Berberine behind the thriller of marked symptomatic bradycardia
Berberine behind the thriller of marked symptomatic bradycardia
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DOI：
10.4330/wjc.v5.i7.261
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发表时间：
2013-07-26
影响因子：
1.9
通讯作者：
Gaita, Fiorenzo
中科院分区：
文献类型：
--
作者：
Cannillo, Margherita;Frea, Simone;Gaita, Fiorenzo
黄连素在传统中药中用于治疗充血性心力衰竭、高血压、糖尿病和血脂异常，具有良好的安全性。我们报告一个病例，53岁的运动员在开始使用黄连素治疗高胆固醇血症后，因疲劳和呼吸困难而到本院就诊。心电图显示窦性心动过缓(45次/分)，一级房室传导阻滞和竞争性交界性心律。测力负荷试验显示，在恢复过程中，变时性能力略有降低，出现了竞争性交界性心律失常、房性心动过速和窦性停顿。经过10天的黄连素洗脱，患者的症状完全消失，测力负荷试验显示良好的变时性能力。动态心电图显示为潜伏性高迷走神经状态。这是第一份病例报告，表明黄连素可能会在迷走神经紧张症患者中出现某些副作用，即使在没有可能导致药物积聚的情况下也是如此。因此，在迷走神经紧张症患者中应该仔细权衡黄连素的使用，因为这种药物的心动过缓和抗心律失常特性可能会导致心律失常，使患者面临潜在的健康风险。(C)2013年白石登。版权所有。
Berberine is used in traditional Chinese medicine for the treatment of congestive heart failure, hypertension, diabetes, and dyslipidaemia and has a good safety profile. We report a case of a 53-year-old sportsman referred to our hospital for the onset of fatigue and dyspnoea upon exertion after he started berberine to treat hypercholesterolaemia. An electrocardiogram showed sinus bradycardia (45 bpm), first-degree atrioventricular block, and competitive junctional rhythm. An ergometric stress test showed slightly reduced chronotropic competence and the presence of runs of competitive junctional rhythm, atrial tachycardia, and sinus pauses in the recovery. After 10 d of wash-out from berberine, the patient experienced a complete resolution of symptoms, and an ergometric stress test showed good chronotropic competence. An electrocardiogram Holter showed a latent hypervagotonic state. This is the first case report that shows that berberine could present certain side effects in hypervagotonic people, even in the absence of a situation that could cause drug accumulation. Therefore, berberine's use should be carefully weighed in hypervagotonic people due to the drug's bradycardic and antiarrhythmic properties, which could became proarrhythmic, exposing patients to potential health risks. (C) 2013 Baishideng. All rights reserved.