Elektrokardiyografi ve İlaç Zehirlenmeleri

Yıl 2022, , 88 - 92, 31.12.2022

Bahadir Taslidere

https://doi.org/10.51262/ejtox.1171416

Öz

Zehirlenme, farklı toksik maddeler nedeniyle vücut fonksiyonlarının bozulmasıdır. İlaç zehirlenmeleri tüm zehirlenmelerin önemli bir bölümünü oluşturmaktadır. Kardiyovasküler sistem etkilendiği için bilinç değişikliği, taşikardi/bradikardi veya hipertansiyon/hipotansiyon gibi semptomlar görülebilir. Kalp tutulumunun derecesine göre klinik bulgularda ve EKG'de değişiklikler ortaya çıkabilir. Acil hekiminin hızlı tanıması ve etkin müdahalesi büyük önem taşımaktadır. Bu derleme, zehirli hastaların tedavisinde EKG kullanımını ele almaktadır. Zehirlenme ile takip edilen bir hastada EKG'nin sistematik olarak değerlendirilmesi, gözden kaçabilecek ayrıntılar için esastır. Hız, ritim, aralıklar ve segmentler, QRS, dalga morfolojileri, süreler, iskemik değişiklikler dikkatle takip edilmelidir.
Ritim analizi yapılırken, stabil olmayan hastalarda ilaç kardiyotoksisitesine dair ipuçları aranmalıdır. EKG'de ektopik atımlar var mı? Bu sorunun cevabı önemli ipuçları taşıyabilir. Sempatomimetiklerin neden olduğu otomatiklik ektopik atımların altında olabilir. Bu, akut koroner sendrom veya elektrolit bozukluklarının neden olduğu bir sorunun ilk belirtisi olabilir. Ritim supraventriküler mi? veya ventriküler? AV bloklu bradikardi mi? Veya AV bloğu olmadan? Taşikardi dar kompleks midir? Yoksa büyük bir kompleks mi? Hayatı tehdit eden ritimler, ventriküler taşikardi, ventriküler fibrilasyon ve tam AV blok gibi sorulara verilen cevaplar, geliştirilen kılavuzlara uyulmalı ve ilk müdahale yapılmalıdır. Taşikardiye neden olabilecek ajanlar; sempatomimetikler (metamfetamin), antikolinerjikler (antidepresanlar, antipsikotikler), sınıf 1A ve 1C antidisritmikler ve TCA'dır. Bradikardiye neden olabilen ajanlar; kalsiyum kanalı / beta blokerleri / digoksin (AV blok), opioidler / etanol, organofosfatlar, lityum. PR aralığının uzatılması beta-adrenerjik antagonizmayı, kalsiyum kanalı antagonizmasını veya digoksin zehirlenmesini gösterebilir. TCA zehirlenmesinin tipik EKG'si, birinci derece AV bloğu, geniş QRS kompleksleri ve aVR'de pozitif R' dalgası ile sinüs taşikardisini gösterir. Zehirlenme ile başvuran hastalarda ilk 10 dakika içinde EKG çekilmeli ve değerlendirilmelidir. Zehirlenme ajanının kardiyovasküler sistemi etkileyen bir ajan olduğunu varsayalım. Bu durumda EKG uygulamasına ek olarak sürekli kardiyak monitörizasyon ve kontrol EKG değerlendirmesinin yapılması gerektiği unutulmamalıdır.

Anahtar Kelimeler

zehirlenme, elektrokardiyografi, kardiyotoksik

Destekleyen Kurum

YOK

Proje Numarası

yok

Electrocardiography and Drug Intoxication

Öz

Intoxication is the deterioration of body functions due to different toxic substances. Poisoning by drugs constitutes an important part of all poisonings. Symptoms such as altered consciousness, tachycardia/bradycardia, or hypertension/hypotension may be seen because the cardiovascular system is affected. Changes in clinical findings and ECG may be revealed according to the degree of heart involvement. Rapid recognition and effective intervention by the emergency physician are of great importance. This review considers the use of ECG in the management of poisoned patients. Systematic evaluation of the ECG in a patient followed up with poisoning is essential for details that may be overlooked. Velocity, rhythm, intervals, and segments, QRS, wave morphologies, durations, ischemic changes should be followed carefully.
When performing rhythm analysis, clues to drug cardiotoxicity should be sought in unstable patients. Are there ectopic beats on the EKG? The answer to this question may carry important clues. Automaticity caused by sympathomimetics may underlie ectopic beats. This may be the first sign of a problem caused by acute coronary syndrome or electrolyte disturbances. Is the rhythm supraventricular? or ventricular? Is bradycardia with AV block? Or without AV block? Is tachycardia narrow complex? Or is it a large complex? Answers to questions such as: For life-threatening rhythms, ventricular tachycardia, ventricular fibrillation, and complete AV-block, the guidelines developed should be followed, and first intervention should be made. Agents that can cause tachycardia; are sympathomimetics (methamphetamine), anticholinergics (antidepressants, antipsychotics), class 1A and 1C antidysrhythmics, and TCA. Agents that can cause bradycardia; calcium channel / beta blockers / digoxin (AV block), opioids / ethanol, organophosphates, lithium. Prolonging the PR interval may indicate beta-adrenergic antagonism, calcium channel antagonism, or digoxin poisoning. Typical ECG of TCA poisoning shows sinus tachycardia with first-degree AV block, wide QRS complexes, and positive R' wave in aVR. The ECG should be taken and evaluated in patients presenting with poisoning within the first 10 minutes. Suppose the poisoning agent is an agent that influences the cardiovascular system. In that case, it should be kept in mind that continuous cardiac monitoring and control ECG evaluation should be performed in addition to the application of ECG.

Anahtar Kelimeler

Intoxication, Electrocardiography, Cardiotoxic

Proje Numarası

yok

Kaynakça

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