Disopyramide for Transient High-degree Atrioventricular Block in a Young Patient with a history of Syncope <Case report>
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概要
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Although high-degree atrioventricular (AV) block in patients with a history of syncope usually requires pacemaker implantation, therapeutic strategies should also be considered. A 35-year-old man presented with complaints of palpitations, nausea and dysgeusia. Since aged 30, the patient had experienced 3 episodes of syncope. Holter monitoring showed transient high-degree AV block (up to 5: 4 block) associated with nausea, eructation and dysgeusia irrelevant to posture as well as ventricular ectopic beats with palpitation. A Head-up tilt test revealed neurally-mediated vasodepression but electrophysiological study showed no abnormalities. These results indicated that his transient high-degree AV block was functional, and syncope would have been because of neurally-mediated vasodepression, not bradycardia. After administration of disopyramide at 300 mg daily, the symptoms subsided and ventricular ectopic beats and AV block disappeared. He has been well for 20 months.失神の既往がある患者に一過性に高度房室ブロックを認めた場合、ペースメーカー植え込みを考慮するが、その治療方針決定には個々で深慮する必要がある。症例は35歳男性、3度の失神の既往を持ち、動悸と嘔気を主訴に来院した。ホルター心電図で動悸を伴う心室性期外収縮と嘔気、おくび、味覚異常を伴う体位に依存しない5:4までの一過性高度房室ブロックを認めた。Head-up.tilt試験では血管抑制型の反応陽性で前失神状態を呈した。心臓電気生理検査で刺激伝導系に異常を認めず、房室ブロックは機能性ブロックと診断した。迷走神経系の関与を疑い、ペースメーカーの植え込みは行わず抗コリン作用を持つⅠ群不整脈薬ジソピラミドを300mg/日で投与すると、症状は軽快し心室性期外収縮と房室ブロックも消失した。5ヶ月後のホルター心電図で心室性期外収縮も房室ブロックも認めず、退院後20ヶ月間経過良好である。
- 2008-08-15
著者
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YAMAMOTO Hideya
Department of Cardiovascular Medicine, Graduate School of Biomedical Sciences, Hiroshima University
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KOHNO Nobuoki
Department of Molecular and Internal Medicine, Graduate School of Biomedical Sciences, Hiroshima Uni
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Hirai Yukoh
Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Science
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Nakano Yukiko
Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Science
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Ogi Hiroshi
Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Science
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KAJIWARA Shinji
Division of Cardiology, Mazda Hospital
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Yamamoto Hideya
Department Of Cardiovascular Medicine Graduate School Of Biomedical Sciences Hiroshima University
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Yamamoto Hideya
Department Of Cardiovascular Medicine Hiroshima University Graduate School Of Biomedical Sciences
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Ogi Hiroshi
Department Of Cardiology Hiroshima University School Of Medicine
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Hayashi Yasuhiko
Department Of Cardiovascular Physiology And Medicine Hiroshima University Graduate School Of Biomedi
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Kohno Nobuoki
Department Of Molecular And Internal Medicine Graduate School Of Biomedical Sciences Hiroshima Unive
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Kohno Nobuoki
Department Of Molecular And Internal Medicine Hiroshima University Graduate School Of Biomedical Sci
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Yamamoto Hideya
Department Of Molecular And Internal Medicine Hiroshima University Graduate School Of Biomedical Sci
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Nakano Yukiko
Department Of Cardiology Hiroshima University School Of Medicine
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Kohno Nobuoki
Department Of Internal Medicine Hiroshima University Graduate School Of Medicine
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Kohno Nobuoki
Second Department Of Internal Medicine Hiroshima University School Of Medicine
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Nakano Yukiko
Department Of Biostructural Science Graduate School Of Tokyo Medical And Dental University
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Nakano Yukiko
Department Of Clinical Laboratory Medicine Hiroshima University School Of Medicine
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Higashi Yukihito
Department Of Molecular Internal Medicine Graduate School Of Biomedical Science Hiroshima University
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Kajiwara Shinji
Division Of Cardiology Mazda Hospital
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Kohno Nobuoki
Department Of Molecular And Internal Medicine Division Of Clinical Medical Science Programs For Appl
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Hirai Yuukou
Division Of Cardiology Akane Foundation Tsuchiya General Hospital
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Nakano Yukiko
Department Of Medicine And Molecular Science Hiroshima University Graduate School Of Biomedical Scie
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Kohno Nobuoki
Department Of Molecular And Internal Medicine Hiroshima University Graduate School Of Biomedical Sci
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Kohno Nobuoki
Department Of Molecular And Internal Medicine Graduate School Of Biomedical Sciences Hiroshima Unive
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Yamamoto Hideya
Department Of Molecular And Internal Medicine Hiroshima University Graduate School Of Biomedical Sci
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Kohno Nobuoki
Department Of Molecular And Internal Medicine Graduate School Of Biomedical Sciences Hiroshima Unive
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Yamamoto Hideya
Department Of Molecular And Internal Medicine Hiroshima University Graduate School Of Biomedical Sci
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Hirai Yukoh
Department Of Internal Medicine Graduate School Of Biomedical Science Hiroshima University
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