Abstract
Purpose
To present a patient with pneumoconiosis who developed a complex, life-threatening atrial tachyarrhythmia during anesthesia. Intravenous diltiazem was effective in controlling the ventricular rate and hemodynamics after failure of other antiarrhythmic drugs and direct current cardioversion.
Clinical features
A 79-yr-old man with pneumoconiosis complicated by cor pulmonale suffered from gout-related cellulitis of the left lower limb. Debridement of the left gangrenous big toe was carried out under general anesthesia. During anesthesia, a wide-QRS tachycardia occurred suddenly and a complex atrial tachyarrhythmia was later diagnosed. Hemodynamics deteriorated despite aggressive treatment with lidocaine, verapamil, direct current cardioversion, magnesium, digoxin and amiodarone. Correction of the underlying respiratory acidosis was not sufficient to control the rapid ventricular response. Eventually, iv diltiazem adequately controlled the rapid ventricular rate and quickly improved the deteriorating hemodynamics.
Conclusion
Life-threatening complex atrial tachyarrhythmias may occur in patients with chronic lung diseases perioperatively. Intravenous diltiazem was effective in the management of complex atrial tachyarrhythmia in a patient with underlying cor pulmonale.
Résumé
Objectif
Présenter un patient atteint de pneumoconiose chez qui s’est développée une tachyarythmie auriculaire grave et complexe pendant l’anesthésie. Le diltiazem intraveineux a permis de contrôler le débit ventriculaire et l’hémodynamique après l’échec d’autres médicaments antiarythmiques et de la cardioversion.
Éléments cliniques
Un homme de 79 ans, atteint de pneumoconiose compliquée d’un cœur pulmonaire, souffrait de cellulite reliée à la goutte au membre inférieur gauche. Le débridement du gros orteil nécrotique a été réalisé sous anesthésie générale. Pendant l’anesthésie, une tachycardie à onde QRS de forte amplitude est survenue soudainement et a conduit au diagnostic de tachyarythmie auriculaire complexe. L’hémodynamique s’est détériorée malgré un traitement agressif comprenant : lidocaïne, vérapamil, cardioversion, magnésium, digoxine et amiodarone. La correction de l’acidose respiratoire initiale n’a pas suffi à contenir la réaction ventriculaire rapide. Finalement, le diltiazem iv a permis de contrôler adéquatement l’accélération du débit ventriculaire et d’améliorer rapidement l’hémodynamique.
Conclusion
De graves tachyarythmies auriculaires complexes peuvent survenir pendant une opération chez des malades souffrant d’affections pulmonaires chroniques. L’administration intraveineuse de diltiazem a permis de traiter une tachyarythmie auriculaire complexe chez un patient atteint de cœur pulmonaire sous-jacent.
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Tsou, CH., Chiang, CE., Liou, JT. et al. Successful use of iv diltiazem to control perioperative refractory complex atrial tachyarrhythmias in a patient with pneumoconiosis. Can J Anesth 50, 36–41 (2003). https://doi.org/10.1007/BF03020184
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DOI: https://doi.org/10.1007/BF03020184