Citation

Trappe HJ. Kardiologe 2012; 6(6): 484-494.

Copyright

(Copyright © 2012)

DOI

10.1007/s12181-012-0461-4

PMID

unavailable

Abstract

BACKGROUND: In 60-70% of intoxications (Int) in adults, the purpose of drug administration is a suicide attempt. In 15-25% of patients, drug ingestion is accidental and in 5% commercial. Among all toxic agents, pharmaceutical drugs are responsible for Int in 80-90% of patients. Most frequent drugs for Int are psychotropic drugs or hypnotics. Cardiovascular drugs are rarely the cause for Int, but digitalis (dig) and betablocking (BB) intoxications are known. Diagnosis: In patients with Int, history, physical examination and the 12-lead surface ECG are essential because most Int due to cardiovascular drugs lead to supraventricular or ventricular arrhythmias. Dig Int leads most frequently to atrioventricular conduction disturbances (AV-blocks), BB Int leads to sinuatrial or AV nodal conduction disturbances, bradycardia and hypotonia. Calcium antagonist Int is associated with AV-conduction disturbances or cardiac arrest. QT prolongation and torsade de pointes tachycardia are greatly feared when class I and III antiarrhythmic drugs were used. Salicylate Int is mostly associated with central nervous system disturbances. Therapy: It is necessary to treat all Int patients in the intensive care unit. In AV conduction disturbances atropine or temporary pacemaker stimulation is recommended. Patients with dig Int should be given a dig antidote, while patients with AD and torsade de pointes tachycardia and/or ventricular fibrillation need direct current cardioversion/defibrillation. Hemodialysis is necessary in severe salicylate Int. © 2012 Springer-Verlag Berlin Heidelberg.

Language: de

Keywords

Intoxication; human; hemodialysis; article; antiarrhythmic agent; drug intoxication; tachycardia; physical examination; heart muscle conduction disturbance; beta adrenergic receptor blocking agent; heart arrest; antidote; atropine; calcium antagonist; QT prolongation; defibrillation; heart ventricle fibrillation; electrocardiography; salicylic acid; Calcium channel blockers; torsade des pointes; bradycardia; cardiovascular agent; central nervous system disease; muscle hypotonia; digitalis; atrioventricular block; medical history; heart ventricle arrhythmia; Salicylates; heart stimulation; Antiarrhythmic drugs; Beta-adrenergic blockers; heart supraventricular arrhythmia; sinoatrial conduction