Cardiovascular emergencies have the characteristics of acute onset, complex condition and critical condition. In clinical practice, the application of drugs for the treatment of cardiovascular emergencies plays a key role.
How to realize the standardized use of emergency medicine is particularly critical.
How can rescue drugs be used safely and effectively?
adenosine
Adenosine is a Class I recommendation for both AVNRT and acute episodes of AVRT. The treatment effect of AVRT is better than that of AVNRT, and it is very effective in terminating most AVRT, but it is condone for patients with atrial fibrillation and bypass pretransmission.
The 2019ESC Guidelines for supraventricular tachycardia mention that adenosine should be the drug of choice in pregnant women with supraventricular tachycardia in the second and third trimesters of pregnancy if non-invasive vagus nerve stimulation is ineffective.
Use adenosine triphosphate (ATP) instead of ADO
what is the relationship between adenosine and ATP?
Adenosine is an endogenous purine nucleoside widely distributed in various tissues of the body, which can activate ADO receptors on cell membrane and play a regulatory role in a variety of physiological processes. Its main role in the heart is to inhibit the sinoatrial node and ventricular automaticity, prolong atrioventricular node conduction, expand coronary microvessels and protect myocardium.
ATP is often used as a substitute for ADO, which degrades into ADP, AMP, and adenosine in the body, and ultimately ADO.
Is there any basis for adenosine triphosphate (ATP) to terminate ventricular tachycardias?
A study analyzed 78 ATP drug instructions from 62 manufacturers in China, and most of the indications in the instructions were expressed as “for the adjuvant treatment of progressive muscular atrophy, sequelae of cerebral hemorrhage, cardiac insufficiency, myocardial diseases and hepatitis.”
Only one specification indication specifies that it can be used to “terminate sudden supraventricular tachycardia relapse into sinus rhythm.”
The “Clinical Drug Instructions” edited by the National Pharmacopoeia Committee does not include ATP, only adenosine, and its indication is “used for the treatment of paroxysmal supraventricular tachytherapy (PSVT).”
PSVT with atrioventricular node involvement in reentry is very effective and can be used as the drug of choice for treatment.”
In addition, adenosine is used to treat PSVT in foreign countries instead of ATP.
Whether ATP is a superindicative drug in the treatment of PSVT remains to be further explored.
Adenosine usage and dosage?
The guidelines recommend rapid injection with a projectile and immediate flush of saline.
Rapid intravenous administration (completed within 1-2 seconds), initial dose of 3 mg for adults, second dose of 6 mg, third dose of 12 mg, each interval of 1-2 minutes, should not be increased in case of high atrioventricular block.
Under what circumstances should adenosine inJ not be used?
Adenosine should not be used in the following patients:
- Degree II or III atrioventricular block (except in patients with artificial pacemakers).
- Sick sinus syndrome (except in patients with artificial pacemakers).
- Patients with a lung disease known or estimated to have bronchial stenosis or bronchospasm (e.g. asthma).
- Patients with known hypersensitivity to ADO.
What are the precautions when applying adenosine injection?
The following conditions should be noted when using adenosine injection:
- Adenosine should be used with caution in patients with prolonged QT duration, whether congenital, drug-induced, or metabolic.
- In chronic obstructive pulmonary disease, ADO may promote or exacerbate bronchospasm.
- Because temporary electrophysiological phenomena may occur when supraventricular tachycardia redevelops into sinus rhythm, it must be administered under hospital ECG monitoring.
- The speed of administration and the distance from the injection point to the heart have important effects on the curative effect.
- In clinical practice, it is recommended to give drugs in the form of pellets in the proximal cardiac vein, followed by flushing the tube with physiological water, so that the drugs can reach the site of action in the heart as soon as possible.
- The effects of ADO are not affected by liver or renal insufficiency.
