoden entwickelt werden können, um die arrhythmogenen Effekte des Histamins zu verhindern.

Schlüsselwörter

Arrhythmogene Effekte Histaminfreisetzung H1- und H2-Rezeptorantagonisten 

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Copyright information

© Springer-Verlag 1982

Authors and Affiliations

  • Roberto Levi
    • 1
  • Aida A. Chenouda
    • 1
  • Jerome P. Trzeciakowski
    • 1
  • Zhao-Gui Guo
    • 1
  • Laura M. Aaronson
    • 1
  • Roger D. Luskind
    • 1
  • Chi-Ho Lee
    • 1
  • William A. Gay
    • 2
  • Valavanur A. Subramanian
    • 2
  • John C. McCabe
    • 2
  • John C. Alexander
    • 2
  1. 1.Department of PharmacologyCornell University Medical CollegeNew YorkUSA
  2. 2.Division of Cardiothoracic SurgeryThe New York Hospital-Cornell Medical CenterNew YorkUSA

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